2 - Diabetes Mellitus Flashcards
(44 cards)
Define diabetes
A metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action, or both
What can diabetes cause?
Microvascular (eye, kidney, nerve), macrovascular, and neuropathic complications
What usually causes type 1 diabetes?
Pancreatic beta cell destruction
What can cause type 2 diabetes?
Predominant insulin resistance w/ relative insulin deficiency, or predominant secretory defect w/ insulin resistance
What is gestational diabetes?
Glucose intolerance w/ onset or first recognition during pregnancy
What is the requirement to perform a FPG or FGT test?
Px can’t have anything to eat or drink for about 8-10 hours
What does an A1C test measure?
- The percentage of hemoglobin that is coated w/ sugar
- Reflects the average blood glucose control for the preceding 2-3 months
What occurs during the oral glucose tolerance test (OGTT)?
- Dose of glucose is given to the px to drink and then blood glucose levels are measured
- Usually, px is fasting prior to test and blood glucose level is measured before and then 2 hours after test
What is the purpose of the OGTT test?
Determine body’s ability to break down and use carbs
What are disadvantages to the FPG test?
- Sample not stable
- High day-to-day variability
- Inconvenient to fast
What are disadvantages to the OGTT test?
- Sample not stable
- High day-to-day variability
- Inconvenient to fast
- Unpalatable
- Cost
What are disadvantages to the A1C test?
- Cost
- Affected by medical conditions, aging, and ethnicity
- Not used for age < 18, pregnant women, or suspected type 1 DM
How is diabetes diagnosed?
- FPG >/ 7 mmol/L
- A1C >/ 6.5% in adults
- 2hPG in a 75g OGTT >/ 11.1 mmol/L or random PG >/ 11.1 mmol/L
What is prediabetes?
- Impaired fasting glucose (FPG of 6.1-6.9 mmol/L)
- Impaired glucose tolerance (2hPG in a 75g OGTT = 7.8-11 mmol/L)
- A1C of 6-6.4%
- At high risk of developing diabetes and its complications
What is metabolic syndrome?
- Abdominal obesity
- Hypertension
- Dyslipidemia
- Insulin resistance
- Dysglycemia
What is the correlation between polycystic ovary syndrome and diabetes?
- PCOS causes inappropriate gonadotropin secretion and hyperinsulinemia => excess androgen production
- Long term may lead to glucose intolerance, dyslipidemia, and increased BP
Who should be screened for type 2 diabetes?
- Anyone 40 y/o and older should be screened every 3 years
- Individuals at high risk should begin screening earlier and more often
OGTT is generally used as a ____ test
Secondary
What should be done for patients w/ IGT, IFG, or an A1C of 5.7-6.4%?
- Referred to an support program targeting weight loss of 7% of body weight and increasing physical activity to at least 150 minutes per week
- Metformin for prevention of T2DM may be considered
What are the goals of treatment for diabetes?
- Decrease/prevent symptoms
- Improve quality of life
- Reduce risk of microvascular and macrovascular complications
- Reduce mortality
What is metformin?
“Insulin sensitizer”
What does metformin do?
- Reduces A1C by 1.5-2%
- Does not cause hypoglycemia when used as a monotherapy
- Modest decrease in weight and cholesterol
- Reduces risk of total mortality
How is metformin eliminated?
Renal
What is metformin recommended to be taken w/ and why?
Food, to reduce GI effects
