Diabetes Managment Flashcards
Diabetes dx Acute symptoms of diabetes plus casual* plasma glucose concentration greater
than or equal to
200
fasting dx criteria
Fasting* plasma glucose greater than or equal to 126 mg/dL.
*Fasting is defined as no caloric intake for at least 8 hours.
2 hour load dx critiera
2 hour post-load plasma glucose in an oral glucose tolerance test greater than or
equal to 200 mg/dL. The test uses a glucose load containing the equivalent of 75
g anhydrous glucose dissolved in water.
Hb A1C dx criteria
Hemoglobin A1C (HbA1C) greater than or equal to 6.5%
pre diabetes dx
Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of standard
glucose load (75 g) or
A1c 5.7% to 6.4%
Type one options
- Rapid Acting
- Short Acting
- Regular Acting
- Intermediate Acting
- Long Acting
- Fixed Combination
two two options
Biguanides (Glucophage/Metformin) Sulfonylureas Alphaglucosidase Inhibitors Thiazolidinediones Meglitinides Selective Sodium-Glucose Cotransporter (SGLT-2) Incretin Therapy • Glucagon-like peptide (GLP-1 agonists) • Dipeptidyl Dipeptidase 4 Inhibitors (DPP-4 inhibitors) Amylin Mimetics
Goals of Treatment for diabetes
- Near normalization of blood glucose
- Individualized goals for children, pregnant women, and older adults
- Prevention of acute complications
- Prevention of chronic complications
- Appropriate individualized self-management
Calculating Glycemic Targets
- Consider age
- Consider whether episodes of hypoglycemia
- Pregnancy status
- Presence/absence of comorbidities
- Medical
- Chronic illness(es)
- End-stage diseases
- Cognitive/Functional
- ADL impairments and severity
- Cognitive impairments and severity
Key concepts in setting goals:
- Individualize goals
- Special considerations for children, pregnant women, and older adults
- Less intensive glycemic goals for patients with severe or frequent hypoglycemia
- More intensive glycemic goals may further reduce microvascular complications at the risk of increasing hypoglycemia
- Postprandial glucose may be targeted if HbA1c goals are not met despite reaching preprandial glucose goals
- Lipid goals should follow ATP IV guideline based on risks; initial evaluation at age 40 years
Children and
adolescents
- A1C
<7.5% or <8% if hypoglycemic
episodes
Nonpregnant adulcts A1C
<7% Maybe <6.5% if: • short-term duration of DM • long life expectancy • Those treated: lifestyle, metformin • no significant CVD
Pregnanct adults A1C
<6-7%
Older adults (healthy) Older adults (with comorbidities, hypoglycemia) A1C
< 7-7.5%
<8-8.5%%
10% higher glycemic targets
Children and
adolescents - fasting bgl
Individualize!
90-250mg/dL prior to exercise
