Beetus 3 Flashcards
What causes DM I?
- autoimmune destruction of ß cells
- often has certain genetic markers
What are DM I pts prone to?
- DKA
- metabolic derangements associated with hyperglycemia
DM I pts require this
Exogenous insulin
What causes DM II?
Combo of
- insulin resistance
- lack/failure of production of insulin
DM II: onset
Adult onset hyperglycemia
DM II: DKA
not as likely to have DKA or metabolic derangements associated with hyperglycemia as a DM I pt
DM II can often be corrected by:
- diet
- exercise
- oral hypoglycemic agents
DM I: age of onset
Usu under 20
DM II: age of onset
Usually over 40
Proportion of cases: DM I vs. II
DM I: 5%
DM II: 95%
DM I: onset
Abrupt (Acute/subacute)
DM II: onset
Gradual
DM I: etiologic factors
- possible viral/autoimmune
- destruction of islet cells
DM II: etiologic factors
- obesity associated
- dec affinity of insulin receptors
Risk factors: DM I
Presence in 1st degree relative
These groups have a 3x greater likelihood of DM II
Black, native american, asian
DM II risk factors
- positive family hx
- ethnicity
- obesity and hyperlipidemia
- increased age
- previous impaired fasting glucose or gestational DM
- HTN
- smoking
Key predictors for increased risk for DM II
- over 55
- BMI over 30
- family hx of DM
Gestational diabetes
- associated with pregnancy
- returns to normal postpartum
DM classification is based upon
IFG test
IFG =
Impaired fasting glucose
IFT =
Impaired fasting tolerance
FPG =
Fasting plasma glucose test
IGT =
Impaired glucose tolerance
What is IGT?
- Ability to regulate a sudden oral glucose load
- drink 75g glucose dissolved in 300 ml water
- blood tested before test and 2 hrs post
When would an IGT test be performed?
- IFT seen on fasting plasma glucose test
- need follow-up testing
OGTT =
Oral glucose tolerance test
Normal OGTT
Below 140 mg/dL
Prediabetes OGTT
140 - 199 mg/dL
Diabetes OGTT
≥ 200 mg/dL
What is used for long term assessment of blood glucose levels?
HbA1c (hemoglobin A1c test)
What does HbA1c test reveal?
average blood glucose over a period of 2-3 months
What does HbA1c measure?
Number of glucose molecules attached to hemoglobin
Normal A1c results
Less than 5.7%
Prediabetes A1c results
5.7-6.4%
Diabetes A1c
6.5% or higher
How does HbA1c complement finger sticks?
- finger sticks are day to day snapshots
- HbA1c is a bigger picture
Summary: dx of DM
- HbA1c
- FPG (fasting plasma glucose)
- OGTT (2 hour glucose tolerance test)
