pre-IC11 Flashcards
How many stages are there in T1DM? Which stage starts to become symptomatic?
3; Stage 3
Describe the pathophysiology of Type 1 DM
An absolute deficiency of pancreatic β-cell function
Describe the pathophysiology of Type 2 DM
Progressive loss of adequate β-cell insulin secretion on the background of insulin resistance
Signs and symptoms of hyperglycemia
- extreme thirst (polydipsia)
- hunger (polyphagia)
- decreased healing
- drowsiness
- dry skin
- frequent urination (polyuria)
- blurred vision
Signs and symptoms of hypoglycemia
- fast heartbeat
- shaking
- hunger
- irritable
- headache
- dizziness
- weakness fatigue
- sweating
- impaired vision
Diagnosis of DM
HbA1c 7% and above
Types of positive antibodies found in T1DM patients
- islet cell autoantibodies and autoantibodies to GAD (GAD65)
- insulin
- tyrosine phosphatases IA-2 and IA-2b
- zinc transporter 8 (ZnT8)
What substance is measured to prove absence of insulin in the body, and why is this measured instead of insulin?
C-peptide; insulin has a short half life
Explain insulin resistance
In the presence of insulin, glucose utilization is impaired and hepatic glucose output increased
Levels of glucose and insulin at an early stage of T2DM
Both elevated (hyperglycemia triggers insulin secretion)
Primary cause of Type 1 Vs Type 2 DM
T1: Autoimmune-mediated pancreatic beta-cell destruction; positive antibodies
T2: Insulin resistance, impaired insulin secretion, negative antibodies
Insulin production (C-peptide level) for Type 1 Vs Type 2 DM
T1: Absent
T2: Normal or abnormal
Age of onset for Type 1 Vs Type 2 DM
T1: Usually <30 years
T2: Often >40 years, although increasing prevalent in obese
children and younger adults
Onset of clinical presentation for Type 1 Vs Type 2 DM
T1: Abrupt
T2: Gradual
Physical appearance for Type 1 Vs Type 2 DM
T1: Often thin
T2: Often overweight
Proneness to ketosis for Type 1 Vs Type 2 DM
T1: Frequent
T2: Uncommon
Onset and progress of hyperglycemia VS hypoglycemia
Hyper: gradual, may progress to diabetic coma
Hypo: sudden, may progress to insulin shock
Measurement of fasting plasma glucose (FPG)
No calorie intake for ≥ 8hrs
Measurement of Postprandial plasma glucose (PPG)
Glucose level measured after meal; usually after 2 hours
Can also be measured using a standardized 75-g oral glucose tolerance test (OGTT)
Measurement of HbA1c
Measures the average amount of glucose in a person’s blood over the past 3 months.
HbA1c = Past 3 months Average of (FPG + PPG)
- Glucose stays attached to hemoglobin for the lifespan of a red blood cell (~120 days)
Contributor to high HbA1c
Greater extent contributed by fasting/ basal hyperglycemia
Contributor to lower HbA1c
Greater extent contributed by postprandial hyperglycemia
Frequency of glucometer use for T1DM, pregnant women, or insulin pump users
- ≥ 4 times daily
- Before meals/snacks, at bedtime, at 3 a.m.
Frequency of glucometer use for T2DM
- ≥ 3 times daily for patients on multiple injections of insulin
- For patients using less frequent insulin injections, noninsulin therapies, or medical nutrition therapy alone, self monitoring of blood glucose (SMBG) may be useful as a guide to the success of therapy
Frequency of glucometer use for practice setting
Patients are to check before breakfast (to see fasting glucose lvl) and 2hr after largest meal (2 times) (to see postprandial glucose)
In the absence of diabetes risk factors, at what age should screening begin and how often should the screening be repeated?
40 y/o; every 3 years
Significance of HbA1c of 6% and below
No diabetes
Cutoff for 2h OGTT for diabetes
11.1 mmol/L and above
Prevention of foot wound of diabetic patients
Maximizing Blood Glucose Control / Reduce risk factors
Self-Examination of the Foot
Foot Protection
Nail and Foot Care and Hygiene
Annual Foot Examination
General DM medication adjustments during Ramadan
TDS to BD
* Reduce medications with high hypoglycemia potential
* Evening dose potency to be higher than morning
Steps to Understanding patient views
Listen, Explain, Acknowledge, Recommend, Negotiate
Most common causes of mild-to-moderate infections in diabetes
Gram positive cocci esp staphylococcus/ streptococcus
Most common causes of chronic/severe infections
Mixed gram-positive cocci and gram-negative bacilli with or without anaerobic organisms
TIME management for diabetic foot/ wound care
- Tissue: Assessing for non-viable or necrotic tissue
- Infection: Chronic wounds get “stuck” in inflammation due to bacteria
- Moisture: Assessment and management of wound exudate
- Edge of Wound: Assessment of non-advancing wound edges and condition of the periwound
Risk factors for foot wounds in diabetes
Poor glycemic control
Peripheral artery disease
Peripheral neuropathy
Visual impairment
Smoking
Risk factors for foot wounds in diabetes
Poor glycemic control
Peripheral artery disease
Peripheral neuropathy
Visual impairment
Smoking
Can moisturiser be used btw toes?
No; may cause fungal infx
Foot examination for PAD
Vascular assessment of pedal pulses
Foot examination for peripheral neuropathy
Neurologic exam with monofilament
