5. Db Flashcards
risk factors for Db2 9
≥40 years old
First degree relative with DM2
High risk population (eg. Aboriginal, African, Asian, Hispanic, or South Asian descent)
Prediabetes (IGT, IFG, A1C 6-6.4%)
Gestational diabetes mellitus (GDM) or delivery of a macrosomic infant
Presence of end organ damage associated with DM
- Microvascular – retinopathy, neuropathy, nephropathy
- Macrovascular – coronary, cerebrovascular, peripheral vascular disease
Presence of vascular risk factors
- HDL cholesterol level <1.0 mmol/L in males, <1.3 mmol/L in females
- Triglycerides 1.7 mmol/L
- Hypertension, Overweight, Abdominal obesity
Presence of associated diseases
- PCOS, Acanthosis nigricans, OSA
- Psychiatric disorders (bipolar, depression, schizophrenia), HIV
Use of drugs associated with DM
- Glucocorticoids, atypical antipsychotics, HAART
Name end organ damage associated with DM
- Microvascular – retinopathy, neuropathy, nephropathy
- Macrovascular – coronary, cerebrovascular, peripheral vascular disease
vascular risk factors for DM
- HDL cholesterol level <1.0 mmol/L in males, <1.3 mmol/L in females
- Triglycerides 1.7 mmol/L
- Hypertension, Overweight, Abdominal obesity
drugs associated with DM
Glucocorticoids, atypical antipsychotics, HAART
how to diagnose DM sx vs asymptomatic pt
1) If symptomatic:
polyuria, polydipsia, unexplained weight loss
AND
positive test (4): 8h FBG, random BG, 2h OGTT or A1C
2) Asymptomatic
AND
2 positive tests on different days (may do same test)
or different tests on same day
* if one test positive only, gotta repeat it
Diagnostic criteria (tests cut offs) (4)
FPG ≥7.0 mmol/L (8h fasting)
A1C ≥6.5%
2hPG in 75g OGTT ≥11.1 mmol/L
random PG ≥11.1 mmol/L
A1C is altered in which conditions
falsely ↑ in anemia; low B12, ROH, opiod use
↓ in pregnancy and renal disease, ASA, vit C and E use
↕ in hemoglobinopathy
up to 0.4 % higher in African Americans, American indians, hispanics and Asians
Diagnose Prediabetes if (3 tests)
A1c 6–6.4%
Impaired fasting Glu (IFG) (FPG 6.1-6.9) = glycémie à jeun altérée
Impaired glu tolerance IGT (2hPG 7.8-11) = intolérance au glucose
A1C not recommended to be checked in which populations
children
pregnant women
suspected DM 1
If any risk factors, screen annually with which tool
40 yo -> FINDRISK or CANRISK
when to ask for a diagnostic testing (FPG, A1C) (according to findrisk)
- 40 yo if canrisk or findrisk low - no need of A1C annually
- 40 yo and if canrisk or findrisk high risk - A1C q 3ans
- if high very high risk q12 mois (any age)
Diagnostic criteria metabolic syndrome 3/5
if ≥3
Elevated waist circumference
Elevated TG 1.7 mmol/L
Reduced HDL-C <1.0 mmol/L in males, <1.3 mmol/L in females
Elevated BP 130/85
Elevated FPG 5.6 +
how many tx for Db depending on A1C target
A1c <1.5% above target, consider 3-6mo lifestyle +- metformin
if >1.5% above target
MTF + another Rx
dtx for sx and or decompensated hypergly (DKA or HHS)
insulin +- MTF
A1C target
6.5 in healthy individuals
A1c ≤7.0 in most patients
7-8.5 in elderly, limited life expectancy, or recurrent severe hypoglycemia
Self monitoring blood glucose pre and post prandial
preprandial 4-7 mmol/L,
2hr postprandial 5-10 mmol/L (or 5-8 if A1C not at target)
Complications of DM 3-3-3
Macrovascular:
- CVD (Cardiovascular Disease) → Maladie cardiovasculaire (MCAS)
- CVA (Cerebrovascular Accident / Stroke) → Accident vasculaire cérébral (AVC)
- PAD (Peripheral Artery Disease) → maladie artérielle périphérique (MAP) / maladie vasculaire athérosclérotique MVAS
Microvascular: Retinopathy, nephropathy, neuropathy
Other:
- Erectile dysfunction (macro/microvascular)
- Foot complications (ulceration, Charcot arthropathy)
-Infection * immunization
general lifestyle counselling and + (6)
Nutrition (Mediterranean diet, low glycemic index)
Physical activity (aerobic >150mins/week, resistance 3 sessions/week)
Smoking cessation
Pre-conception counselling prn
Enquire about hypoglycemia
Driving safety
WHEN to do an ECG to a pt with Db 1 or 2
Screening resting ECG initial AND repeat q3-5y:
Age >40 years
Duration of diabetes >15 years
DB1 as above AND if Duration of diabetes >15 years and age >30 years
End organ damage (microvascular, macrovascular)
Cardiac risk factors
when to consider and exercise ECG stress test
Typical or atypical cardiac symptoms (e.g. unexplained dyspnea, chest discomfort)
Signs or symptoms of associated diseases
Peripheral arterial disease
Carotid bruits
Transient ischemic attack
Stroke
Resting abnormalities on ECG (e.g. Q waves)
in a pt with db 2 follow up q3-6 months (2)
BP, target <130/80
A1C
in a pt with db 2 follow up annually 3 + 3
eGFR (creat) and Urine ACR (albumin:creatinine ratio) (r/o nephropathie)
Retinopathy optometry q1-2y
Neuropathy
Other:
ED, depression, MASLD
Neuropathy how to screen 2+3
Monofilament
Vibration perception tests
Foot exam: ROM, skin, pulses r/o PAD
nephropathy diagnosis of CKD in a db pt
eGFR (creat) and Urine ACR (albumin:creatinine ratio) q 1an
if eGFR <60 OR ACR 2-20, repeat 2x in 3 months
At least 2 of 3 random urine ACR abnormal to diagnose nephropathy: 2-20 microalbuminuria,
or if ACR >20 overt nephropathy
