DM Flashcards
کامپلیکیشن هایی که به دنبال هایپرگلایسمی رخ میدن هر کدوم در چه استیجی از بیماری رخ میدن؟
those secondary to acute hyperglycemia may occur at any stage of the disease, whereas those related to chronic hyperglycemia typically begin to appear during the second decade
در Hx کسی که تشحیص دیابت گذاشتیم چیارو باید جتما بپرسیم؟ 8
A complete medical history should be obtained with special empha- sis on DM-relevant aspects such as
1-current weight as well as any recent changes in weight,
2-family history of DM and its complications,
3-sleep history, 🛌😴
4-risk factors for cardiovascular disease,
5-exercise, 🚴🏻♀️🤸🏻♀️🏋🏻♀️
6-smoking status, 🚬🚬
7-history of pancreatic disease,
8-and ethanol use. 🍺🍷
علائم هایپرگلایسمی که تو هیستوری میگه بهمون ؟ ۸
1-polyuria, 2-polydipsia, 3- weight loss, 4-fatigue, 5-weakness, 6-blurry vision, 7-frequent superficial infections (vaginitis, fungal skin infections), 8- and slow healing of skin lesions after minor trauma.
Blurred vision results from changes in the water content of the lens and resolves as hyperglycemia is controlled.
چه metabolic derangements ای به دنبال DM ایجاد میشه؟
علتش چبه؟
Metabolic derangements relate mostly to hyperglycemia (osmotic diuresis)
and to the catabolic state of the patient
(urinary loss of glucose and calories, muscle breakdown due to protein degradation and decreased protein synthesis).
بیمار دیابتی که new نیست، در هیستوری ش تاکیدمون رو چیه؟
In a patient with established DM, the initial assessment should include a review of symptoms at the time of the initial diabetes diagnosis. This is an essential part of the history that can help define whether the correct type of DM has been diagnosed.
2-prior diabetes care, including types of thera- pies tried,
3-the nature of any intolerance to previous therapies,
4-prior HbA1c levels,
5- self-monitoring blood glucose results,
6-frequency of hypoglycemia (<3.0 mmol/L, <54 mg/dL),
7- presence of DM-specific complications,
8-and assessment of the patient’s knowledge about diabetes, exercise, nutrition, and sleep history.
8-the presence of DM-related comorbidities should be established (cardiovascular disease, hypertension, dyslipidemia).
هیپوگلایسمی یعنی زیر چند؟
۵۴ گرم بر dl
خانومی که دیابت داره و میخواد بچه دار باشه، چه شزایطی باید داشته باشه که اوکی بده؟
all women of childbearing age be counseled about the importance of tight glycemic control (HbA1c <6.5%) prior to conception.
در دیابت چه نکاتی در معاینه خیلی مهمه برامون؟
1-weight 2- and BMI 3, retinal examination 4, orthostatic blood pressure 5, foot examination 6, peripheral pulses 7, and insulin injection sites. 8-BP 9-Because periodontal disease is more frequent in DM, the teeth and gums should also be examined.
در دیابتی ها فشار چند باشه HTN محسوب میشه؟
Blood pressure >130/80 mmHg is considered hypertension in individuals with diabetes.
معاینه سالانه پای دیابتی چجوری انجام میشه؟
An annual foot examination should
(1) assess blood flow (pedal pulses), sensation (vibratory sensation [128-MHz tuning fork at the base of the great toe], the ability to sense touch with a monofilament [5.07, 10-g monofilament], pinprick sensation, ankle reflexes, and nail care;
(2) look for the presence of foot deformities such as hammer or claw toes and Charcot foot; and
(3) identify sites of potential ulceration.
The ADA recommends annual screening for distal symmetric polyneuropathy beginning with the initial diagnosis of diabetes and annual screening for autonomic neuropathy 5 years after diagnosis of type 1 DM and at the time of diagnosis of type 2 DM. This testing is aimed at detecting loss of protective sensation (LOPS) caused by diabetic neuropathy
مشخصات charecteristic، دیابت تایپ ۱؟ 5
Individuals with type 1 DM tend to have the following characteristics:
(1) onset of disease prior to age 30 years
(2) lean body habitus
(3) requirement of insulin as the initial therapy;
(4) tendency to develop ketoacidosis
(5) an increased risk of other autoimmune disorders such as autoimmune thyroid disease, adrenal insufficiency, pernicious anemia, celiac disease, and vitiligo.
مشخصات charecteristic، دیابت تایپ ۲ ؟
(1) diabetes onset after the age of 30 years
(2) are usually obese (80% are obese, but elderly individuals may be lean);
(3) may not require insulin therapy initially;
(4) may have associated conditions such as insulin resistance, hypertension, cardiovascular disease, dyslipidemia, or polycystic ovarian syndrome.
In type 2 DM, insulin resistance is often associated with abdominal obesity (as opposed to hip and thigh obesity) and hypertriglyceridemia.
Although most individuals diagnosed with type 2 DM are older, the age of diagnosis is declin- ing, and there is a marked increase among overweight children and adolescents.
Some individuals with phenotypic type 2 DM present with diabetic ketoacidosis but lack autoimmune markers and may be later treated with oral glucose-lowering agents rather than insulin (this clinical picture is sometimes referred to as ketosis-prone type 2 DM).
What is latent autoimmune diabetes of the adult?
این بیماران چه مشخصاتی دارن؟
some individuals (5–10%) with the phenotypic appearance of type 2 DM do not have absolute insulin deficiency but have autoimmune markers (GAD and other ICA autoantibodies) suggestive of type 1 DM (termed latent autoimmune diabetes of the adult).
Such individuals are more likely to be <50 years of age, thinner, and have a personal or family history of other autoimmune disease than individuals with type 2 DM.
They are much more likely to require insulin treatment within 5 years.
مشخصات دیابت های مونوژنیک؟ 4
Monogenic forms of diabetes should be considered in
1-those with diabetes onset in childhood or early adulthood and especially those diagnosed within the first 6 months of life
2-an autosomal pattern of diabetes inheritance
3-diabetes without typical features of type 1 or 2 diabetes
4-and stable mild fasting hyperglycemia
چه لب تست هایی رو برای بیمار دیابتی چک میکنیم؟
1-The laboratory assessment should first determine whether the patient meets the diagnostic criteria for DM
2-and then assess the degree of glycemic control.
3-the patient should be screened for DM-associated conditions (e.g., albuminuria, dyslipidemia, thyroid dysfunction).
4- Serum insulin or C-peptide measurements may be useful, but should always be interpreted with a concurrent blood glucose level. A low C-peptide in the setting of an elevated blood glucose level may confirm a patient’s need for insulin.
گول درمانی ما در دیابت چیه؟
The goals of therapy for type 1 or type 2 diabetes mellitus (DM) are to
(1) eliminate symptoms related to hyperglycemia
(2) reduce or eliminate the long-term microvascular and macrovascular complications of DM
(3) allow the patient to achieve as normal a lifestyle as possible.
To reach these goals, the physician should identify a target level of glycemic control for each patient, provide the patient with the educational and pharmacologic resources necessary to reach this level, and monitor/treat DM-related complications.
گلوکز پلاسما ب چند برسه علایم رفع میشه؟
Symptoms of diabetes usually resolve when the plasma glucose is 200 mg/dL, and thus most DM treatment focuses on achieving the second and third goals.
Guidelines for Ongoing, Comprehensive Medical Care for Patients with Diabetes?
- Individualized glycemic goal and therapeutic plan
- Self-monitoring of blood glucose (individualized frequency)
- HbA1c testing (2–4 times/year)
- Lifestyle management in the care of diabetes, including:
- Diabetes-self-management education and support
- Nutrition therapy
- Physical activity
- Psychosocial care, including evaluation for depression, anxiety
• Detection, prevention, or management of diabetes-related complications, including:
• Diabetes-related eye examination (annual or biannual)
• Diabetes-related foot examination (1–2 times/year by provider; daily by
patient)
• Diabetes-related neuropathy examination (annual)
• Diabetes-related kidney disease testing (annual)
- Manage or treat diabetes-relevant conditions, including:
- Blood pressure (assess quarterly;)
- Lipids (annual)
- Consider antiplatelet therapy
- I nfluenza/pneumococcal/hepatitis B immunizations
چه مواردی هست که باید به بیمار دیابتی یاد بدیم که خودش انجام بده؟
Self management
1-self-monitoring of blood glucose (SMBG);
2-urine ketone monitoring (type 1 DM);
3-insulin administration;
4-guidelines for diabetes management during illnesses;
5-prevention and management of hypoglycemia
6-foot and skin care;
7-diabetes management before, during, and after exercise;
8-and risk factor-modifying activities.
ورزشی که با هدف افزایش insulin sensitivity و پایین اوردن قند انجام شه چقدر باید باشه؟
In patients with diabetes, the ADA recommends 150 min/week (distributed over at least 3 days) of moderate aerobic physical activity with no gaps longer than 2 days.
بیماران دیابتی چه نوع ورزشی براشون ضرر داره؟
چرا؟
چی میشن؟
Despite its benefits, exercise presents challenges for individuals with DM because they lack the normal glucoregulatory mechanisms (nor- mally, insulin falls and glucagon rises during exercise).
Skeletal muscle is a major site for metabolic fuel consumption in the resting state, and the increased muscle activity during vigorous, aerobic exercise greatly increases fuel requirements.
Individuals with type 1 DM are prone to either hyperglycemia or hypoglycemia during exercise,
اینکه به دنبال ورزش هایپر گلایسمی ایجاد شه یا هیپوگلایسمی به چی بستگی داره؟
1-depending on the preexercise plasma glucose
2-the circulating insulin level
3-and the level of exercise induced catecholamines.
🔹If the insulin level is too low, the rise in catecholamines may increase the plasma glucose excessively, promote ketone body formation, and possibly lead to ketoacidosis.
🔹Conversely, if the circulating insulin level is excessive, this relative hyperinsulinemia may reduce hepatic glucose production (decreased glycogenolysis, decreased gluconeogenesis) and increase glucose entry into muscle, leading to hypoglycemia.
چجوری میشه جلوی هایپو/ هایپرگلایسمی به دنبال ورزش در دیابتی هارو گرفت؟
(1) monitor blood glucose before, during, and after exercise
(2) delay exercise if blood glucose is >14 mmol/L (250 mg/dL) and ketones are present;
(3) if the blood glucose is <5.6 mmol/L (100 mg/dL), ingest carbohydrate before exercising;
(4) monitor glucose during exercise and ingest carbohydrate to prevent hypoglycemia;
(5) decrease insulin doses (based on previous experience) before and after exercise and inject insulin into a nonexercising area;
(6) learn individual glucose responses to different types of exercise.
کدوم دیابتی ها ورزش براشون ممنوعه؟
Untreated proliferative retinopathy is a relative contraindication to vigorous exercise, because this may lead to vitreous hemorrhage or retinal detachment.
از چه اندکس هایی Glycaemic control را متوجه میشیم؟
the patient’s measurements provide a picture of short-term glycemic control, whereas the HbA1c reflects average glycemic control over the previous 2–3 months.
