Diabetes Flashcards
DM Screening
Adults (any age) who are overweight and have one risk factor (familail, comorbids, inactivity, non-white)
Patients with pre-diabetes
Women diagnosed with gestational diabetes (test every 3 years)
Age 45+ (even if no risk factors)
Normal = re-test every 3 years or earlier if change in risk
Hallmarks of Type 2 DM disease
Decreased glucose uptake (insulin resistance)
Increased hepatic glucose production
Impaired insulin resistance
Type 2 Progression
As insulin resistance increases, postprandial glucose increases, insulin production wanes and fasting glucose increases.
Metabolic Syndrome
Group of metabolic issues
Abdominal obesity, insulin resistance, elevated triglyceride, decreased HDL, hypertension, pro-inflammatory state
Precursor to DM often
DM Presentation
polyuria, polydipsia, polyphagia, weight loss, blurred vision, and fatigue
Type 2 may be asymptomatic for years until above signs or signs of neuro-vascular issues
Diabetes Periodic Exams
1 - evaluate glucose control
2 - assess for presence of end-organ damage
3 - assess for associated diseases such as other auto-immune or CV
Diagnostic Criteria for T2DM
HbA1c of 6.5% or more
Fasting Glucose 126 or more
Random Glucose of 200 or more with symptoms
Glucose Tolerance Test of 200 or more
Pre-diabetes Criteria
HbA1c 5.7 - 6.4 %
Fasting Glucose 100-125
Glucose Tolerance 140-199
Random glucose for pre-diabetes not recommended
HbA1c Limits
May be inaccurate in anemia/blood disorders or transfusion
May be inaccurate in pregnancy and post-partum
Verify point of care tests with verified lab
Secondary causes of DM
Cushing Pheochromocytoma Acromegaly Hypokalemia Hyperaldosteronism Excess diuretic use Pancreatitis Infection
Gestational Diabetes
Glucose intolerance onset during pregnancy, though an elevated A1c may indicate pre-existing diabetes
HbA1c Goals
Less than 7% for most patients, less than 8% for some
Elderly - goal is to minimize hyperglycemia and hypoglycemia episodes
DM and Exercise
Well controlled Type 1 can participate in exercise
Avoid exercise when glucose is 250+ with ketones or 300+ without ketones
Avoid exercise if less than 100
Exercise lag = glucose can drop after exercise, even many hours later (overnight)
Exercise is critical for T2DM management (150min per week, 2 session of strength training)
DM Follow-ups
Every 3 months is ideal
HbA1c, BP, weight, eye exam, foot exam, lipids, renal
Liver at least yearly
EKG yearly after age 40
Type 1 DM Insulin Requirements
Typically 20-40 units per 24 hours (may vary by patient response)
Half basal insulin, half bolus insulin
Consider starting 0.5 units per KG (half is basal)