Diabetes Flashcards
(35 cards)
Impaired glucose tolerance with impaired fasting glucose
prediabetes
A1c: 5.7-6.4
Fasting glucose: 100-125
2 hour BG during 75g OGTT: 140-199
prediabetes
how do you treat prediabetes?
Dietary and lifestyle modifications
Metformin
With any diagnosis of prediabetes or diabetes patients must be checked every 3 months for A1C levels
3Ps: polyuria, polydipsia, polyphagia
Frequent infections such as vaginitis, chronic candida vulvovaginitis, balanoposthitis
Can also manifest with acanthosis nigricans, HTN, centripetal fat distribution, retinopathy, nephropathy, chronic and non-healing wounds
type 2 diabetes
Excess visceral adiposity, metabolic syndrome
History of hyperglycemia, prediabetes, gestational diabetes, race/ethnicity (AA, hispanic, NA,AA,pacific), age, HTN, HLD, decreased physical activity, obesity
are RF for
type 2 diabetes
Insulin resistance + insulin deficiency from progressive, non-autoimmune loss of insulin production from inflammation, oxidative stress, pancreatic exhaustion, aging
→ leading cause of ESRD, blindness, nontraumatic limb amputation
Genetic + environmental
type 2 diabetes
UA: glucosuria, ketonuria
plasma/serum: glucose >126 after 8+ hours of fasting on 2 separate visits = diagnostic
Oral glucose tolerance test: >200 after 75g of sugar = diagnostic
Hemoglobin A1c >6.5
Consider fructosamine over 1-2 weks in pregnancy, ESLD, ESRD
type 2 diabetes
what are diagnostic values for diabetes?
plasma/serum: glucose >126 after 8+ hours of fasting on 2 separate visits = diagnostic
Oral glucose tolerance test: >200 after 75g of sugar = diagnostic
what are goals of diabetic treatment?
A1C <7%
Preprandial glucose = 80-130
Postprandial = <180
What are first line treatments for type 2 diabetes?
Dietary modification and increased exercise
Reduce carb + sugars, reduce portion sizes, walking, lifting weights
Medications:
Biguanides (metformin)
Can cause weight loss, lactic acidosis, GI upset, no hypoglycemia
What can you add on for diabetes (2nd line)?
DPP-4 inhibitors (gliptin)
SGLT2 inhibitors (flozin)
-Can cause euglycemic DKA
GLP1/GLP1-GIP agonists
Insulin
Insulin secretagogues
–Meglitinides (glinide) - safe in sulfa allergy, repaglinide for renal
–Sulfonylureas if unable to tolerate metformin - glimepiride, glyburide, glipizide
—-can cause hypoglycemia
Glucose absorption inhibitors
TZDs
—-Peripheral edema, fluid retention, CHF
Established ASCVD, HF, CKD → SGLT2 or GLP1 agonists, independent of A1C
Weight, advancing age, postmenopausal status, low socioeconomic status, high carb diet, smoking, physical inactivity
Cluster of abnormalities related to insulin resistance, dyslipidemia, obesity
–increased risk of developing type 2 DM and atherosclerotic heart disease
metabolic syndrome
you need — things to diagnose metabolic sydnrome
3
need 3 to diagnose metabolic syndrome –
Must have 3 to diagnose:
Obesity
Waist circumference >40 (m) >35 (f)
Hyperglycemia
>/= 100
Dyslipidemia
TG >150
Low HDL
<40 (m) <50 (w)
HTN
>130/85, on meds
how do you treat metabolic syndrome?
Lifestyle modifications! Weight loss, diet, increased exercise
Metformin
anti-HTN agents
Statins
3Ps: polydipsia, polyphagia, polyuria
Unintentional weight loss
Blurry vision, N/V/abdominal pain, anorexia
Fruity breath, increased frequency of infections
Paresthesias, stupor, coma
Commonly presented with hyperglycemia without acidosis, diabetic ketoacidosis
type 1 diabetes
genetic/familial history
Generally <30 years
Cellular-mediated autoimmune destruction of pancreatic beta cells (type 1a) with strong inherited associations – HLA-DR3, DR4, DQ
Type IV hypersensitivity
Screening recommended if 1st degree relative family history
type 1 diabetes
UA: glucosuria, ketonuria
Plasma: glucose>126 after 8+ hours of fasting (2 separate visits) = diagnostic
OGTT: >200 after 75g of sugar = diagnostic
Hemoglobin A1c >6.5
Serum fructosamine helpful in pregnancy, ESLD, ESRD
C-peptide level, autoantibodies of GAD-65, ZnT8, ICA, IA2
More antibodies = quicker onset of insulin dependence
Glutamic acid decarboxylase 65 POSITIVE
type 1 diabetes
type 1 diabetes treatment
Insulin!
Long acting
Glargine, detemir, degludec
Intermediate acting
NPH N
Short acting
NPH R
Rapid acting
Lispro, aspart, glulisine, afrezza
3 Ps: polydipsia, polyphagia, polyuria
N/V/abdominal pain, dehydration, tachycardia, HOTN, weight loss, fruity breath, Kussmaul respirations, AMS, acute cerebral edema, nocturia
Hypovolemia
Hyperglycemia + acidosis + ketonemia
DKA
Ketoacidosis and hyperglycemia from infection, discontinuation of insulin or inadequate insulin therapy, new onset T1DM, MI, CVA, medications (steroids, dobutamine, terbutaline, thiazides, 2nd gen antipsychotics, SGLT2 inhibitors), cocaine use, malfunction of insulin pumps
DKA
Serum glucose >250
+ high serum ketones
Elevated B-hydroxybutyric acid + acetoacetic acid
Elevated anion gap >10
Serum bicarb <18
pH <7.3
Elevated BUN/Cr (can cause prerenal AKI due to dehydration)
Potassium can be high, low, or normal
DKA
how do you treat DKA?
Fluid resuscitation
If glucose <200 → add dextrose
Check potassium levels -
>5.3 = start insulin drip
3.5-5.3 = add IV KCl until K is 4-5
<3.5 = IV KCl before insulin
Insulin is short acting
N/V/abdominal pain
Hypokalemia, hypovolemia
Tachycardia + HTN
Tachypnea
Malnourished individuals and chronic alcoholics with binge drinking
alcoholic ketoacidosis
