T2DM Flashcards
T2DM - who to screen
- when to use AUSDRISK (2)
- when to use fasting glucose (7)
- AUSD risk
- ATSI >18
- Age >40
- ask for fasting BSL every 3 years
- AUSDRISK >=12
- Age >40 + BMI > 30
- Premature CV disease
- Gestational DM
- PCOS
- People on anti-psychotic
- Impaired fasting glucose- every 12 months
Physical findings suggest insulin resistance (4)
Skin tag
Acanthosis nigricans
Hirsutism
Central obesity
diagnosis of metabolic syndrome (4)
- waist circumference (men >94 cm, women >80 cm)
- HTN >130/85
- Fasting BSL > 5.5
- dyslipidaemia (HDL <1.0, TG > 1.7)
when to suspect T1DM in new Dx DM (5)
- age < 50
- BMI < 25
- rapid onset of symptoms
- polyuria /polydipsia (occur more in T1DM)
- ketones in urine
immunological marker for T1DM (3)
High GAD Abs (glutamic acid decarboxylase Ab)
High IA 52 Ab (Insulinoma Antigen 2 Ab)
Low C-Peptide (low as low insulin)
T2DM - diagnosis (4)
- fasting BSL >7.0
- Random BSL >11.0
- HbA1C > 6.5
- OGTT
- fasting > 7.0
- 2 hours
- < 7.8 –> no DM
- 7.8 - 11.0 –> impaired glycaemic control
- > 11.0 –> DM
who needs self BSL monitoring
- new diagnose DM
- pt on sulfonylureas and insulin (risk of hypoglycaemia)
- when sick (risk of hyperglycaemia)
- pregnant
- change medication
Target BSL (fasting, postprandial, HbA1C)
fasting 6-8 postprandial 8-10 HbA1C < 7.0 - gestational DM <6.0 - high risk of hypoglycaemia <8.0
Diabetic cycle of care (10)
BMI x2 BP x2 HbA1C x1 lipid profile x1 eGFR x1 Urine ACR x1 eye check x1 / 2years foot assessment x2 medication review x1 physical activity/smoking x1
vaccination in DM
- dTPA (boostrix) at age of 50 years
- influenza vaccine
- pneumococcal vaccine x2 doses
a. ATSI
- <50 years
- at diagnosis
- 10 years later or at age of 50 (later)
- > 50 years
- at age of 50
- 5 years later
b. Others
- <65 years
- at diagnosis
- 10 years later or at age of 50 (later)
- > 65 years
- at age of 65
- 5 years later
gestational DM - time and diagnosis
28/40
75g OGTT (oral glucose tolerance test)
Fasting glucose → > 5.1
1 hour glucose → > 10.0
2 hours glucose → > 8.5
gestational DM- non-pharmacological Mx (8)
- Self BSL monitoring x4 reading/day
- limit weight gain during pregnancy by limiting calorie intake
- Dietary advice with restriction of CHO
- Increase physical activity 2.5 hours/week
- Folic acid 5mg daily
- Multi-disciplinary team (obstetric and endocrinologist)
- Referral to a dietitian
- Close monitoring of fetal welfare
target lipid profile in T2DM
cholesterol < 4.0
TG <2.0
LDL < 2.0
HDL > 1.0