Numbers for ENDO exam 2 Flashcards
prediabetes A1C
above 5.6 to 6.4
hypoglycemia
less than 60 to 70
how o
how often to screen for DM and who
when -
all adults 35 years old or more.
if screen -, repeat every 3 years
if positive, retest annually
who -
at 24 weeks for preg
or 1st prenatal visit for risk factors
any age with risk of gestational DM, pancreatitis, prediabetes, are overweight, and have 1+ DM risk factor
HIV + (ART makes them more susceptible to DM)
ADA Risk test
Screening tests for DM
Fasting BG
2Hr plasma glucose during oral glucose tolerance test OGTT - 75 mg
HgbA1c (not for DM1)
random plasma glucose
BGTT is using 75 g standarized form and 2 hrs later. a 2 hr postprandial is unstandardized 2 hours after a meal.
Metabolic syndrome criteria
Waist circumference: > 40in (M) or > 35in (F) Fasting TGs: > 150 OR on meds for it Metabolic Syndrome HDL cholesterol: < 40 (M) or < 50 (F) OR on meds (MetS)
BP: > 130 systolic or > 85 diastolic, or on meds Fasting plasma glucose: ≥ 100 OR on meds
3 +
being on meds for it counts
Risk factors type II DM
- WARM family BAG
Weight
Activity
Race- blacks, latinos, asisans, hawii, native americans
Metabolic syndrome -ANY aspects of metabolic syndrome - (clinical presentation part of it)
Family
B irthweight over 9 lbs (increases the moms risk of gestational DM)
Age
G lucose high - or A1C over 5.6% (prediabetes)
Clinical presentation of metabolic syn
increased waist circumference
HTN
acanthosis nigricans - velvety darkening of skin folds assoc w insulin resistant
Hepatic enlargement - if fatty liver present
hyperuricemia - gouty arthritis
PCOS - menstrual irreg, obese, hirutism, infertile
OSA -obesity and HTN
fasting plasma glucose, 2 hr plasma glucose, hemoglobin A1c in a normal person
70 to 99, less than 140, 4.0 to 5.6%
fasting plasma glucose, 2 hr plasma glucose, hemoglobin A1c in a diabetic
126, 200, 6.5%+
interfering factors glucose
increased
pregnancy elevates it - sometimes get gestastional diabetes.
HCT < 40%
interfering factors glucose - decreased
acetaminophen can make you hypoglycemic
uric acid level high
HCT > 50%
Uric acid causes insulin resistance
Hgb1Ac interfering decreased
decreased-
RBCs have to be around for a while to accumulate Aba1c - if you lose blood, create new fresh blood, and kill blood cells, it lowers it.
Hemoglobinopathies - HbF for example. if you have F you dont have enough H
Hgb1Ac interfering increased
splenectomy (spleen isnt around to kill/phagocytize old blood cells)
- prolonged stress increases your blood sugar, so if it goes on long enough your HgbA1c will pick it up and be increased
high blood glucose reasons
pancreatitis - if its inflamed then it won’t be making enough insulin
chronic renal failure - insulin resistance. it can also make glucose high or low
pancreatitis = sticky glucose pancakes
How much of Hgb is HbA1
HbgA is 7% of HgbA
proportion of hemoglobin A1 that has been glycosylated
8 to 12 weeks measure
Glucose Tolerance Testing -
75 mg in 300mL
30 m, 1 hr, 2, 3, 4 hr in AM
avoid physical activity b/c phys act increases insulin sensitivity
smoking is bad
C peptide and C peptide insulin ratio
eval of insulinomas, identify causes of hypoglycemia
C peptide is more stable and has a longer HL
C peptide - interfering factors - elevated
-renal failure because its renally excreted so it accumulates
-pancreas transplant: more pancreas more insulin
-sulfonylureas: zaps the insulin to make more
Ketones - test & interfering factors
eval presence of ketosis (blood or urine)
greater than 3 is concerning
during exercise, or ill, or cold, the body goes through its sugar supplies and starts using gluconeogeneisis
Vitamen C can interfere, valporic acid, levodopa, phenazopyridine (acids)
DM goals for non pregnant adults pts w DM
HgbA1c check every 3 to 6 mo <7%
fasting GH 80 to 130
post prand glucose 1-2h after - <180
contin. glucose monitors CGM - be in target range 70% of time
How many times do you check T1DM a day
3+/d
how many times a day do you check T2DM
1-2/d
Who is high protein diets NOT for (if they go on a low carb keto diet)
diabetic neuropathy
DM mangement besides pharm?
Medical Nutrition Therapy
routine vaccinations (they are considered ICP)
regular exercise, 150/min/wk of moderate aerobic exercise divded over 3+ days. no more than 2 d without exercise. no more than 90 min in a sedentary position.
Diabetes BP HTN goal
<130/80
1st line is ACE or ARB if elevated.
CCB or thiazide if they don’t have CAD or albuminuria
How often should diabetics get their HLD checked
HLD checked yearly. usually on moderate to high intensity statin (above age 40)
Antiplatelets Tx for diabetics
75-162 mg ASA for DM who have ASCVD or if their risk of developing it is calc to be more than 10%
& NO increased bleeding risk
Diabetics CVD screening and HF screening
NO ROUTINE SCREENING for CAD unless s/s
HF - screen all DM adult.
screen HF with a BNP. echo is abnormal.
Diabetes Peripheral vascular dz screening -
ankle brachial index IF -
50 y/o, or had DM for 10 years.
or have end organ damage from DM
or foot complications.
DM - nephropathy check in who?
- In every DM1 after 5 years of treatment - then check annual
- In all DM with HTN
- In DM2 at the time they are diagnosed
- protien intake should be 0.8
- ACE/ARB is pref. for proteinuria
- SerCreatine K+ BMP periodically
DM retinopathy
dialated and comprehensive eye exam first
DM1 - w/i 5 years for T1 of onset
DM2 - immediately
After first exam, do a dialated exam every year
can be every 2 years if you didn’t find anything in the first exam
Liver Disease in DM
70% of T2DM has non alcoholic fatty liver disease
Screen with** FIB-4 score:**
Obesity
CVD
Insulin Resist
50+
AST or ALT elevated > 6 mo
if moderate to high risk then rx GLP-1R agonist (semaglutide mimics incretins which reduces appetite)
predict to not need to know criteria but more need to know FIB -4 and se
DM Prediabetes - how to manage?
definition - Presence of impaired fasting glucose, impaired glucose tolerane, Alc 5.6-6.4%
tell patient to achieve 7% body wt loss and increase physical activity
Metformin - reduces risk of DM esp if are morbidly obese (BMI 35), if they are young (less than 60), or have had gestational diabetes in the past
Treat and screen for CVD (obese, HTN, HLD)
a greater life expectancy makes more sense to treat chronic issues
DM neuropathy -
- diabetic foot exam is yearly in T1Dm pts with at least 5 years of dx
- T2DM from onset
- screen by monofilament, and 1+ neuro test - pinprick, vibe, reflex)
- foot care edu
IF they have loss of foot sensation, deformities, PAD, or foot ulcer history, or amputee, always examine their feet at each visit
Type 1 diabetic treatment is what
Insulin tx
When would we give insulin to DM2
its last line
Insulin formula
0.5U/kg
50% basal
50% bolus to cover meals throughout the day
most units are 100
if i weigh 50 kg, then i need 25 U of insulin for the whole day. 50% (12.5 for basal) and 12.5 for bolus. I take 12.5 and divide that by three for breakfast lunch and dinner.
insulin pens are adjustable so that you can get exactly how much you want.
Insulin pumps are used for
it automatically injects insulin in you so that you dont have to manually inject yourself. high risk of hypoglycemia because you might not eat enough that day…
What is the starting guideline for carb counting before fine tuning it to each person
45 g/meal, 15g/snack for women
60g/meal, 30g/snack for men
Somogyi means what
-so much insulin. need to bring insulin down lower at bedtime.
-their body is countering the exogenous insulin so you want to lower the insulin.
AM rebound hyperglucemia - dip super low and go back up
Dawn phenomenon
-down insulin
increase the bedtime insulin dose but only if certain
AM hyperglycemia - naturally process, their sugar dips but not as low
Dosing regimen for basal bolus
3-4 times a day w meals
dosing regimen for mixed
dosed 2-3 /d and check 2-3 / d
dosing regimen for long acting
once a day
is analog insulin better than human insulin?
yes. its effect is more consistent and predictable. human insulin has more variation, absorption, and peak. analogs are more consistent . this is true for both basal and bolus dosing.
Biguanides are
metformin
thiazolidinediones are
Pioglitazone