2 - Diabetes Mellitus Flashcards
Define diabetes
A metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action, or both
What can diabetes cause?
Microvascular (eye, kidney, nerve), macrovascular, and neuropathic complications
What usually causes type 1 diabetes?
Pancreatic beta cell destruction
What can cause type 2 diabetes?
Predominant insulin resistance w/ relative insulin deficiency, or predominant secretory defect w/ insulin resistance
What is gestational diabetes?
Glucose intolerance w/ onset or first recognition during pregnancy
What is the requirement to perform a FPG or FGT test?
Px can’t have anything to eat or drink for about 8-10 hours
What does an A1C test measure?
- The percentage of hemoglobin that is coated w/ sugar
- Reflects the average blood glucose control for the preceding 2-3 months
What occurs during the oral glucose tolerance test (OGTT)?
- Dose of glucose is given to the px to drink and then blood glucose levels are measured
- Usually, px is fasting prior to test and blood glucose level is measured before and then 2 hours after test
What is the purpose of the OGTT test?
Determine body’s ability to break down and use carbs
What are disadvantages to the FPG test?
- Sample not stable
- High day-to-day variability
- Inconvenient to fast
What are disadvantages to the OGTT test?
- Sample not stable
- High day-to-day variability
- Inconvenient to fast
- Unpalatable
- Cost
What are disadvantages to the A1C test?
- Cost
- Affected by medical conditions, aging, and ethnicity
- Not used for age < 18, pregnant women, or suspected type 1 DM
How is diabetes diagnosed?
- FPG >/ 7 mmol/L
- A1C >/ 6.5% in adults
- 2hPG in a 75g OGTT >/ 11.1 mmol/L or random PG >/ 11.1 mmol/L
What is prediabetes?
- Impaired fasting glucose (FPG of 6.1-6.9 mmol/L)
- Impaired glucose tolerance (2hPG in a 75g OGTT = 7.8-11 mmol/L)
- A1C of 6-6.4%
- At high risk of developing diabetes and its complications
What is metabolic syndrome?
- Abdominal obesity
- Hypertension
- Dyslipidemia
- Insulin resistance
- Dysglycemia
What is the correlation between polycystic ovary syndrome and diabetes?
- PCOS causes inappropriate gonadotropin secretion and hyperinsulinemia => excess androgen production
- Long term may lead to glucose intolerance, dyslipidemia, and increased BP
Who should be screened for type 2 diabetes?
- Anyone 40 y/o and older should be screened every 3 years
- Individuals at high risk should begin screening earlier and more often
OGTT is generally used as a ____ test
Secondary
What should be done for patients w/ IGT, IFG, or an A1C of 5.7-6.4%?
- Referred to an support program targeting weight loss of 7% of body weight and increasing physical activity to at least 150 minutes per week
- Metformin for prevention of T2DM may be considered
What are the goals of treatment for diabetes?
- Decrease/prevent symptoms
- Improve quality of life
- Reduce risk of microvascular and macrovascular complications
- Reduce mortality
What is metformin?
“Insulin sensitizer”
What does metformin do?
- Reduces A1C by 1.5-2%
- Does not cause hypoglycemia when used as a monotherapy
- Modest decrease in weight and cholesterol
- Reduces risk of total mortality
How is metformin eliminated?
Renal
What is metformin recommended to be taken w/ and why?
Food, to reduce GI effects
What are common side effects of metformin?
- GI (diarrhea, stomach upset)
- Metallic taste
- Interference w/ B12 absorption
- Hypoglycemia w/ intense exercise
- Lactic acidosis (weakness, fatigue, muscle pains)
How do patients self-monitor their blood glucose?
Test blood sugar
What determines the frequency of self-monitoring?
- Type of diabetes and therapy
- Glycemic control
- Patient factors
- Hypoglycemia risk
- Occupation
- Acute illness
What is the goal A1C for type 1 and type 2 diabetes?
7.0%
What is the goal pre-meal blood glucose for type 1 and type 2 diabetes?
4-7 mmol/L
What is the goal 2h post-meal blood glucose for type 1 and type 2 diabetes?
5-10 mmol/L or 5-8 mmol/L if A1C target not met
When should the goal A1C for a patient be less than 7%?
Some px w/ type 2 diabetes to further reduce risk of nephropathy and retinopathy (must be balanced against the risk of hypoglycemia)
When should the goal A1C for a patient be more than 7%?
- Limited life expectancy
- High risk of functional dependency
- Extensive coronary artery disease
- Multiple co-morbidities
- History of recurrent severe hypoglycemia
What are the 2 trials that determined the goal A1C and blood glucose levels?
- DCCT (diabetes complications and control trial) – studied type 1
- UKPDS (united kingdom prospective diabetes study) – studied type 2
What are some non-pharms regarding eating for diabetes prevention and management?
- Have 3 meals/day no greater than 6 hours apart; healthy snacks may be beneficial
- Eat high-fibre foods
- Encourage drinking water when thirsty
- Decrease sugars and sweet items
- Decrease high-fat foods
- Encourage physical activity
What are examples of sulfonylureas?
- Gliclazide
- Glimepiride
- Glyburide
What do sulfonylureas do?
- Enhance insulin secretion
- Decrease A1C by 1.5%
- Cause hypoglycemia and weight gain (not often used)
What are examples of meglitinides?
- Nateglinide
- Repaglinide
What do meglitinides do?
Stimulate insulin secretion, but require presence of glucose
What does orlistat do?
Reduces up to 30% of dietary fat absorption
What is the dose of orlistat?
120mg 3 times daily w/ fatty meal
What are the early signs of symptoms of hypoglycemia?
- Shakiness
- Headache
- Hunger
- Sweating
- Numb lips or tongue
What is the treatment for mild to moderate hypoglycemia?
- Oral ingestion of 15g of carbohydrate
- Wait 15 minutes and test blood glucose, if still below 4 mmol/L, take another 15g of glucose
- To prevent another episode, px should eat snack w/ 15g carbs plus protein
Why are glucose or sucrose tablets preferred over orange juice or glucose gels?
Tablets provide a faster increase in blood glucose and relief of symptoms
What are diabetics at an increased risk of experiencing?
- Skin infection
- Slower rate of healing
- Impaired defense against infections
