Diabetes Flashcards
FPG 100- 125 mg/dL or 2-h plasma glucose in the 75 g OGTT 140–199 mg/dL: IGT (affected 1st) OR A1C 5.7–6.4%
Prediabetes: Diagnosis Criteria
A1C ≥ 6.5% OR Fasting plasma glucose (FPG) ≥126 mg/dL OR 2-h plasma glucose ≥200 mg/dL during an OGTT OR A random plasma glucose ≥200 mg/dL
Diagnosis of Diabetes
what do you need to dx diabetes in the absence of unequivocal hyperglycemia
two abnormal test results
Type 2 Diabetes - Risk Factors
- First-degree relative with diabetes
- High-risk race/ethnicity (AA, Latino, NA, Asian A, Pacific Islander)
- History of CVD
- Hypertension >140/90 mmHg or on anti-HTN
- HDL cholesterol level <35 mg/dL
- Triglyceride level >250 mg/dL
- Polycystic ovary syndrome
- Physical Inactivity
- Conditions with insulin resistance (severe obesity, acanthosis nigricans)
Criteria for Screening:
Prediabetes and Type 2 Diabetes
Informal assessment of risk factors or validated tools should be considered in asymptomatic adults for prediabetes and T2DM . (B)
- Testing for overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and one + risk factors (B)
- Testing should begin at age 45 years. (B)
- If tests are normal, repeat testing at a minimum of 3-year intervals. (C)
When to screen for gestational diabetes?
At the first prenatal visit if pt has risk factors.
Test for GDM at 24-28 weeks of gestation in women not previously known to have diabetes (A)
When to test post-partum mom who had GDM for prediabetes/ diabetes
4-12 weeks postpartum, using the 75-g oral glucose tolerance test; lifelong screening Q3 years
*Intensive lifestyle interventions/ metformin
How is T2DM different in kids from adults?
- More rapidly progressive decline in Beta-cell function (can end up on insulin sooner)
- Accelerated development of diabetes complications
Criteria For Screening:
Youth and Adolescents for DM
Risk-based screening after puberty or ≥10 years of age
- overweight (BMI ≥85th percentile) or obese (BMI ≥95th percentile) and
- one or more additional risk factors for diabetes
• Repeat testing Q3 years or more frequently if BMI is
increasing (C)
• Overweight/obesity test pancreatic autoantibodies to exclude the possibility of autoimmune T1DM. (B)
Youth and Adolescent DM Risk Factors
• FH of T2DM in 1st or 2nd-degree relative
• Race/ethnicity: AA, NA, Asian A, Latino, Pacific Islander
• Signs/conditions associated with insulin resistance
– acanthosis nigricans, hypertension, dyslipidemia, PCOS, or SGA
• Maternal history of diabetes or GDM during gestation
A 63-year-old patient has a fasting blood glucose of
127 mg/dl. He has a BMI of 32, a HbA1c of 6.4%, and a
strong family history of type 2 diabetes. What is the
most prudent next step?
Tell him he needs a glucose tolerance test or repeat A1C
A 17-year-old patient has a BMI in the 86%. His social
history reveals he is a high school football player. His
family history is negative for type 2 diabetes. His
mother had GDM with him and she has a current A1C =
5.1. What is the most prudent next step?
Tell him he is at risk for developing diabetes and order an A1C for screening purposes.
components of diabetes physical exam
- BMI, BP
- Fundoscopic examination
- Thyroid palpation
- Skin examination for acanthosis nigricans and insulin injection sites
components of diabetes foot physical exam
Comprehensive foot examination at least yearly
• Inspection
• Palpation of dorsalis pedis and posterior tibial pulses
• Presence/absence of patellar and achilles reflexes
• Proprioception, vibration and monofilament sensation
how often to get A1c lab for Diabetes pts
At least twice a year of controlled.
A1C, every 3 months if not at target or if something has changed
yearly diabetes lab tests
- Fasting Lipid profile (Total, LDL, HDL and triglycerides)
- Liver function tests (esp if on metformin)
- Urine albumin-to-creatinine ratio
- Serum creatinine and calculated GFR
- TSH in T1DM, dyslipidemia, or women over 50 years
Immunizations needed for diabetes pts
- Influenza yearly
- Pneumonia
- PCV 13 and PPSV23 (additional dose at/after age 65)
- Hepatitis B vaccine ages 18 through 59 years.
- 3-dose series of hepatitis B vaccine to unvaccinated adults with diabetes ages ≥60 years.
American Diabetes Association Glycemic targets:
HbA1C:
Preprandial PG:
Postprandial PG:
HbA1C: <7.0%, PG: ~ 150–160 mg/dl
Preprandial PG: 80 - 130 mg/dl (7.2 mmol/l)
Postprandial PG: <180 mg/dl (10.0 mmol/l)
What should diabetic do if blood glucose is <70?
Glucose (15-20 g) for conscious individual
- Repeat SMBG 15 minutes after treatment and repeat treatment prn. Once
SMBG is normal, consume a meal/snack
What should diabetic pt take if blood glucose is <54?
Prescribe Glucagon if at risk of level 2 hypoglycemia (<54 mg/dL)
physical activity recommendation for children?
60 min/day at least 3 days/week of moderate/vigorous-intensity
aerobic and muscle/bone-strengthening activities.
physical activity recommendation for adults?
150 min at least 3 days/week of moderate/vigorous intensity aerobic activity with no more than 2 consecutive days without activity and 2-3 sessions/week of resistance exercise on nonconsecutive days
Prevention/Delay of Type 2 Diabetes
• Prediabetes:
- Targeting weight loss of 7% of body weight
- Increasing physical activity to at least 150 min/week of moderate activity (walking)
- Monitor for development of diabetes annually
- Screen for and treat modifiable risk factors for CVD
• Consider metformin
- Especially for those with BMI >35 kg/m2, age <60 years, and women with prior GDM (A)
what to know about metformin?
preferred first line agent
Once initiated, metformin should be continued; other agents, including insulin, should be added to metformin.
• Long-term use of metformin associated with vitamin B12 deficiency
