ENDOCRINE WEEK 1- diabetes Flashcards
What types of drugs can interfere with blood glucose in patients with diabetes?
beta blockers (atenolol, metoprolol)
Statins (HMG-CoA reductase inhibitors)
Thiazide/ loop diuretics
Steroids
Anti-rejection drugs
Atypical Antipsychotics
What are some clinical features that can distinguish type 1 diabetes from type 2?
In type 2 there are physical signs of insulin resistance such as obesity and Acanthosis nigricans
is a skin condition that causes a dark discoloration in body folds and creases.
How often do you screen for type 2 diabetes?
For individuals aged 40 + with minimal risk factors the screening is every three years
For individuals with presence of high risk factors you screen every 6-12months
What are the vascular risk factors for T2DM?
- abdominal obesity
- HDL-C less than 1 in males, less than 1.3 in females
-HTN
-being over weight - TG above 1.7
- smoking
what diseases increases an individual for T2DM?
- psych
- cystic fibrosis
- pancretitis
-gout
-sleep apnea - pcos
- HIV
what are some other risk factors for T2DM
- 40 +
- gestational DM
- first degree relative to T2DM
-delivery of macrocosmic infant - presence of end organ damage
what is lab values indicate pre-diabetes?
fasting plasma glucose 6.1 -6.9 mmol/L
HBA1C = 6-6.4%
what FPG and A1C lab values are considered normal?
FPG less than 5.6 mmol/L
HbA less than 5.5%
what lab values are used to diagnose diabetes
A fasting plasma glucose of ≥ 7.0 mmol/L
Glycated hemoglobin (A1C) of ≥ 6.5 %
Random Plasma Glucose ≥ 11.1 mmol/L
2 hour plasma glucose (PG) value in a 75 g oral glucose tolerance test of ≥11.1 mmol/L
Jane is 45 years old and her Fasting plamsa glucose level is 7.5 mmol/L
She denies having any polydipsia/polyuria
Can you diagnose her with T2DM based off this one lab value and clinical observation?
No.
In order to diagnose a pt with diabetes they must have any of the following:
- symptomatic hyperglycemia + A1c above 6.5% OR FPG above 7.0
- X2 FPG lab values above 7.0
- X2 A1C above 6.5%
- A1C above 6.5% and FPG above 7.0
what is metabolic syndrome?
- abdominal obesity
- HTN
- dyslipidemia
- elevated BG
What are macrovascular complications of T2DM?
- stroke
- heart attack
what are microvascular complications of type 2 diabetes
neuropathy
kidney disease
erectile dysfunction
vision changes
what would be your first line treatment for T2DM if Jane’s A1C target is 8.0% and her current A1C is 6.8%?
first line would be non pharm for any patient that is less than 1.5% above target
BUT you must check in 3months, and if A1C is not met in 3 months pharmacotherapy should be initiated
what are non pharm measures for t2DM
- self management education
- individualized nutrition management
- self monitoring of blood glucose
- exercise: aerobic more than 150 min/week and resistance training twice a week
For an individual with T2/T1DM what screening/assessments must you perform as their primary care provider?
- BP at all visits
- Annual monofilament foot exam
- Annual CKD screening (creatine, urine ACR)
- Annual examination of patient BG meter and comparing to phlebotomy draw (within 15% accuracy)
- Ophthalmology eye exam at the time of diagnosis (T2DM) and then every 1-2 years
- Optho exam 5 years after T1DM diagnosis then annually
- HBA1C q3 months in those who have not reached their target
- Lipid screening at the time of diagnosis, then annually if results are normal, if treatment is initiated lipids should be checked q 3-6 months