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CM 1A: Heme/Onc/Endo > Lecture 25: DM Screening/Mgmt, Part 1 > Flashcards

Lecture 25: DM Screening/Mgmt, Part 1 Flashcards

1
Q

What are the S/S in DM usually caused by?

A
  • Hyperglycemia
  • Hyperosmolality
  • Glycosuria
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2
Q

What are the 3 polys found in T1DM?

A
  • Polyuria
  • Polydipsia
  • Polyphagia
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3
Q

What are the S/S of T1DM?

A
  • 3 Polys
  • Weight LOSS
  • Postural hypotension
  • Weakness
  • Blurred vision (exposure of lens to hyperosmolar fluids)
  • Peripheral neuropathy (neurotoxicity)
  • Skin (dry, itchy, poor wound healing)
  • Severe: Dehydration and ketoacidosis
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4
Q

What geographic factor increases T1DM risk?

A

Further distance from equator.

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5
Q

How does T2DM presentation onset vary from T1DM?

A

T2DM is more insidious in onset and has minimal S/S.

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6
Q

What S/S differ between T2DM and T1DM?

A
  • T2DM: weight gain
  • T2DM: Acanthosis nigricans
  • T2DM: No polyphagia
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7
Q

Why is delivering a baby with large BW associated with T2DM risk?

A

High BW often implies that the mother had a high level of glucose.

Could be caused by mother with gestational diabetes.

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8
Q

What are the S/S of hypoglycemia caused by?

A
  • Increased epi
  • Decreased CNS levels of glucose
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9
Q

What serum level of glucose is typically seen in hypoglycemia S/S?

A

Usually < 60-70 mg/dL

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10
Q

What 4 types of patients should be routinely screened for prediabetes/DM?

A
  • Anyone over 45y.
  • Any obese/overweight pt with 1+ risk factor
  • Gestational DM: 1st prenatal visit if risk factors present, otherwise 24-28 weeks.
  • HIV+ pts on ART.
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11
Q

What tests can be used to screen for DM?

A
  • HbA1c (not preferred for T1DM check)
  • FPG
  • 2 hr PG post 75g OGTT (least common but most accurate)
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12
Q

If a patient presents with a FPG of 150 mg/dL but no S/S, what is the next step?

A

Repeat to confirm.

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13
Q

What are the cutoffs for diabetes for FPG, 2 hr PG, and HbA1c?

A
  • FPG: > 126 mg/dL
  • 2 hr PG: > 200 mg/dL
  • HbA1c: > 6.5%
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14
Q

What are the two types of samples we can obtain BG from?

A
  • Plasma: 10-12% higher than whole blood
  • Whole blood/capillary (aka fingersticks)
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15
Q

What kind of samples/sites may increase BG readings?

A
  • Plasma samples are 10-12% higher.
  • Arterial samples are 3-5 mg higher than venous.

Ideal is venipuncture

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16
Q

How does low hematocrit < 40% affect BG readings?

A

Elevates it.

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17
Q

What can decrease a BG reading?

A
  • Acetaminophen
  • Alcohol
  • High uric acid levels
  • Hct > 50%
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18
Q

What diseases might result in high BG?

A
  • Cushing’s
  • Pheo
  • Pancreatitis
  • Chronic renal failure
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19
Q

What diseases might result in low BG?

A
  • Excess insulin
  • Hypopituitarism
  • Liver disease
  • Addison’s
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20
Q

What does HbA1c represent?

A

Glycosylated HbA1, which is a subtype of HbA.

Generally averages the past 8-12 weeks, with emphasis on past 4.

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21
Q

When is HbA1c diagnostic for diabetes?

A

> 6.5% twice.

6.5 donuts

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22
Q

What can generally cause false lows of HbA1c?

A
  • Hemoglobinopathies such as SCD (high HbF)
  • “Young” RBCs
  • Low protein levels
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23
Q

What can generally cause false elevations of HbA1c?

A
  • Old RBCs: splenectomy
  • Stress
24
Q

What is the target A1c level for diabetics per the ADA?

A

7.0%

Higher is considered uncontrolled.

25
Q

What is normal A1c?

A

< 5.6%

26
Q

When is OGTT indicated?

A
  • Assist with DM diagnosis
  • Assist with hypoglycemia evaluation
27
Q

How is an OGTT performed?

A

75g in 300 mL given to pt.
PG measured periodically.

Ideally done in the AM.

Peds get weight based dose.

28
Q

What special considerations must be considered for an OGTT?

A
  • Low-carb diets can interfere with insulin release. (need to eat 150g for 3 days prior to fix)
  • Avoid PA and smoking until OGTT is done.
29
Q

What is a normal glucose reading at 2 hrs post OGTT? Diabetic reading?

A
  • < 140 mg
  • > 200 mg
30
Q

When is a C-peptide or C-peptide/Insulin ratio test indicated?

A
  • Evaluation of beta-cell function
  • Identify causes of hypoglycemia
  • Evaluation of insulinomas
31
Q

What is C-peptide?

A

Peptide found in preproinsulin and proinsulin. Only found from endogenous insulin.

32
Q

Why is a C-peptide test sometimes preferred over serum insulin?

A

C-peptide has a long half-life and is more stable.

33
Q

When is measuring C-peptide helpful?

A
  • Anti-insulin antibodies
  • Factitious hypoglycemia
  • Exogenous insulin
  • Unknown if T1 or T2.
34
Q

What could increase C-peptide artificially?

A
  • Renal failure
  • Sulfonylureas
  • Pancreas transplant
35
Q

What C-peptide/insulin ratio suggests DM?

A
  • Low C-peptide
  • Low insulin
36
Q

What C-peptide/insulin ratio suggests sulfonylurea use or chronic renal failure?

A
  • High C-peptide
  • High insulin
37
Q

What insulin autoantibody is most useful in diagnosing childhood T1DM?

A

Insulin autoantibody (IAA)

38
Q

Why are ketones measured for diabetics?

A

Checking if someone is in ketosis.

Urine or serum

39
Q

What are the 3 ketone bodies that result in acidosis? MC?

A
  • Acetone
  • Acetoacetate
  • Beta-hydroxybutyrate (MC for DKA)

Beta-hydroxybutyrate cannot be checked via urine ketone test!!!

40
Q

What serum ketone level is concerning?

A

> 3 mmol

41
Q

What are the general goals of treating DM?

A
  • Achieving glycemic control.
  • Reducing/eliminating long-term complications.
  • Maintain quality of life (DSMES).

Diabetes Self Management Education and Support

42
Q

What are the BG glucose targets for DM?

A
  • HbA1c < 7.0%
  • FBG: 80-130
  • Postprandial: < 180
43
Q

What are some of the hypoglycemic management guidelines?

A
  • Carry glucose tablets
  • If unconscious, IV glucose or nasal glucagon
  • If persistent, re-evaluate therapy
44
Q

How often is Self-monitoring of BG (SMBG) used?

A
  • T1DM: 3+ times a day
  • T2DM: 1-2 times a day
45
Q

What is the recommended general diet of someone with DM?

A
  • Low-carb
  • Hypocaloric
  • Aim for 500-700 kcal deficit daily if overweight

High protein can be dangerous in diabetic neuropathy.

46
Q

What kind of exercise is recommended for DM?

A

Moderate (50-70% max HR) aerobic exercise.

47
Q

When is pneumococcal vaccination recommended for DM pts?

A

PCV20 for anyone 2+.

48
Q

What is first-line pharmacotherapy for a DM patient with risk of HTN?

A

ACEI or ARB

Aiming for < 130/80

49
Q

When is enteric coated baby ASA indicated for DM pts?

A

Clinical ASCVD or > 10% ASCVD 10-year risk.

Cannot have any condition for increased bleeding risk.

50
Q

How do we check nephropathy in DM pts?

A
  • Urinary albumin
  • eGFR
51
Q

If a DM patient presents with proteinuria, what is the first-line pharmacotherapy?

A

ACEI or ARB.

52
Q

What are the guidelines for retinopathy monitoring in diabetics?

A
  • T1DM: dilated + comprehensive within 5 years of Dx.
  • T2DM: dilated + comprehensive at time of Dx.
  • Evidence of retinopathy: Dilated exam every year.
53
Q

How do you check for neuropathy in diabetics?

A
  • Diabetic Foot Exam (ANNUAL)
  • Monofilament testing
  • 2nd neuro sensation test
54
Q

What should be encouraged regarding T1DM and eating?

A

They need to eat consistently!

54
Q

What medication may be used to prevent the progression of prediabetes? What are the indications?

A

Metformin.

  • BMI > 35
  • Age < 60y
  • Hx of gestational diabetes

CM 1A: Heme/Onc/Endo (28 decks)

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