Diabetes Flashcards
what are the 5 Rs to consider when organizing diabetes care in the office or clinic
recognize register resource relay recall
what three tests can be used for diabetes screening and diagnosis
- HbA1c
- fasting plasma glucose
- 2 hour plasma glucose
how do you determine a patients glycemic targets
patients age
duration of diabetes
risk of hypoglycemia
CV disease presence
life expectancy
how often should you do blood work for diabetes follow up
every 3 months HbA1c
can do every 6 months if targets consistently met and treatment and lifestyle are stable
what causes type 1 diabetes
beta celld estruction
leading to total insulin deficiency
susceptible to ketoacidosis
either autoimmune or unknown etiology
what is latent autoimmune diabetes
a slow progressive form of autoimmune diabetes that shares clinical characteristics of T2DM
it is a form of T1DM
what causes T2DM
combination of insulin resistance and inadequate insulin secretory response
risk factors for T2DM
age over 40
first degree relative with T2DM
member of high risk population i.e aboriginal, hispanic, south asian, asian, african descent
history of prediabetes
history of gestational diabetes
presence of vascular risk factors
presence of associated diseases
use of medications associated with diabetes
what vascular risk factors increase risk of T2DM
obesity
DLD
HTN
abdo obesity
vascular disease
what other diseases are associated with T2DM
PCOS
acanthosis nigricans
HIV
psychiatric disorders
what medications are associated with diabetes
atypical antipsychotics
highly active ART
glucocorticoids
can T1DM be prevented
no
can T2DM be prevented
yes–onset and course can be ameliorated using lifestyle modification and pharmacologic intervention
would you consider pharmacologic treatment even in patients without diabetes but with impaired glucose tolerance
yes–can consider metformin or acarbose
screening guidelines for T2DM
q3 years at age 40 and above or those at high risk
screen more frequently in people with additional risk factors for DM
what is a screening tool you can use for DM
the CANRISK questionnaire
Canadian Diabetes Risk Assessment Questionnaire
what criteria can be used to diagnose DM
fasting plasma glucose of 7 or higher
HbA1c of 6.5% or higher
2 hour plasma glucose of 11.1 or higher after a 75g oral glucose tolerance test
a random plasma glucose of 11.1 or higher in a patient with the classic symptoms of hyperglycemia
what are the classic symptoms of hyperglycemia
polyuria
polydipsia
unexplained weight loss
in a patient with no symptoms of diabetes/hyperglycemia, what do you do if one screening lab test returns in diabetes range?
a repeat, confirmatory test (preferably the same test) must be done another day (in a timely fashion) –if the results of the two different tests are both above diagnostic cutoff, dx is confirmed
*a repeat test is not required if they have symptoms
if you suspect T1DM, should you delay treatment while waiting for the confirmatory test
no
what does the following “R” suggest in the 5Rs of diabetes management:
recognize
consider diabetes risk factors for all patients and screen appropriately
what does the following “R” suggest in the 5Rs of diabetes management:
register
develop a list of patients with diabetes to facilitate recall ad track changes in practice management