Endocrine Flashcards
What are the hallmark signs of type one diabetes?
Polyuria, polydipsia, polyphagia
What occurs in type two diabetes?
Impaired insulin secretion, insulin resistance and/or abnormally elevated glucose production by liver
Name eight risk factors for T2DM.
BMI >27, physical inactivity, first degree relative, PCOS, HTN, Indigenous/Hispanic/Asian/African American, CVD, hx of GDM
Who should be screened for T2DM and how often?
Every 3 years in those > or equal to 40 years of age using fasting plasma glucose OR A1C or for those high risk (based on risk calculator)
How often should patients with T2DM be screened for retinopathy?
At diagnosis and if none, every 1-2 years
What are key aspects of a T2DM assessment?
Fundoscopic, monofilament, foot assessment, weight
What is the diagnostic criteria for T2DM?
Fasting glucose of > or equal to 7 mmol, A1C > or equal to 6.5% (on two tests, at two separate times)
What criteria qualifies pt as prediabetic?
A1C of 6-6.4%
For children and adolescents with risk factors, how often should diabetes screening be done?
Every 2 years
What are T2DM risk factors for children/adolescents?
Obesity, a part of high risk ethnic group, first degree relative, signs/symptoms of insulin resistance
How often should those with risk factors for diabetes be screened?
Every 6-12 months
What is the A1C target for someone with T2DM?
<6.5% if low risk for hypoglycemia and to reduce CVD/retinopathy risk, <7% for most others, higher in elderly/those at +hypoglycemia risk
When should women with hx of GDM be screened for T2DM?
6 weeks-6 months postpartum with 2h 75g oral GTT, before future pregnancy, every 3 years
Name two ways to screen for diabetic neuropathy.
Monofilament, on-off method with tuning fork
How often should A1C testing be done in T2DM?
Q3months, q6months when stable/ A1C’s have been at target
What are the ABCDES of reducing CVD events?
A- A1C <7%, B-blood pressure <130/80, C-cholesterol LDL <2 mmol/L, D-drugs to protect hearts, E-exercise/eating, S-stop smoking, limit stress
How often should individuals be screened for CKD with a urine ACR?
Baseline/at diagnosis and then annually
What qualifies pts for diagnosis of CKD?
Urine ACR >2 mg/mmol x2, and/or eGFR <60 ml/min x2
If first urine ACR >2 mg/mmol or eGFR <60 ml/min, when should the next one be repeated?
Should have two more tests completed over three months
What are some factors that may elevate urine ACR?
Infection, menstruation, marked HTN, marked hyperglycemia, CHF, vigorous exercise within 24 hours of test
What is stocking distribution?
Symptom of peripheral neuropathy, usually bilateral and symptoms resemble stocking or glove
What are microvascular complications of T2DM?
Nephropathy, neuropathy, retinopathy
What are macrovascular complications of T2DM?
CAD, PAD, CVD
What is the most common form of diabetic neuropathy?
Distal symmetric polyneuropathy
How can autonomic neuropathy manifest?
Innervation of the heart, GI tract (gastroparesis), GU system, sexual dysfunction)
What are some of the risk factors for developing a foot ulcer in those with T2DM?
Peripheral neuropathy, PAD, hx of ulcer/amputation, structural deformity, limited joint mobility, increased A1C, onychomycosis
What is one thing to be aware of in men with T2DM?
May have decreased testosterone, should be screened for ED
What is an appropriate A1C for elderly who frail and/or with dementia?
<8.5%
What is an appropriate A1C for elderly who are functionally dependent?
<8%
What is the best predictor of T2DM outcomes in the elderly?
Postprandial glucose
What is the effect of hormones on diabetes?
Estrogen plays role in insulin secretion and sensitivity. When estrogen declines, these things are reduced and this places those who experience premature menopause @ greater risk
What are the recommendations around screening for CVD in those with diabetes?
Suggested an ECG completed q3-5 years for those >40 years, duration of diabetes >15 years and >30 years, end organ damage, > or equal to 1 CVD risk factors
What is the LDL-C goal for those with T2DM?
<2 or >50% reduction from baseline
What is the recommendation for those with elevated triglycerides >4.5?
Fasting (>8 hours) lipid panel should be completed
