Flashcards in diabetes Deck (20):
what common maladies does diabetes cause?
leading cause of renal failure, non traumatic limb amputation, blindness among adults. major cause of heart attack and stroke. nerve damage, periodontal disease and depression
prediabetic screening results
fasting glucose: 100-125, A1c: 5.4-6.4. 2hr plasma glucose: 140-199
testing for diabetes in asymp. patients
test of BMI> 25, if asian then greater than 23, they have one additional risk factor begin testing at 45. if normal then repeat in 3 year intervals. treat CVD risk factors
additional risk factors
physical inactivity, first degree relative with diabetes, high-risk race or ethnicity (blacks, latinos, native americans, asians), women who have delivered a baby greater than 9lbs or with gestational diabetes. hypertension/hyperlipidemia, PCOS, A1c in the pre diabetic range, history of CVD.
when to test children for type II
if they are overweight and have 2 additional risk factors.
type I screening?
first test for pancreatic autoimmunity (GAD65, Ia-2, ZnT8, insulin autoantibody
when to test for GDM?
if risk factors, test at the first visit. screen at 24-28 weeks in women not known to have. test 6-12 weeks postpartum for persistent DM.
recommendations for the treatment of diabetes in younger no history of CVD
agressive glycemic treatment.
treatment for older adults or with longer history of DM or CVD
gentle with higher A1c goals
what other things are necessary to prescribe to patients
smoking cessation, weight management, exercise
treatment of type I
most patients should be on MDI 3-4 injections daily or continuous infusion. they need to be educated on how much postprandial insulin they will need based on the carbohydrate.
what to look for on follow-up for diabetes
diet, exercise, presence of microvascular and macrovascular complications. evaluate dentition, depression, pain, cognition and behavioral change.
physical exam on followup
height, weight, BMI, BP, thyroid, skin, heart, chest, abdomen, feet, dilated eye exams every 1-2 years.
labs for follow up
A1c 2-4 a year. annual fasting lipid panel, annual renal assessment, liver function, TSH and coeliac panel with T1D
major complication of DM
CVD, sensory, ulcers, neuropahty, retinopathy, renal disease, sexual dysfunction, atherosclerosis, bacterial and fungal infections, autonomic neuropathy,
screening for renal disease in DM
look for urine albumin annually and at all type II patients at diagnosis. they need an ACEi or ARB.
stages of kidney disease
1.) kidney damage with normal or increased GFR, >90
2.) kidney damage with mildly decreased GFR, 60-89
3.) moderately decreased GFR (30-59).
4.) severely decreased GFR (15-29)
5.) kidney failure <15 or dialysis
management of CKD
yearly measures of Cr and albumin as well as potassium for all patients. If GFR (45-60) referral, consider dose adjustment, monitor GFR every 6months. monitor electrolytes, bicarb, hemoglobin, calcium, assure that VITD sufficient bone density. lower GFR gets more strict time line. and if lower than 30 then refer to a nephrologist.
type 1 within 5 years they need to see a ophtho. typeII need immediately after diagnosis. if no signs, then every two years. if present than every year.