unit 3: gen DM Flashcards
DM1 cause
auto-immune B-cell destruction > absolute insulin deficiency
DM2 cause
progressive loss of B-cell insulin secretion frequently on the background of INSULIN RESISTANCE
gestational DM
- dx’d in 2nd or 3rd trimester
- could just have been DM not clearly manifested prior to gestation
- BG can return to normal in non-DM pts but is a risk factor for DM2 later
other types of DM r/t specific causes
1) monogenic diabetes syndrome: neonatal DM, maturity-onset DM of the young
2) diseases of the exocrine pancreas: cystic fibrosis, pancreatitis
3) drug or chemical induced diabetes: glucocorticoids, HIV/AIDS tx, s/p organ transplant
consider screening for prediabetes & DM2 in asymptomatic adults w
ANY overweight or obese adult with 1+ additional risk factor
overweight BMI
- american = 25-29.9
- asian = 23-37.4
obesity BMI
- american = 30+
- asian = 27.5+
risk factors for DM/preDM in asymptomatic adults
- first degree relative w DM
- high risk race/ethnicity = AA, latino, native, asian, pacific islander
- hx of CVD
- hypertension 140/90+ or on treatment for HTN
- HDL <35
- triglycerides >250
- women w PCOS
- physical inactivity
- other clinical conditions AW insulin resistance
an A1C of ____ is associated w
5.7+ prediabetes
pts w prediabetes, impaired glucose tolerance, or impaired fasting glucose should be tested every
year
women dx’d w GDM should have ______ testing every _____
lifelong, every 3y
at what age should pts without indications for DM testing begin testing
45
pts w ______ should be tested for DM
HIV (medications can induce)
if glucose testing results are normal at the 45y screen, when should you test again?
minimum of 3y w consideration of more frequent depending on initial results and risk tatus
In overweight or obese children with an additional RF for DM, when should you consider testing?
after onset of puberty or after 10y of age- whichever comes first
DM RF for asymptomatic children & adolescents (4)
- maternal hx of DM or GDM during child’s gestation
- 1st or 2nd degree relative w DM2
- race/ethnicity: Native, AA, latino, asian, pacific islander
- signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, small for gestational age birth weight)
what is required to dx DM?
*2 abnormal test results from the same sample
OR
*2 separate test samples
marked discrepancies between A1C and plasma glucose levels should prompt?
consideration that A1C may not be reliable for that individual…. one should consider using an A1C assay without interference or plasma BG
A1C for prediabetes dx
5.7-6.4%
A1C for diabetes dx
6.5% +
2h BG after 75g OGTT for prediabetes dx
140-199
2h BG after 75g OGTT for diabetes dx
200+
FBG for prediabetes dx?
100-125
FBG for diabetes dx?
126+
random plasma glucose for DM dx?
200+
if a pt has borderline test results for either preDM or DM dx what do you do?
follow pt closely and repeat test in 3-6m
