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Endo/Eye/Derm - Women/Men > EXAM 4 DM Clinical Presentation & Monitoring Dr. Hess > Flashcards

EXAM 4 DM Clinical Presentation & Monitoring Dr. Hess Flashcards

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1
Q

Which function starts to diminish before the diagnosis of diabetes?

A

insulin resistance

-> common cause: obesity

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2
Q

Which activity changes with an increase in insulin resistance?

A

insulin secretion to compensate and keep the glucose level stable
-> strain on the pancreas

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3
Q

What are other factors that increase risk for inuslin resistance?

A

genetics (if patients, siblings have T2DM, you are more likely to develop insulin resistance)

-lack of exercise

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4
Q

Meds that cause insulin resistance?

A

long-term Corticosteroids -> increase in blood glucose

ex: Prednisone, Dexamethasone

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5
Q

What are the effects of Statins on Insulin?

FYI

A

decreases the secretion of insulin from the pancreas

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6
Q

Risk factors for T1DM

A

-strong genetic component

-Trigger: it is unclear what may trigger it
EBV virus
cow milk
honey

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7
Q

When do patients patients present with T1DM?

A

late in the disease stage, 90% of ß-cells are destroyed by immune cells
-may have DKA and end up in the hospital

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8
Q

Diagnosis of T1DM

A

Antibody test against the autoimmune cells

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9
Q

Clinical Presentation T1DM

Age, BMI, Insulin resistance, Antibodies, Onset

A

-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

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10
Q

Clinical Presentation T2DM

Age, BMI, Insulin resistance, Antibodies, Onset

A

-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

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11
Q

Why is T1DM prone to DKA?

A

because they don’t have insulin at all -> and start turning to ketosis for energy production earlier and predominantly compared to T2DM

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12
Q

What are the symptoms of untreated T1DM?

Central/Brain

A

-Lethargy
-Stupor: near-unconsciousness

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13
Q

What are the symptoms of untreated T1DM?

Respiratory/breath

A

-Kussmaul respiration (hyperventilation): they are trying to exhale all the ketone

-fruity breath: Acetone smells fruity

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14
Q

What are the symptoms of untreated T1DM?

Systemic

A

Weight loss (burning fat -> energy source instead of glucose)

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15
Q

What are the symptoms of untreated T1DM?

Gastric

A

-Abdominal pain, N/V

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16
Q

What are the symptoms of untreated T2DM?

Central/Brain, Urine, Eye

A

-Polydypsia: excessive thirst
-Polyphagia: extreme hunger

Urinary
-Polyuria
-Glycosuria

Eye
-Blurry vision

17
Q

What are the diagnosis tools?

A

-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)

18
Q

What are the A1c levels?

A

Normal: <5.7%
Prediabtes: 5.7-6.4%
Diabetes: > 6.5%

19
Q

What are the Fasting glucose levels?

A

Normal: <100 mg/dl
Prediabtes: 100-125 mg/dl
Diabetes: > 126 mg/dl

20
Q

When is a patient considered diabetic when performing the 75g OGTT?

A

> 200 mg/dl after taking 75g of glucose

21
Q

What if a patient has a fasting glucose of 90 mg/dl and an A1c of 7%?

A

the fasting glucose is normal, but the A1c is diabetic
-> so diabetic bc the fasting glucose is just a measure of that moment

22
Q

How often do providers test for A1c?

A

-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)

23
Q

Which monitoring tool should be used especially in T1DM?

A

Urinary Ketosis

Others:
-Self-monitoring Blood glucose (SMBG)
-Continuous glucose monitoring (CGM)

24
Q

What is the A1c goal for most non-pregnant adults based on ADA?

A

<7% (may be better for older patients to prevent hypoglycemia risk)
to reduce the risk of diabetic complication

AACE says: <6.5%

25
Q

What is the PRE-prandial glucose goal for most non-pregnant adults based on ADA?

A

80-130 mg/dl
-> 50 bullet

AACE says: 80-110 mg/dl

26
Q

What is the POST-prandial glucose goal for most non-pregnant adults based on ADA?

A

<180 mg/dl within 1-2 h after the meal

AACE says: <140 mg/dl within 2h

27
Q

A1c goals for Children and older patients

A

Children: <7.5%

Older adults: <7.5% / <8% / 8.5%
depending on comorbidities

28
Q

What is the wearing time of the newly approved OTC CGMs? (Sensor duration)

A

15 days

the Libre devices: 14 days
Dexcom: 10 days

29
Q

How frequently is glucose measured in the different CGMs?

A

usually every minute

Dexcom G6: every 5 minutes

30
Q

What is the Mean Absolute Relative Difference?

A

the difference in glucose reading from the actual blood glucose

-the standard is <9% (the lower, the better)

31
Q

What is the Glucometric Goal for adults and older adults?

A

adults: >70% in range
-> correlates with 7% A1c goal

older adults: >50% in range

32
Q

What is the blood level considered in range?

A

70-180 mg/dl

33
Q

Why might an A1c not be representative of a patient’s average blood glucose?

A

they may spend too much time above or below the range and still have an A1c average of <7%

34
Q

What is a significant difference between SMBG and CGM?

A

CGM measures interstitial glucose whereas SMBG measures blood glucose

-SMBG is used to confirm hyperglycemia or hypoglycemia

35
Q

When should T1DM patients test for ketones?

A

Hyperglycemia (>240 mg/dl) during:
-acute illness
-infection
->increases the insulin need

-symptoms of DKA!

36
Q

What are the symptoms of DKA?

A

-N/V/D
-Abdominal pain
-Fruity breath

37
Q

How does a Ketone test work?

A

Urine test -> Urinate in cup and dip the test strip inside -> read results

38
Q

Is the Ketone test Qualitative or Quantitative?

A

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)

Endo/Eye/Derm - Women/Men (30 decks)

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