EXAM 4 DM Clinical Presentation & Monitoring Dr. Hess Flashcards
Which function starts to diminish before the diagnosis of diabetes?
insulin resistance
-> common cause: obesity
Which activity changes with an increase in insulin resistance?
insulin secretion to compensate and keep the glucose level stable
-> strain on the pancreas
What are other factors that increase risk for inuslin resistance?
genetics (if patients, siblings have T2DM, you are more likely to develop insulin resistance)
-lack of exercise
Meds that cause insulin resistance?
long-term Corticosteroids -> increase in blood glucose
ex: Prednisone, Dexamethasone
What are the effects of Statins on Insulin?
FYI
decreases the secretion of insulin from the pancreas
Risk factors for T1DM
-strong genetic component
-Trigger: it is unclear what may trigger it
EBV virus
cow milk
honey
When do patients patients present with T1DM?
late in the disease stage, 90% of ß-cells are destroyed by immune cells
-may have DKA and end up in the hospital
Diagnosis of T1DM
Antibody test against the autoimmune cells
Clinical Presentation T1DM
Age, BMI, Insulin resistance, Antibodies, Onset
-Age: <20 y
-BMI: <25
-Insulin resistance: uncommon
-Antibodies: present
-Onset: abrupt
-Hyperglycemia symptoms: dramatic
-prone to ketosis
-need immediate insulin therapy
-complications rare at diagnosis
Clinical Presentation T2DM
Age, BMI, Insulin resistance, Antibodies, Onset
-Age:30 y
-BMI: >25 and increased WC (waist circumference)
-Insulin resistance: common
-Antibodies: not present
-Onset: Gradual
-Hyperglycemia symptoms: uncommon to mild
-not prone to ketosis
-insulin therapy delayed for years
-complications common at diagnosis
Why is T1DM prone to DKA?
because they don’t have insulin at all -> and start turning to ketosis for energy production earlier and predominantly compared to T2DM
What are the symptoms of untreated T1DM?
Central/Brain
-Lethargy
-Stupor: near-unconsciousness
What are the symptoms of untreated T1DM?
Respiratory/breath
-Kussmaul respiration (hyperventilation): they are trying to exhale all the ketone
-fruity breath: Acetone smells fruity
What are the symptoms of untreated T1DM?
Systemic
Weight loss (burning fat -> energy source instead of glucose)
What are the symptoms of untreated T1DM?
Gastric
-Abdominal pain, N/V
What are the symptoms of untreated T2DM?
Central/Brain, Urine, Eye
-Polydypsia: excessive thirst
-Polyphagia: extreme hunger
Urinary
-Polyuria
-Glycosuria
Eye
-Blurry vision
What are the diagnosis tools?
-A1c test
-Fasting glucose
-75g OGTT (not common may be done for pregnancy, bc they have to take glucose and wait for 1h later, 2h and 3h later)
What are the A1c levels?
Normal: <5.7%
Prediabtes: 5.7-6.4%
Diabetes: > 6.5%
What are the Fasting glucose levels?
Normal: <100 mg/dl
Prediabtes: 100-125 mg/dl
Diabetes: > 126 mg/dl
When is a patient considered diabetic when performing the 75g OGTT?
> 200 mg/dl after taking 75g of glucose
What if a patient has a fasting glucose of 90 mg/dl and an A1c of 7%?
the fasting glucose is normal, but the A1c is diabetic
-> so diabetic bc the fasting glucose is just a measure of that moment
How often do providers test for A1c?
-well-controlled diabetes:
6 months
-NOT well controlled:
3 months
-> because the average RBC lives 3 months (measuring the new set of RBC to tell if the A1c has improved)
Which monitoring tool should be used especially in T1DM?
Urinary Ketosis
Others:
-Self-monitoring Blood glucose (SMBG)
-Continuous glucose monitoring (CGM)
What is the A1c goal for most non-pregnant adults based on ADA?
<7% (may be better for older patients to prevent hypoglycemia risk)
to reduce the risk of diabetic complication
AACE says: <6.5%
What is the PRE-prandial glucose goal for most non-pregnant adults based on ADA?
80-130 mg/dl
-> 50 bullet
AACE says: 80-110 mg/dl
What is the POST-prandial glucose goal for most non-pregnant adults based on ADA?
<180 mg/dl within 1-2 h after the meal
AACE says: <140 mg/dl within 2h
A1c goals for Children and older patients
Children: <7.5%
Older adults: <7.5% / <8% / 8.5%
depending on comorbidities
What is the wearing time of the newly approved OTC CGMs? (Sensor duration)
15 days
the Libre devices: 14 days
Dexcom: 10 days
How frequently is glucose measured in the different CGMs?
usually every minute
Dexcom G6: every 5 minutes
What is the Mean Absolute Relative Difference?
the difference in glucose reading from the actual blood glucose
-the standard is <9% (the lower, the better)
What is the Glucometric Goal for adults and older adults?
adults: >70% in range
-> correlates with 7% A1c goal
older adults: >50% in range
What is the blood level considered in range?
70-180 mg/dl
Why might an A1c not be representative of a patient’s average blood glucose?
they may spend too much time above or below the range and still have an A1c average of <7%
What is a significant difference between SMBG and CGM?
CGM measures interstitial glucose whereas SMBG measures blood glucose
-SMBG is used to confirm hyperglycemia or hypoglycemia
When should T1DM patients test for ketones?
Hyperglycemia (>240 mg/dl) during:
-acute illness
-infection
->increases the insulin need
-symptoms of DKA!
What are the symptoms of DKA?
-N/V/D
-Abdominal pain
-Fruity breath
How does a Ketone test work?
Urine test -> Urinate in cup and dip the test strip inside -> read results
Is the Ketone test Qualitative or Quantitative?
Qualitative
-> change in color -> might tell if there is a small or large amount of ketones in the urine
->small amounts of the ketone are self-treatable, large amounts are likely symptomatic (vomiting, dehydration, may need to go to the hospital)
