DM type 2

Question 1

GH has what role?

Answer 1

secreted as part of puberital growth, further increases insulin resistance to insulin

Question 2

How DM type 2 begins

Answer 2

increased tissue resistance,

hyperinsulinemia,

hyperglycemia,

increased insulin demand negatively affects pancreas

Question 3

Age of diagnosis

Answer 3

10- 19 years

Question 4

highest prevalence

ethnicity and gender?

Answer 4

native Americans / females

Question 5

lowest prevalence

ethnicity and gender?

Answer 5

Caucasians / males

Question 6

associated problems

Answer 6

HTN, dyslipidemia, CVD, eye disease, kidney disease, fatty liver

Question 7

Random plasma glucose level

Answer 7

200mg/dl +

Question 8

Fasting plasma glucose

Answer 8

126 mg/dl +

Question 9

diagnosis requires

Answer 9

one of the high tests and s/s: polyuria, polydipsia, unintentional weight loss or overweight

Question 10

postprandial glucose level

Answer 10

200mg/dl + (2 hours after meal)

Question 11

diagnostic Hgb a1c

Answer 11

6.5% +

Question 12

History clues

Answer 12

P/P/P, nocturia/bed wetting, blurred vision, obesity, fatigue, freq/slow healing infections, premature adrenarche (sex characteristics), family hx of DM 2

Question 13

presenting s/s

Answer 13

DKA, dehydrated, overweight (BMI >85-95%) obese (BMI >95%), acanthrosis nigrans- axilla, neck, groin, knuckles, folds (most easily visible indicator or insulin resistance) Vaginal yeast/thrush, PCOS- acne, hirtuism, HTN

Question 14

assess at PCP visits Q 3-4 months

Answer 14

BP, ht, wt, tanner, history

Question 15

when to screen

Answer 15

Hgb a1c 10 years old, or onset of puberty (which ever occurs first)

then every three years if normal

Question 16

Who to screen - primary clue +2

ethnicities, indicators of resistance, history

Answer 16

Overweight/obese BMI > 85% for age/gender PLUS 2 of these:

family hx type 2

• native american, AA, Latino, Asian, Pacific islander
• indications of resistance (AN/PCOS/HTN/dyslipidemia/SGA at birth)
• mat h/o DM or gest DM Use clinical judgement for screening in patients who don’t meet criteria but are high risk

Question 17

What to check at time of diagnosis

Answer 17

BP, lipid panel, TSH, free T4, liver enzymes, urine for microalbumenia, insulin level. Then annually

Question 18

First line medication therapy, age it is approved for?

Answer 18

Metformin - only FDA approved option Kids 11+ with type 2 DM check BG before Bfast and 2 hours p dinner insufficient alone to control new onset DM Added with rosiglitazone has better results

Question 19

Why monitor Vitamin B12?

Answer 19

monitor routinely for B12 and high homocysteine levels

Vit B 12 corrects homocystinemia and can allow insulin therapy to be reduced

Question 20

what is the first therapy recommendation

Answer 20

education and lifestyle modifications and referral to peds endo

?and metformin?

Question 21

When to initiate insulin

Answer 21

Random BG > 250mg/dl, or A1c > 9% monitor for hypoglycemia and weight gain

Question 22

Routine monitoring for the patient with DM

frequency initially and once well controlled?

Answer 22

A1c and visit Q3months - with PCP, endo, nutr, psyc, education (care team) once well controlled can be Q6 months

Question 23

Exercise and diet

Answer 23

60 min vigorous per day, dietitian referral

limit screen time

Question 24

sleep

Answer 24

screen for OSA, refer if needed

Question 25

Dilated eye exam and foot exam frequency?

Answer 25

annual

Question 26

Urine for microalbumin

Answer 26

annual

Question 27

Hgba1c frequency and goal

Answer 27

Q3 months and <7%

Question 28

BP

Answer 28

at every visit

Question 29

sexuality

Answer 29

precocious puberty counsel due to risk of pregnancy to health

Question 30

psyc

Answer 30

screen for substance abuse and eating disorders

Question 31

resources

Answer 31

mysugar jr and my sugar

DM logbook

carb counting with lenny

fooducate

Question 32

When is BS checked if on Metformin?

Answer 32

before breakfast

two hours after dinner