Endocrine Flashcards
Recommendations for screening
Entire population > 45 every 3 years
Annual screening BMI >25 and one or more risk factors for DM
DM risk factors
Age greater than 45 BMI > 25 Family history Physical inactivity HTN HDL 250 Women with PCOS Hx vascular disease Large infant
ADA Dx criteria for IIDM
- AIC > 6.5
- FBG > 126
- 2 hour plasma glucose > 200 during OGTT
- Random > 200 with sx of hyperglycemia
Criteria 1-3 needs to be confirmed with repeat testing
Prediabetes
fasting BG 100-125
acanthosis nigricans
Indicates insulin insensitivity
Common eye problems with diabetes
Microaneurysms - Red dots. Can leak and reduce vision.
Hemorrhages
Exudates - fatty deposits
Target AiC
< 7%
< 6% in pregnancy
< 7% with co-morbitities and limited anticipated lifespan
Target glycemic goals
Preprandial 70-130
Postprandial - < 180 (1-2 hours after eating)
Action of metformin
Reduces hepatic glucose production and enhances action of insulin
Sulfonylurea agents
(glimeperide, glipizide) Potentiate insulin secretion May cause hypoglycemia Weight gain Ideal use - insulinopenic patents, non-obese or mild obesity Use in combo or monotherapy
Insulin (basal or NPH)
Sx weight gain, hypoglycemia
Stop sulfonylureas when initiating meal time insulin
When should you consider insulin
A1C > 10% Fasting glucose > 250 Maxed out orals Sx hyperglycemia Pregnant patients
Initiating basal insulin
Total daily insulin needs for adults 1-1.2 u/kg/day
Start 0.2 u/kg as bolus or 10 units
Measure AM fasting glucose if FBG > 130 then increase basal insulin by 2-3 units every 2-3 days until at goal
Normal TSH
0.5-4.5 mU/L
Elevated = hypo
decreased = hyper
Primary hypothyroidism - replacement principles
Adults need 1.6mcg/kg/day
