DM type 2 Flashcards
GH has what role?
secreted as part of puberital growth, further increases insulin resistance to insulin
How DM type 2 begins
increased tissue resistance,
hyperinsulinemia,
hyperglycemia,
increased insulin demand negatively affects pancreas
Age of diagnosis
10- 19 years
highest prevalence
ethnicity and gender?
native Americans / females
lowest prevalence
ethnicity and gender?
Caucasians / males
associated problems
HTN, dyslipidemia, CVD, eye disease, kidney disease, fatty liver
Random plasma glucose level
200mg/dl +
Fasting plasma glucose
126 mg/dl +
diagnosis requires
one of the high tests and s/s: polyuria, polydipsia, unintentional weight loss or overweight
postprandial glucose level
200mg/dl + (2 hours after meal)
diagnostic Hgb a1c
6.5% +
History clues
P/P/P, nocturia/bed wetting, blurred vision, obesity, fatigue, freq/slow healing infections, premature adrenarche (sex characteristics), family hx of DM 2
presenting s/s
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
assess at PCP visits Q 3-4 months
BP, ht, wt, tanner, history
when to screen
Hgb a1c 10 years old, or onset of puberty (which ever occurs first)
then every three years if normal
Who to screen - primary clue +2
ethnicities, indicators of resistance, history
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
What to check at time of diagnosis
BP, lipid panel, TSH, free T4, liver enzymes, urine for microalbumenia, insulin level. Then annually
First line medication therapy, age it is approved for?
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
Why monitor Vitamin B12?
monitor routinely for B12 and high homocysteine levels
Vit B 12 corrects homocystinemia and can allow insulin therapy to be reduced
what is the first therapy recommendation
education and lifestyle modifications and referral to peds endo
?and metformin?
When to initiate insulin
Random BG > 250mg/dl, or A1c > 9% monitor for hypoglycemia and weight gain
Routine monitoring for the patient with DM
frequency initially and once well controlled?
A1c and visit Q3months - with PCP, endo, nutr, psyc, education (care team) once well controlled can be Q6 months
Exercise and diet
60 min vigorous per day, dietitian referral
limit screen time
sleep
screen for OSA, refer if needed
Dilated eye exam and foot exam frequency?
annual
Urine for microalbumin
annual
Hgba1c frequency and goal
Q3 months and <7%
BP
at every visit
sexuality
precocious puberty counsel due to risk of pregnancy to health
psyc
screen for substance abuse and eating disorders
resources
mysugar jr and my sugar
DM logbook
carb counting with lenny
fooducate
When is BS checked if on Metformin?
before breakfast
two hours after dinner
