T2DM Flashcards

1
Q

T2DM - who to screen

  1. when to use AUSDRISK (2)
  2. when to use fasting glucose (7)
A
  1. AUSD risk
    • ATSI >18
    • Age >40
  2. 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
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2
Q

Physical findings suggest insulin resistance (4)

A

Skin tag
Acanthosis nigricans
Hirsutism
Central obesity

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3
Q

diagnosis of metabolic syndrome (4)

A
  1. waist circumference (men >94 cm, women >80 cm)
  2. HTN >130/85
  3. Fasting BSL > 5.5
  4. dyslipidaemia (HDL <1.0, TG > 1.7)
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4
Q

when to suspect T1DM in new Dx DM (5)

A
  1. age < 50
  2. BMI < 25
  3. rapid onset of symptoms
  4. polyuria /polydipsia (occur more in T1DM)
  5. ketones in urine
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5
Q

immunological marker for T1DM (3)

A

High GAD Abs (glutamic acid decarboxylase Ab)
High IA 52 Ab (Insulinoma Antigen 2 Ab)
Low C-Peptide (low as low insulin)

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6
Q

T2DM - diagnosis (4)

A
  1. fasting BSL >7.0
  2. Random BSL >11.0
  3. HbA1C > 6.5
  4. OGTT
    • fasting > 7.0
    • 2 hours
      - < 7.8 –> no DM
      - 7.8 - 11.0 –> impaired glycaemic control
      - > 11.0 –> DM
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7
Q

who needs self BSL monitoring

A
  1. new diagnose DM
  2. pt on sulfonylureas and insulin (risk of hypoglycaemia)
  3. when sick (risk of hyperglycaemia)
  4. pregnant
  5. change medication
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8
Q

Target BSL (fasting, postprandial, HbA1C)

A
fasting 6-8
postprandial 8-10
HbA1C < 7.0 
      - gestational DM <6.0
      - high risk of hypoglycaemia <8.0
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9
Q

Diabetic cycle of care (10)

A
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
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10
Q

vaccination in DM

A
  1. dTPA (boostrix) at age of 50 years
  2. influenza vaccine
  3. 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
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11
Q

gestational DM - time and diagnosis

A

28/40

75g OGTT (oral glucose tolerance test)
Fasting glucose → > 5.1
1 hour glucose → > 10.0
2 hours glucose → > 8.5

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12
Q

gestational DM- non-pharmacological Mx (8)

A
  • 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
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13
Q

target lipid profile in T2DM

A

cholesterol < 4.0
TG <2.0
LDL < 2.0
HDL > 1.0

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