Diabetes General Overview

Question 1

What is Type II Diabetes?

Answer 1

What is Type II Diabetes?

decreased sensitivity in the cells response to insulin (insulin resistance)

Question 2

Diagnosing

Fasting Blood Glucose:

Random Blood Glucose (RBG):

Oral Glucose Tolerance Test (OGTT)

Hemoglobin A1C (HgA1c)

Answer 2

Diagnosing

Fasting Blood Glucose:

a. Prediabetes: 100-125 mg/dL
b. diabetes: >/= 126 mg/dL

Random Blood Glucose (RBG): >/= 200 + symptoms
polyuric, polydipsia, polyphasic, nocturne, unexplained weightless, fatigue, recurrent infections

Oral Glucose Tolerance Test (OGTT)

a. Prediabete: 140-199 mg/dL
b. Diabetes: >/= 200 mg/dL

Hemoglobin A1C (HgA1c)
PRediabetes: 5.7%-6.4%
Diabetes: >/= 6.5%

Question 3

Risk Factors for diabetes

Answer 3

Risk Factors

1. BMI >/= 25 KG/M^2 OR >/= 23 KG/M^2 in Asian Americans
2. physical inactivity
3. first degree relative with diabetes
4. High risk race/ethnicity (African american, Latino, Native american, Asian American, Pacific islander
5. women who delivered a baby weighing 9lb or more (diagnosed with gestational diabetes)
6. Hypertension (>/= 140/30 mmHg or on therapy for hypertension
7. HDL <35 mg/dL and/or a triglyceride level >250 mg/dL
8. women with Polycystic ovarian syndrome
9. A1C >/= 5.7%, IGT, or IFG on previous testing
10. other clinical conditions associated with insulin resistance (severe obesity, acanthuses nigricans)
11. history of CVD

Question 4

Acute complications

Answer 4

Acute complications

1. Hypoglycemia
2. Hyperglycemia
3. Diabetic KEtoacidosis (DKA)
4. Hyperglycemic Hyperosmolar State (HHS)

Question 5

Chronic Complications

Answer 5

Chronic Complications

Microvascular Complications

1. Retinopathy
2. Nephropathy
3. Neuropathy

Macrovascular Complications

4. Cerebrovascular disease
5. Heart Disease
6. Peripheral vascular disease

Question 6

Sick Day Management:

Answer 6

Sick Day Management:
continue long acting insulin
use rapid insulin when/if eating at normal dosing

continue all oral medications except Metformin, SGLT2i, GLP1-RA
read labels for cough and cold. get diabetic versions
Sick day = infection, injury, surgery, trauma, invasive procedure, or major life stress
test blood glucose q2h
TD1M-test rin/blood ketones q4h
monitor temperature
keep hydrated
track symptoms (nausea/vomiting/thirst/urination

Question 7

Gestational diabetes

what is the preffered agent?

what’re the A1C target goals?

Answer 7

Gestational diabetes
insulin is preferred agent, but metformin and glyburide an be used sparingly.
after delivery consider starting metformin
STRICT a1c targets (<6%), FBG <95 mg/dL
1hr PPG <140 mg/dL or 2 hr PPG <120 mg/dL

Question 8

Cystic Fibrosis-Related Diabetes

Answer 8

Cystic Fibrosis-Related Diabetes
screening for CFRB with OGTT should begin by age 10 years old (use of A1C not recommended)
treat with insulin
annual monitoring of complications beginning at 5 years after dx.

Question 9

Hypoglycemia

BG

Causes:

Signs and Symptoms:

Treatment:

Answer 9

Hypoglycemia

BG< 70 mg/dL

Causes: food, exercise, , defect in glucagon secretion
medications: ace inhibitors, oral anti diabetics, fabric acid derivatives, salicylic acid and APAP, SSRI’s, quinine, pentamidine, MAO-Is

Signs and Symptoms:

a. stage 1: anxiety, palpitations, tremors, pallor, diaphoresis, numbness/ tingling
b. stage 2: dizziness, transient hemiplegia, impaired mentation, confusion, amnesia, drowsiness, aphasia, seizures, coma, death

Treatment:
Rule of 15.
1. check BG to confirm hypoglycemia
2. eat 15g of fast acting carb: orange juice, soda, candy
3. follow up with a more substantial snack (include protein, carbs, and fat.

Glucagon Recombinant (Glucagon, GlucaGen)
a. use in severe hypoglycemia
b. Dosse: 1 mg IV, IM, Sub-Q and NS
c. side effects: N+V
Counseling: family member or whoever is in close contact must know how to properly mix and administer

Question 10

Hyperglycemia

BG

Signs and Symptoms:

Treatment

Answer 10

Hyperglycemia

BG >250 mg/dL)

Signs and Symptoms:
weakness, malaise, visual changs, polyuria, polyphagia nocturia, weightloss.

Treatment
Monitor BG frequently
Insulin (if available)
rest
water
exercise

Question 11

Diabetic Keto Acidosis

what is it?

difference btw DKA and HHS?

most common in what type DM?

how long does it take to develop?

Answer 11

Diabetic Keto Acidosis

absolute or near insulin deficiency, resulting in

1. severe hyperglycemia
2. Ketone body production

develops in 1-2 days

most common in type 1, but increasingly seen in type 2

Question 12

Hyperglycemic hyperosmolar state

what is it?

difference btw DKA and HHS?

most common in what type DM?

how long does it take to develop?

Answer 12

Hyperglycemic hyperosmolar state

severe relative insulin deficiency, resulting in
profound hyperglycemia and hyperosmolarity (from urinary free water losses)
No significant ketone production or acidosis

develops over days to weeks

Higher mortality rate than DKA

typically seen in type 2 or previously unrecognized diabetes

Question 13

Lifestyle changes

Answer 13

Lifestyle Changes

1. Medical Nutrition Therapy (MNT)
   a. individualized program used to achieve treatment goals. recommended for T1DM, T2DM, prediabetes, and gestational.
   b. emphasize portion control and healthy food choices
   c. Weight loss >5%
   d. My plate Method
   e. = 2 drinks per day for adult man
   = 1 drink per day for adult woman
   alcohol consumption may increase risk for hypoglycemics in diabetics. eat before you drink
2. Physical activity: 150 min or more of moderate to vigorous intensity aerobic exercise per week. (split into 2-3 sessions). no more than 2 consecutive days without exercise.
   2-3 sessions/ week of resistant exercise.
   flexibility training for older adults with diabetes
3. Smoking cessation

Question 14

Pediatrics:

what are the general A1C goals?

Answer 14

Pediatrics:
Type 1: strict a1c goals
type2: same as adults