DM background Flashcards
Type 1 DM
deficiency of insulin secretion as result to destruction of pancreatic B-cells (autoimmune or virus–> rubella, coxsakievirus B, cytomealvirus, adenovirus, mumps)
Type 2 DM
insulin resistance in muscles and adipose tissue
decline in pancreatic insulin secretion
unrestricted hepatic glucose production
over 90% of all DM cases
S&S of Hyperglycemia
polyuria, polydypsia, polyphagia (loosing weight)
Type 2 DM risk factors
overweight
sedentary lifestyle
fam hx
cardiovascular dz
previously had an impaired glucose tolerance or impaired fasting glucose
HTN
DM screening
BMI greater than 25 Kg/M
if test is negative, test again in 3 yrs
A1C
hemoglobin carries glucose in blood, testing A1C can give you an idea how much glucose the hemoglobin has been picking up in the past 3 months (3 mo=life of RBC)
Normal A1C
less than 5.7%
Pre-Diabetic AIC
between 5.7-6.4%
A1C thats diabetic
greater than 6.5%
Normal fasting plasma glucose
less than 100mg/dL
Pre-Diabetic Fasting plasma glucose
100-125mg/dL
Diabetic Fasting plasma glucose
over 126
Oral glucose tolerance test–> 2 hrs post
used to Dx gestational diabetes
Normal 2 hrs post oral glucose tolerance test
less than 140mg/dL
Pre-Diabetes 2 hrs post oral glucose tolerance test
140-199 mg/dL
Diabetes 2 hrs post oral glucose tolerance test
over 200 mg/dL
Tx goals in Dm
keep A1C below 7%
keep fasting under 100 mg/dL
keep before meal blood glucose level between 7–130mg/dL (which lets you know how well the previous meal was covered)
Tx of Pre-Diabetes
metformin can be used esp if they have a BMI of greater than 35kg/m2, and are under 60
Macrovascular Complications of DM
coronary artery dz
HTN
dyslipidemia
Microvascular Complications of DM
retinopathy
neuropathy
nephropathy
Management of complications of CAD w/DM
men over 50, women over 60 with DM and atleast 1 other risk factor (fam hx of CVD, HTN , Smoking, dyslipedemia, albumenemia)
given 81mg ASA
Management of HTN with Dm
goal 140/80
use ACE-I or ARB (angiotinsen II receptor blocker) (these are first line tx because they protect kidney)
Management of Dyslipidemia with Dm
Goal: LDL under 100
Tx with statin (esp with Hx of MI)
management of retinopathy with DM
manage HTN and glucose
Management of Neuropathy in DM
manage HTN and glucose
Tx of Peripheral neuropathy with DM
gabapentin (2400-3600mg daily dose) divided
TCA’s
TX of Autonomic retinopathy
PDE-5 inhibitor (erectile dysfunction) reglan erythromycin (gastropyresis) stool softeners)
Non-Pharm therapy in management of DM
Exercise–> 30 mins/day
Diet–>avoid high fat foods, carbs, and sugar
increase fober
15g of carbs=1 serving
can usually have 2 servings at breakfast
Complications of gestational DM
macrosomia (baby over 9 lbs)
neonatal metabolic problems–> mothers sugar was always high, so new borns sugar will drop right away when born
HTN and preeclampsia
When to test for gestational DM
24-28 weeks if no known DM (using OGTT)
Tx options for gestational DM
Diest and exercise 1st
Sulfonylureas (glipizide and glyburide) 9aka insulin)
