DM Flashcards by Kasey May

DM symptoms

Fatigue
Weakness
Polyuria
Polydipsia
Polyphagia
Infection
Slowed healing
Blurred vision

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Diagnostic criteria for DM

Fasting glucose greater than 126
Causal glucose greater than 200 plus classic symptoms
2 hr post prandial glucose greater than 200
A1C greater than or equal to 6.5%

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Pre diabetes

Impaired fasting glucose 100-125
Impaired glucose tolerance 140-199 post 2 hour glucose
A1C 5.7-6.4

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Who to test

BMI 25 or more
Children greater than 85% for weight
Metabolic syndrome
Diabetes in pregnancy
If none- test at age 45 and retest every 3 years, screen with A1C

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Gestational DM

2 hour OGT at 24-28 weeks gestation for all pregnancies
Confirmed if fasting glucose greater than 95
1 hour post glucose greater than 14
2 hours post load greater than 120

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Type 1 DM

Insulin dependent
Insulin level or C peptide low
Antibody marker seen
Rapid onset
Weight loss
Ketones in urine and blood, kussmauls

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Type 2 DM

Insulin resistance and declines in insulin production
Insulin and C peptide levels vary could be very high or normal or low
Family history
No antibodies
Associated with HTN, HLD, obesity
Gradual onset
Weight gain
No ketones in blood or urine
May have end organ damage
Skin infections
UTI
Hair loss
Dupuytrens contracture

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Latent autoimmune diabetes of adulthood

Often dx as type 2
Anti GAD antibodies
Insulin deficiency occurs more quickly than type 2 but slower than type 1

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Maturity onset diabetes of the young

Several genetic defects in beta cells can cause diabetes early on
Not used for common type 2

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Metabolic syndrome AKA insulin resistance AKA cardiovascular dysmetabolic syndrome

Insulin resistance
Related to HTN, obesity, HLD
Can occur before BG elevates
dX when 3 or more are met
-waist circumference for men greater than 40 and women greater than 35
- TG greater than 150
-HDL in men less than 40, less than 50 in women
-BP greater than 130/85
-FBS greater than 100
Manage with anti hypertensive, diabetic meds, statin, omega fatty acid, ACEI
High fiber diet, lifestyle modification

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Complications

Neuropathy
Nephropathy
CAD
Wounds
Dental disease
PAD

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TX for DM 1

Insulin required- 0.4-0.5 units per kg per day
Rapid and basal
Pump is an option
Adjuncts like symlin
Glucose monitoring

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Goals for DM

Less than 7 A1C
BP less than 130/80
TC less than 200
FBG less than 100
2 hr Less than 140
HDL above 45
LDL less than 100, less than 70 if CAD
TG less than 150
Smoke cessation

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Hypoglycemia risk factor

Old age
Female
Long duration of DM
Neuropathy
Renal impairment
Previous hypoglycemia
May be due to missed meals and elevated A1C

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Use a statin regardless of LDL if pt is DM and

Greater than 40
Has one of the following
-HTN
-family history of CAD
-low HDL
-smoking

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Risk factors for DM

Greater than 45
Family hx of DM or CVD
overweight or obese
Sedentary lifestyle
Non Caucasian
Metabolic syndrome
PCOS
acanthosis nigrigans
NAFL
HTN
HLD
Gestational DM
Baby greater than 4 kg
Antipsychotic therapy for schizophrenia or BPD
Chronic steroids
OSA

DX criteria

FBG greater than 126
2 hr greater than 200 or random
A1C greater than 6.5

A1C can be misleading in

Ethnic populations
Those with hemoglobinopathies, iron deficiency, hemolytic anemias, thalassemia, spherocytes, severe hepatic or renal disease
A1C not recommended for dx gestational or DM 1

Whipples triad

S/S of suggestive hypoglycemia
Low plasma glucose
Symptoms resolution with plasma glucose correction

Screen DM patients for

CANCER! High risk
Especially if increased BMI greater than 25
Strong association with endometrial, gall bladder, esophageal, renal, thyroid, ovarian, breast and colorectal

HHS

Glucose greater than 600
pH greater than 7.3
Bicarbonate greater than 15
Minimal ketones
Serum osmolality greater than 320
Developed days to weeks
Higher mortality rates
Dehydration

What to Prescribe

Metformin 1st
Secondary depends on pre existing condition like CAD or CHF
If A1C greater than 9 triple therapy is recommended-symptomatic prescribe insulin

According to guidance from ADA which of the following agents is the preferred agent for DM 2 and CHF

SGLT2

In a proactive study pioglitazone was associated with

CHF

Which is the following is the most potent GLP 1 receptor agonist

Ozempic aka semaglutide

Which of the following drugs is most likely to cause dehydration and dizziness because of glucosuria

Canagliflozin AKA invokana

Most SGLT2 inhibitors are available in 2 doses which of the following statement should be used as a guide when prescribing

The prescriber should start with the lowest dose but be aware that higher doses may provider greater benefits without increasing risk for genital infections

Mr smith is an overweight male with family history of diabetes which reported symptom is least likely to be associated with DM 2

Nasal congestion

The patient ask you what his target BP should be assuming he has DM what is the goal

140/90 JNC 140/80 ADA 130/80 AHA

If you have give a patient an anti hypertensive with DM what would you use

ACEI or ARB

Two weeks later Mr smith brings in his 15 year old son upon exam you note brownish discoloration at the nape of his neck the area is velvet in appearance what is the name of this

Acanthosis nigricians

What does acanthosis Nigerians suggest

Increased insulin levels

Mr smith is a 40 year old male with DN when he can to your practice he is on 20 units of Lantus at dinner, tolerates well. AM glucose fasting are 100-112. Post 2 hr meals 200 A1C 8% 68 inches tall and weighs 203 pounds No surgery No other meds No oral meds Renal status normal What do you prescribe

Metformin

The patient ask for a referral for a dietician to help him lose weight what would be a reasonable weight range for this patient

138lb, 153 lb, 168lbs

James is a type 2 DM under fair control last A1C was 8.2% her before glucose meals are 100-130, post 2 hr is greater than or equal to 280 Has a typical diabetic lipid panel What do you expect to see on his fasting lipid panel

High triglycerides, low HDL, normal to moderately high LDL

If a DM patient lipid panel shows elevated TG, normal to moderately LDL, low HDL- how will it changes if medications and diet changes are made

Lower TG, lower LDL, slight increase or no change to HDL