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(C) 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
What is normal A1c?
< 5.6%
26
When is OGTT indicated?
* Assist with DM diagnosis * Assist with hypoglycemia evaluation
27
How is an OGTT performed?
75g in 300 mL given to pt. PG measured periodically. | Ideally done in the AM. ## Footnote Peds get weight based dose.
28
What special considerations must be considered for an OGTT?
* 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
What is a normal glucose reading at 2 hrs post OGTT? Diabetic reading?
* < 140 mg * > 200 mg
30
When is a C-peptide or C-peptide/Insulin ratio test indicated?
* Evaluation of beta-cell function * Identify causes of hypoglycemia * Evaluation of insulinomas
31
What is C-peptide?
Peptide found in preproinsulin and proinsulin. Only found from endogenous insulin.
32
Why is a C-peptide test sometimes preferred over serum insulin?
C-peptide has a long half-life and is more stable.
33
When is measuring C-peptide helpful?
* Anti-insulin antibodies * Factitious hypoglycemia * Exogenous insulin * Unknown if T1 or T2.
34
What could increase C-peptide artificially?
* Renal failure * Sulfonylureas * Pancreas transplant
35
What C-peptide/insulin ratio suggests DM?
* Low C-peptide * Low insulin
36
What C-peptide/insulin ratio suggests sulfonylurea use or chronic renal failure?
* High C-peptide * High insulin
37
What insulin autoantibody is most useful in diagnosing childhood T1DM?
Insulin autoantibody (IAA)
38
Why are ketones measured for diabetics?
Checking if someone is in ketosis. | Urine or serum
39
What are the 3 ketone bodies that result in acidosis? MC?
* Acetone * Acetoacetate * Beta-hydroxybutyrate (MC for DKA) ## Footnote Beta-hydroxybutyrate cannot be checked via urine ketone test!!!
40
What serum ketone level is concerning?
> 3 mmol
41
What are the general goals of treating DM?
* Achieving glycemic control. * Reducing/eliminating long-term complications. * Maintain quality of life (DSMES). ## Footnote Diabetes Self Management Education and Support
42
What are the BG glucose targets for DM?
* HbA1c < 7.0% * FBG: 80-130 * Postprandial: < 180
43
What are some of the hypoglycemic management guidelines?
* Carry glucose tablets * If unconscious, IV glucose or nasal glucagon * If persistent, re-evaluate therapy
44
How often is Self-monitoring of BG (SMBG) used?
* T1DM: 3+ times a day * T2DM: 1-2 times a day
45
What is the recommended general diet of someone with DM?
* Low-carb * Hypocaloric * Aim for 500-700 kcal deficit daily if overweight | High protein can be dangerous in diabetic neuropathy.
46
What kind of exercise is recommended for DM?
Moderate (50-70% max HR) aerobic exercise.
47
When is pneumococcal vaccination recommended for DM pts?
PCV20 for anyone 2+.
48
What is first-line pharmacotherapy for a DM patient with risk of HTN?
ACEI or ARB | Aiming for < 130/80
49
When is enteric coated baby ASA indicated for DM pts?
Clinical ASCVD or > 10% ASCVD 10-year risk. | Cannot have any condition for increased bleeding risk.
50
How do we check nephropathy in DM pts?
* Urinary albumin * eGFR
51
If a DM patient presents with proteinuria, what is the first-line pharmacotherapy?
ACEI or ARB.
52
What are the guidelines for retinopathy monitoring in diabetics?
* T1DM: dilated + comprehensive within 5 years of Dx. * T2DM: dilated + comprehensive at time of Dx. * Evidence of retinopathy: Dilated exam every year.
53
How do you check for neuropathy in diabetics?
* Diabetic Foot Exam (ANNUAL) * Monofilament testing * 2nd neuro sensation test
54
What medication may be used to prevent the progression of prediabetes? What are the indications?
Metformin. * BMI > 35 * Age < 60y * Hx of gestational diabetes
55
What should be encouraged regarding T1DM and eating?
They need to eat consistently!

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

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