Diabetes Flashcards
(17 cards)
what are risk factors for Type 2 DM
obesity - BMI > 95 Fhx of type 2 DM female specific ethnic groups signs of insulin resistancen - PCOS, acanthosis
How can type 2 DM present
asymptomatic
polyuria/polydipsia without ketoacidosis
DKA
hyperglycemic hyperosmolar state - no ketones, serum osmolality >330 mOsm/kg,
Canadian - recommends testing asymptomatic children for T2DM at what age and who?
Screening q2 yrs with FPG if any of A,B,C:
A) ≥3 RF in nonpubertal or ≥2 RF in pubertal
- Obesity (BMI ≥95th)]
- High-risk ethnic group
- Family history of type 2 diabetes and/or GDM
- Signs or symptoms of insulin resistance (including acanthosis nigricans, hypertension, dyslipidemia, NAFLD [ALT >3X upper limit of normal or fatty liver on ultrasound], PCOS)
B) Impaired fasting glucose or impaired glucose tolerance
C) Use of atypical antipsychotic medications
How do you Dx DM
1) FPG ≥ 6.9 mmol/L or 2) OGTT - Plasma glucose ≥ 11.1 mmol/L or 3) symptoms + random BG ≥11.1
How do you Dx impaired fasting glucose
1) FPG ≥5.6 mmol/L to 6.9 mmol/L
and
2)OGTT - Plasma glucose ≥7.8 mmol/L to 11.0 mmol/L
insulin resistance syndrome CF
aka =metabolic syndrome which consists of:
insulin resistance
compensatory hyperinsulinemia
obesity
dyslipidemia of the high TGL or low- or high-density lipoprotein type, or both
HTN
what do you need to ensure before starting metformin
No significant hepatic dysfunction
No impaired renal fct - leads to lactic acidosi
for type 1DM, when do you screen for nephropathy?
if had DM> 5 yrs and are > 12
yearly screen
albumin creat ratio
for type 1 DM, when do you screen for retinopathy?
if DM > 5 yr and are > 15
yearly
what does low TSH mean
hypERthyroidism
what does a high TSH
hyPOthyroidism
If you see a neonate with a goiter, what are possible causes
1) exposure to maternal antithyroid meds-methimazole, propylthiouracyl
2) inborn error of metabolism - incorporating iodine
or issue with hormone biosynthesis
3) severe iodine def
when do you want to start treating congenital hypothyroidism?
as soon as possible
good IQ outcome if treat before a month-6 weeks
what are CF that make you think of congenital hypothyroidism?
late for gestation BW > 4 kg prolonged jaundice poor feeding large fontanelles edema delayed MEC delayed osseus dev
what BW done on a “ healthy” term baby makes you worry for congenital hypothyroidism?
High TSH and high prolactin
Low FT4
if you get a call that a newborn failed the NBS for hypothyroidism, what should you do?
- confim by doing TSH and free T4 but don’t delay treatment
- start L-thyroxine at 10-15 microgram/kg
- repeat FT4 and TSH 2 weeks later
- no soy formula
how should you monitor an infant with congenital hypothyroidism
FT4 and TSH monthly in the first 6 mo of life, and then every 2-3 mo between 6 mo and 2 yr
