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Endocrinology > Diagnosis and Screening Management, Part 1 > Flashcards

Diagnosis and Screening Management, Part 1 Flashcards

1
Q

Condition due to near complete or total absence of circulating insulin

A

Type I DM

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2
Q

Type I diabetics eventually require ___ to survive

A

insulin

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3
Q

What causes type II DM?

A

insulin resistance, decreased insulin secretion, increased hepatic glucose production
“Ominous Octet”

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4
Q

Many signs and symptoms of DM are related to _____, its resultant _____, and ______ associated with diabetes

A

hyperglyceumia, hyperosmolality, glycosuria

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5
Q

What are the 3 polys in diabetes?

A

Polyuria
Polydipsia
Polyphagia

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6
Q

S/S of type I DM

A

3 polys
Weight loss
Postural hypotension
Weakness
Blurred vision
Peripheral neuropathy
Chronic infections, dry skin, poorly healing wounds
Severe: marked dehydration, ketoacidosis

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7
Q

What are risk factors for type I DM?

A

Family history
Genetics
Geography-further from the equator
4-7 y/o, 10-14 y/o
Low vitamin D, cow’s milk, viral exposure

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8
Q

What are s/s of Type II DM

A

Insidious onset
Polys
Overweight or obese weight
Blurred vision
Peripheral neuropathy
Chronic infections, dry skin, itching, poorly healing wounds
Severe: marked dehydration, hyperglycemic hyperosmolar state

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9
Q

What are risk factors for Type II DM?

A

Family history
Native americans, blacks, latino/a, asians, NHOPI
Overweight or obese
Physical inactivity
Gestational DM, IGT, IFG, or A1C >5.6
Women who delivered baby >9 lbs
Metabolic syndrome, acanthosis nigricans, PCOS, CV disease

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10
Q

What are exam findings of DM?

A

Poorly healing wound/foot ulcer
Candidal vulvovaginitis/balanoposthitis
Rash in intertriginous fold
Acanthosis nigricans

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11
Q

why does hypoglycemia occur in DM?

A

combination of epinephrine and decreased CNS levels of glucose

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12
Q

What are s/s of hypoglycemia

A

Neuro
Autonomic

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13
Q

Who should be screened for DM?

A

Everyone starting at age 45
Any age if overweight or obese, and have 1+ DM risk factors
Gestational DM (1st prenatal visit if risk factors, otherwise at 24-28 weeks)
HIV + patients

Repeat every 3 years

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14
Q

How can DM screening be done?

A

using A1C, FPG, or 2-hr PG after 75 g OGTT

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15
Q

What are normal fasting plasma glucose levels? A1C?

A

70-99 mg/dL, 4-5.6%

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16
Q

What is a prediabetic fasting plasma glucose? A1C?

A

100-125 mg/dL, 5.7-6.4%

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17
Q

What is a diabetic fasting plasma glucose? A1C?

A

126 mg/dL or higher, 6.5% or higher

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18
Q

what are indications for fasting, capillary BG?

A

identification of BG levels
Screening or monitoring DM/prediabetes

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19
Q

How does a sample being plasma/whole blood impact the sample?

A

Plasma will have higher BG than whole blood

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20
Q

If a venipuncture/arterial puncture is used to get BG what is something to keep in mind?

A

arterial samples tend to be 3-5 mg/dL higher than venous samples

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21
Q

What factors can cause a elevation in blood glucose?

A

Major physical stressors
Steroids
Caffeine
Hct
Pregnancy
IV fluids containing sugars

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22
Q

What factors can cause a decrease in blood glucose?

A

Acetaminophen
Alcohol
High uric acid levels
Hct >50%

23
Q

How could you interpret a high blood glucose other than prediabetes or diabetes?

A

acute stress response, cushing syndrome, pheochromocytoma, pancreatitis, chronic renal failure

24
Q

What are indications of hemoglobin A1C?

A

diagnosis and monitoring of abnormal glycemic states, primarily prediabetes and DM

25
Q

What can cause hemoglobin A1C to be falsely depressed?

A

Hemoglobinopathies, in particular high levels of HbF
Young RBCs: shortened erythrocyte survival, decreased mean erythrocyte age, IV iron or erythropoietic drugs
Abnormally low protein levels

26
Q

What can cause hemoglobin A1C to be falsely elevated other than diabetes?

A

Old RBCs (splenectomy)
Prolonged or recurrent acute stress response

27
Q

What are interpretations of high A1C?

A

Diabetes
Prediabetes
Nondiabetic hyperglycemia
Splenectomy

28
Q

What are interpretations of low A1C?

A

hemolytic anemia
chronic blood loss
chronic renal failure

29
Q

What are indications for glucose tolerance testing?

A

assist with DM diagnosis, assist with hypoglycemia evaluation

30
Q

How is glucose tolerance testing done?

A

Glucose load is administered to patients and glucose measured at start of test and at 30 min, 1 hr, 2 hr, 3 hr, 4 hr
Ideally in AM

31
Q

What are side effects of glucose tolerance testing?

A

May cause dizziness, tremors, anxiety, sweating, or fainting

32
Q

What are patient education points prior to glucose tolerance testing?

A

Low carb diets can interfere with insulin release and cause abnormal results
Should avoid physical activity and smoking until test is complete

33
Q

What are interfering factors with glucose tolerance testing?

A

acute stress response
endocrine disorders
exercise
fasting or reduced dietary intake prior to test
smoking
vomiting

34
Q

What are indications for C-peptide and C-peptide/insulin ratio

A

evalutation of beta-cell function; identify causes of hypoglycemia; evaluation of insulinomas

35
Q

Why might measuring c-peptide be helpful?

A

If patient has anti-insulin antibodies
Factitious hypoglycemia
Patient on exogenous insulin
Unknown if patient is a type 1 or type 2 diabetic

36
Q

If a patient has increased c-peptide, what could that means?

A

Renal failure; sulfonylureas, pancreas transplant

37
Q

If a patient has decreased c-peptide, what could that means?

A

destruction of all or part of the pancreas

38
Q

What are indications for ketones testing?

A

evaluation for the presence of ketosis either in urine or serum

39
Q

What are general goals of treating DM?

A

achieve glycemic control
Reduce or eliminate long-term complications
Maintain quality of life and overall wellbeing: DMSES

40
Q

What are goal levles for patients with DM/

A

Hemoglobin A1C <7
Preprandial capillary glucose 80-130 mg/dL
Postprandial capillary glucose <180 mg/dL

Check A1C every 3-6 months

41
Q

Consider a lower target A1C if

A

shorter diabetes duration
long life expectancy
T2DM tx with lifestyle or metformin only
No significant CVD/vascular complications

42
Q

Consider a higher target A1C if

A

severe hypoglycemic history
Severe disease
Long-term DM patients

43
Q

How are pediatric glycemic control guidelines different?

A

A little less stringent, A1C <7.5

44
Q

At every visit what should you ask about?

A

Hypoglycemic episodes
Advise patients to carry glucose tablets/gel
Can give glucagon if at risk for severe hypoglycemia

45
Q

If a patient is conscious what can you do for hypoglycemia?

A

Give 15-20 g of glucose orally

46
Q

If a patient is unconscious, what can you do for hypoglycemia?

A

IV glucose, injectable or nasal glucagon kit

47
Q

If hypoglycemia is frequent, severe, or no s/s

A

re-evaluate therapy to reduce hypoglycemia incidence
if pre-exercise glucose is <100 mg/dL, consider ingesting carbs

48
Q

Self monitoring

A
49
Q

What are diet therapy guidelines?

A

Medical nutrition therapy for all DM patients
Preferred to use a diabetes educator or dietitian who is experienced with DM patients

50
Q

What are goals of MNT?

A

Healthful eating pattern to improve overall well-bieng
Achieving goals for glycemic control, weight, BP, and lipids
Delay or prevent DM complications

51
Q

What are exercise guidelines for DM?

A

Regular exercise for weight control, improved insulin sensitivity, improved CV health
at least 150 min/week of moderate aerobic exercise divided over 3+ days
No more than 2 consecutive days without exercise
Resistance training 2+ days/week
Try to spend no more than 30-90 minutes at a time in a sedentary position

52
Q

What are risk of exercise?

A

hypoglycemia, cardiovascular complications, and injury

53
Q

What are immunization guidelines for DM?

A

All patients should receive routine vaccinations
Influenza vaccine
Pneumococcal vaccine
Hepatitis B vaccine
COVID19 vaccine

Endocrinology (6 decks)

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