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
what vaccines are advised for individuals with diabetes?
annual influenza
Pneumococcal 23 18-64
A second pneumococcal vaccination is recommended for patients over 65 and had their vaccine more than 5 years ago.
How do you treat mild to moderate hypoglycemia?
oral source of sugar:
-15g of glucose
- 6 life savers
- 3/4 cup of juice or regular soft drink
this will raise bg up to 2mmol in 20 mins
how do you treat severe hypoglycemia?
pt will have neuroglycopenic symptoms, confusion ,odd behaviour, disorientation
IF conscious:
- oral glucose preparation consisting of 20g of carbs
- preferably glucose tablet
what are the adverse affects of insulin?
- hypoglycemia
- localized fat hypertrophy
- allergic reaction
- immune-mediated resistance
If an individual is MORE than 1.5% above their a1c target, what treatment would you consider?
initiate metformin immediately and consider adding a second antihyperglycmic
how would you treat an individual with symptomatic hyperglycemia and metabolic decompesition?
initiate insulin and maybe metformin
What class of medication is metformin?
Metformin is a Biguanide and is the first choice for uncomplicated t2dm
how does metformin work?
Metformin lowers a1c 1-1.5%
it is NOT associated with weight gain
It decreases hepatic glucose production and lowers glucose absorption
