DM Clinical and Lab Flashcards
DM 1 caused by?
destruction of β-cells -> no insulin prdxn
DM 2 caused by?
Insulin resistance and inadequate secretion
Key sxs?
Polyuria
Polydipsia
Polyphagia
Other sxs?
Blurred vision
Infections
Delayed healing
Exam findings: mild/moderate?
normal
Exam findings: advanced?
Retinal ∆
Dry muc memb
Skin/Feet ∆
Exam findings: emergent?
hypoglycemia
DKA
Nonketotic hyperosmolar synd
Normal glucose levels?
FPG < 100
Oral Glu Tolerance Test (OGTT) < 140
Impaired Glucose Tolerance glucose levels?
FPG 100 - 125
OGTT 140 - 199
Diagnositc DM glucose levels?
FPG ≥ 126 or
OGTT ≥ 200 or
Random PG w/ sxs of hypergly ≥ 200
If no sxs, repeat tests to confirm
Diagnotic DM HgbA1c level?
≥ 6.5%
HgbA1c is?
Tells us?
glycosylated HgbA (glucose attached to Hgb)
average blood glu of preceding 2-3 mo
HgbA1c level for controlled DM?
Level for poorly controlled?
≤ 1% above top normal (i.e. 7%)
> 3% above top normal
HgbA1c should be rechecked how often?
6 mo if controlled
3 mo if uncontrolled or therapy change
Gestational DM (GDM) may result in?
Fetal death during 3rd tri Large babies Deformities Hypogly/Ca2+ Polycythemia Jaundice
GDM diagnostic glucose levels?
(Screen at 24 wks)
FPG ≥ 92
1hrGTT ≥ 180
2hrGTT ≥ 153
Glucosuria caused by?
blood glu over tubular threshold
150 - 180, lower for preggos
HgbA1c level for prediabetes?
5.7 - 6.4%
Glucose goals for DM tx?
FBG: 80 - 120
2hrPPG: 100 - 160
BedtimeG: 100 - 140
HgbA1c < 7%
Glucose goals for GDM tx?
FBG ≤ 95
1hrPPG ≤ 140
2hrPPG ≤ 120
Microalbuminuria best test?
+ levels?
Early sign of?
24hr urine
Micro: 30 - 300
clinical: > 300
DM nephropathy
DM screening protocol?
> 44yo Q 3 yrs
younger if risks/sxs
HgbA1c, FPG, OGTT
DM dyslipidemia tx goals?
LDL ≤ 100 or 70 if CAD
HDL > 40
trigly < 400
BMI ≤ 25
Triglycerides > 1000 risk of what?
pancreatitis
Signs of MICROvascular disease? (3)
retinopathy
nephropathy
neuropathy
Ketones result from?
inability of body to use glu as fuel (inadequate insulin)
Body catabolizes fat -> ketones are waste prd
Test for ketones?
If +, next step?
Urine dip
serum CO2: low = acidosis
If + ketones and acidosis, next step?
serum ketone: if + admit
DKA labs summary? (4)
↑ blood/urine glucose
↓ blood CO2
+ urine ketones
+ serum ketones
True Hypoglycemia is?
Sxs?
glu < 40
↑ epi causes:
sweat, tachy, weak, hunger, tremor
↓ CNS glu causes:
HA, dizzy, vision, confusion, etc
Hypoglycemia tx:
If can take PO?
Severe or can’t swallow?
Carb-rich food/drink (juice, candy)
Glucagon subQ or
IV D50W:
bolus + drip
Fasting Hypoglycemia caused by?
High insulin ETOH Liver/kidney dz Glucocort deficiency Hypopitu
Postprandial Hypoglycemia signs?
results from?
caused by?
1-2hrPP
sweat, tachy, weak, hunger, tremor
NORMAL blood glu
rapid glu absorption followed by high insulin response
ETOH
Rx
Insulin levels:
Normal?
Hypoglycemia?
2 -20
< 6 (N response is to inhib insulin secretion)
High insulin levels w/ hyopglycemia caused by?
Insulinoma (secreting tumor)
Over-admin of insulin
Sulfonylureas
Insulin Ab’s
C-peptide tells us?
if pt is producing insulin
if hypoglycemia is from injected insulin (c-peptide will be low)
Lab results if hypogly from Insulinoma?
↑ insulin, proinsulin, c-peptide
Lab results if hypogly from sulfonylurea?
↑ c-peptide
Lab results if hypogly is factitious (insulin abuse)?
↑ insulin
↓ c-peptides
