Endocrine - Online MedEd - outpatient diabetes Flashcards
Type 1 diabetes is
autoimmune destruction of pancreas
Type 2 diabetes need to be screened early to stop micro and macro complications of diabetes… who should be screened?
> 45 yo (old)
BMI>25 (fat)
HTN
How to screen for diabetes?
Random Blood glucose with symptoms of diabetes
Better way: fasting blood glucose, 2x for confirmation (no diabetes –> pre diabetes –> diabetes)
If pre diabetes –> can do 2 hour oral glucose tolerance test - simulate post-prandial glucose. If diabetic, cannot handle glucose load
*If infected, on steroids, can have elevated glucose!
Preferred method: HgbA1c (considered the best test)
>6.5 diabetes
<5.7 normal
In between is prediabetes
HgbA1c measures
Avg blood sugar x 3 months
How much RBCs and sugars are around, get stuck
Capture what’s actually happening in 3 months
Type 1 diabetes - presentation
Polydypsia Polyuria BG is very high Not called juvenile or insulin dependent This is autoimmune destruction Can be in both children and adults
Type 1 diabetes measure antibodies
IA2
GAD is better
*If Ab positive, then meds won’t work
Will need to treat with insulin
When to check antibodies/suspect Type 1?
Not necessarily young ppl
Do so in rapidly progressive and obvious S/S of diabetes
Diagnosis of pre diabetes –> need to do what?
Lifestyle and metformin
How to treat Type 2 diabetes?
1) Lifestyle + metformin Come back 3 months and check A1c 2) If not at target, add a second agent Come back 3 months, check A1C 3) Add insulin! *Metformin is always first
Metformin is contraindicated… in
CKD,
CHF
Liver disease
*Cause lactic acidosis
No good evidence stating which second agent is better than other… classes… how to pick?
1) Biguanide - metformin - side effect: diarrhea - be careful in CHF, CKD
2) Sulfonylureas - gliclazide and glyburide, used to be the second agent to use - increase expression of insulin! Side effect: hypoglycaemia - be careful in CKD
3) TZDs - glitazones - increase insulin sensitivity - side effect: cause weight gain, CHF - people scared to used them!
4) DDP-4s - gliptins - useful because weight neutral
5) GLP-1s - utides - cause weight loss
6) Alpha-glucosidase inhibitors - acarbos - blocks intestinal absorption of sugar - terrible diarrhea, gas
7) SGLT-2 inhibitors - euglycemic DKA! stay away from this
* Pick from: metformin (always use), sulfonyureas, then choose between TZDs, DDP4s, GLP1s
After 2 oral agents… failure to control means go to
Insulin!
Oral agents decrease HgbA1C by 3%, insulin by 7%
If HgbA1c is greater than what…. do you start with insulin right away?
> 9%
What to do in clinic with DM patient?
1) A1C every 3 months, goal <7% (older patient don’t need such tight control). If super low A1C like <5.7%, can get hypoglycaemic events (fatal)
2) Eyes - retinopathy
3) Kidneys - nephropathy
4) Feet - neuropathy
* Need annual screen for each
Retinopathy
Diabetic
Need laser ablation
Retinal exam
