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PDAT2 > 10 - Diabetes Intro > Flashcards

10 - Diabetes Intro Flashcards

1
Q

When is a second test required to confirm DM or Pre-DM?

A

Required UNLESS:

Overtly HYPERglycemic = BG > 200

with Symptoms of DM

Test is RandomPG or 2 HR post 75g OGTT

>200 mg/dl

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2
Q

How often do we test

A1C?

A

Every 3 MONTHS until goal is achieved

every 6 MONTHS if AT GOAL

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3
Q

Max Fasting Glucose level

A

140 mg/dl

this is the level where Insulin’s Sensitivity PEAKS

Does not respond to the glucose effectively / efficiently

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4
Q

MicroVascular

Complications of DM

A
  • EYE
    • ​High BG / BP -> damages blood vessels
      • Retinopathy / Cataracts / Glaucoma
  • KIDNEY
    • ​Damaged small BV’s / Excess BG
      • overworks kidney -> Nephropathy
  • NEROPATHY
    • ​HYPERglycemia -> damages nerves in PNS
      • Pain / Numbness
        • Feet wounds -> infection -> Gangrene
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5
Q

Second Test for PRE-DM

A

HgBA1C = 5.7% - 6.4%, THEN,

SECOND TEST NEEDED TO CONFIRM PRE-DIABETES

required if BG is NOT >200 (overtly hyperglycemic) with symptoms

then test 2 Hour PPG (post prandial glucose)

140 - 199 (mg/dl)

IGT (impaired glucose tolerance)

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6
Q

First Line therapy for HYPERTENSION?

A

ACE INHIBITOR** or **ARB
1st line if proteinuria is present

BP > 140/90

CCB + Thiazide Diuretic

BP > 160/100 use 2 agents

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7
Q

High Risk Ethnicities for DM

A

Native American

African American

Latino

Asian American = Middle eastern counts

Pacific Islander

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8
Q

ADA 2018 Glycemic Goals

A1C

FBG

2hr PPG

A

A1C = < 7%

FBG = 80-130 mg/dL

2HR PPG = <180 mg/dL

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9
Q

Major Differences between T1DM

vs T2DM

A
  • T1DM
    • <30 y/o
    • Abrupt Onset
    • Lean Body
    • no insulin resistance
    • Symptomatic
    • Auto AB’s present
    • little or no Macro/Microvascular complications at diagnosis
    • Ketones at Baseline
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10
Q

S/S of DM

A
  • HYPERglycemia:
    • PolyURIA / PolyDIPsia / PolyPHAgia
  • Top:
    • Headache / blurry VISION / Fatigue
  • Body:
    • Poor wound healing / dry skin / sexual dysfunction
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11
Q

ADA 2018 Diabetes Screening Guidelines

A
  • Normal Weight / No Risk factors
    • screen at age 45, or if GDM History
      • test every 3 years
  • ​​PRE-Diabetes
    • Test Annually
  • Overweight or Obese w/ 1> Risk Factors
    • ​Prediabetes / 1st degree relative with DM
    • High Risk ethnicity / GDM / PCOS
    • h/o CVD / HTN
    • Inactive lifestyle
      • SCREEN
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12
Q

A1C Correlation with Mean Plasma BG

How much A1C by adding avg BG?

A

INCREASE A1C by 1%

then add

~30mg/dL to PPG

Ex- 6->7% A1C ——> 150->180mg/dL PPG

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13
Q

Diagnosis for Diabetes

HgbA1C? FPG?

A

HgbA1c = > 6.5% or

FPG = > 126 (mg/dl) - IFG (impaired fasting glucose)

SECOND TEST NEEDED TO CONFIRM DIABETES

required if BG is NOT >200 (overtly hyperglycemic) with symptoms

then test RPG or 2 Hour post 75mg OGTT (oral glucose tolerance test)

_>_200 (mg/dl) IGT

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14
Q

2013 ACC/AHA Cholesterol Guideline

A

ASCVD Risk Reduction Trial

  • DM - Aged 40-70
    • w/ LDL between 70-189 mg/dl
      • 10 year ASCVD risk of 7.5%
        • w/ moderate intensity statin
      • ​10 yr ASCVD risk of > 7.5%
        • ​w/ HIGH intensity statin
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15
Q

When to initiate HYPERTENSION medication?

A

BP > 140 / 90

Ace inhibitor or ARB
1st line if proteinuria is present

CCB / Thiazide Diuretic

Use 2 BP agents if BP >160/100

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16
Q

Second Test for DM

A

SECOND TEST NEEDED TO CONFIRM DIABETES

required if BG is NOT >200 (overtly hyperglycemic) with symptoms

then test RPG or

2hr post 75g OGTT

> 200 (mg/dl)

17
Q

Antiplatelet Therapy

A

ASA 81mg QD

in women & men >50 yrs with

diabetes + 1 major risk factor

ASCVD / HT / Dyslipidemia / Smoking / CKD

not at increased risk of bleeding

18
Q

Preventative Care / health maintenance

A

QUIT SMOKING / overdrinking

Dilated Eye Exam

Foot Exam

Dental Exam

Family planning for pregnant women

19
Q

Pathophysiology of T1DM

A
  • Genetic Predisposition (from birth)
  • Immunologic Abnormalities (onset is later)
    • At some point there is a TRIGGER
      • -> that leads to the Destruction of B-Cell Mass
  • ​​Dies gradually over time
  • Honeymoon Period
    • Period where B-cell mass APPEARS to regenerate
      • but ultimately still dies.
20
Q

A1C Goal of <8%

Is for what Patient Specific Group?

A

ELDERLY

H/O of hypoGlycemia or hypoGlycemia unawareness

long disease duration

short life expectance

CVD

poor support system

21
Q

Pathophysiology of T2DM

“Omnious OCTET”

A
  1. Decreased Insulin Secretion
  2. Decreased Inretin Effect
  3. Decreased Glucose Uptake
  4. NT Dysfunction
  5. Increased Lypolysis
  6. Increased Glucose Reabsproption
  7. Increased Hepatic Glucose Production
  8. Increased Glucagon Secretion
22
Q

DM Screening for <18 years old

A

Overweight + _>_1 risk factor –> SCREEN FOR DIABETES

  • Overweight =
    • >85th percentile for age and sex
      • weight for height
    • OR weight >120% of ideal for height
  • Risk factors:
    • MATERNAL HISTORY of DM or GDM (during child’s gestation)
    • F/H of T2DM in 1st or 2nd degree relative
    • Other insulin resistance conditions
    • HIGH RISK ETHNICITY
23
Q

Risk Factors

ADA 2018

A

Overweight / Obese + 1> Risk factor –> SCREEN FOR DIABETES

  • 1st degree relative with DM
  • PCOS / GDM (gestational) / HTN
  • Physically Inactive / Insulin Resistance
  • H/o CVD
  • low HDL
    • (< 35mg/dl )
  • HIGH TG
    • ( > 250mg/dl )
24
Q

Pathophysiology of T2DM

“Egregious Eleven”

A

By the time diabetes is Diagnosed, 80% of B-cell fxn is LOST

  • Addition to the 8:
    • Abnormal Microbiota
      • ​**possible decreased **GLP1 secretion
    • BRAIN
      • increased appitite
      • decreased morning dopamine surge
    • ​Immune Dysregulation / Inflammation
25
Q

Diagnosis for Pre-Diabetes

HgbA1C? FPG?

A

HgbA1c = 5.7 - 6.4 % or

FPG = 100 - 125 (mg/dl) - IFG (impaired fasting glucose)

SECOND TEST NEEDED TO CONFIRM PRE-DIABETES

required if BG is NOT >200 (overtly hyperglycemic) with symptoms

then test 2 Hour PPG (post prandial glucose)

140 - 199 (mg/dl) IGT

26
Q

MACROVascular

​Complications of DM

A
  • BRAIN
    • ​Increased risk of Stroke / CVD
      • Transient Ischemic Attack / Cognitive Impairment
  • HEART
    • ​High BP & Insulin Resistance ->
      • increase risk of CAD
  • EXTREMETIES
    • ​Narrowing of BV -> increase risk for reduced or lack of blood flow to legs
      • -> Gangrene / Poor Wound Healing
27
Q

HgbA1c Lab Test

A
  • Measure of glucose that is bound to HgB in RBC
    • ​over the previous 2-3 months
  • ​MEAN VALUE
    • does not show DAY to DAY fluctuations
  • FASTING NOT REQUIRED

PDAT2 (22 decks)

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