Flashcards in DM Overview Deck (61):
Define diabetes mellitus
1. Syndrome with altered metabolism & inappropriate hyperglycemia
A. CHO, protein & fat catabolism
B. Due to insulin deficiency, insulin resistance, or combination of both
What is the cause of T1DM?
1. Often due to autoimmune pancreatic Islet cell destruction
A. Associated w/ DKA
What is the cause of T2DM?
1. Results from insulin resistance & defect in compensatory insulin secretion
A. Drug induced DM
How is DM diagnosed?
Diagnose with FBS; GTT; or HbA1c
What are complications of DM?
2. Renal failure
3. Non-traumatic amputation
4. TIA, CVA, dementia
5. ACS, CHF
7. retinopathy, glaucoma, cataracts
8. Peripheral, autonomic neuropathy
9. Microalbuminuria, nephropathy, ESRD
How does DM affect the risk of MI and stroke?
MI & stroke increased X 2
What are the types of DM?
1. Type I
2. Type II
What is the FBS level for impaired glucose tolerance/pre-diabetes?
FBS 100-126 mg/dL
What is the random glucose level or 2 hr GTT that is indicative of DM?
When does a fasting blood sugar need to be followedup with a 2 hr GTT?
If FBS ≥ 126 mg/dL, F/U with 2 hr GTT
Define 2 hr GTT
1. 75 gm glucose in 300 ml water
2. Blood samples obtained @ 0 and 120 mins after ingestion
What is the 2 hr GTT result for impaired/pre-diabetes?
2 hr GTT 140-200 mg/dL
What is a negative FBS?
< 100 mg/dl
What is a negative 2 hr GTT?
< 140 mg/dl
Reflects state of glycemia over past 8-12 weeks
How does RBC life span influence HbA1C?
False low result in pts with shortened RBC life span
What is the normal HbA1c?
HbA1c < 5.7 %
What is prediabetes HbA1c?
What is diabetic HbA1c?
HbA1c ≥ 6.5%
What are the HbA1c percentage correlations to mean glucose levels?
1. HbA1c: 5, Gluc: 97
2. HbA1c: 6, Gluc: 126
3. HbA1c: 7, Gluc: 154
4. HbA1c: 8, Gluc: 183
5. HbA1c: 9, Gluc: 212
6. HbA1c: 10, Gluc: 240
7. HbA1c: 11, Gluc: 269
8. HbA1c: 12, Gluc: 298
What are common comorbidities for DM?
1. Depression & anxiety
2. Obstructive sleep apnea
3. Fatty liver disease
6. Cognitive impairment
7. Low testosterone in men
8. Periodontal disease
9. Hearing impairment
10. Other Autoimmune Disease (Type 1)
A. Celiac Dz
B. Thyroid Dz
What are the non modifiable risk factors for macrovascular complications of DM?
What are the modifiable risk factors for macrovascular complications of DM?
5. Thrombogenic factors
(use of antiplatelet agents)
What is the HbA1c level goal to reduce risk of macrovascular complications?
1. Goal HbA1c < 7.0 %
2. Goal individualized & changes over time
A. Depends on presence/progression of comorbidities
B. Depends on risk of hypoglycemia
When does the risk of hypoglycemia increase?
Risk of hypoglycemia ↑ w/duration of DM and advancing age
What are the sxs of hyperglycemia?
3. Frequent urination
7. Blurred vision
What are the causes of hyperglycemia?
1. Too much food
2. too little exercise
3. too little medications
7. Short time between meals and snacks
What are the sxs of hypoglycemia?
8. Slurred speech
What are the causes of hypoglycemia?
1. too little food
2. too much medicine
3. more activity than usual
4. Too long between meals and snacks
What is the FBS goal according to ADA?
80 – 130 mg/dl
What is the PP glucose range 1-2 hours after a meal according to the ADA? < 180*
What is the HbA1c goal according to the ADA?
What is the BP goal to reduce macrovascular complications?
What drug class are diabetic commonly prescribed for BP control? What else is recommended?
1. ACE inhibitor or ARB; if one class not tolerated, substitute the other. Do not use in pregnancy
2. Multiple drug therapy (≥ 2 agents) generally required
3. Administer one or more medications at bedtime
4. Lifestyle modification
How is dyslipidemia controlled to reduce macrovacular complications in diabetics?
1. Statins - drug of choice
2. Lifestyle modification
What are the t. chol, trig, and HDL goals for diabetics?
1. T. Chol < 200 mg/dL
2. Trig < 150 mg/dL
3. HDL > 40 mg/dL (men) > 50 mg/dL (women)
What is the goal LDL for pts without CVD?
Goal LDL-C <100 mg/dL
What is the goal LDL for pts with CVD?
- Goal LDL-C <70 mg/dL
What antiplt agent is used for secondary prevention (+) ASCVD (arteriosclerotic cardiovascular dz)?
- Aspirin 81mg/day
What antiplt agent is used for primary prevention (-) ASCVD?
- Aspirin 81mg/day for those at ↑ risk.
A. Men > 50 yr
B. Women > 60 yr w/ at least 1 additional major risk factor
What antiplt agent is used of the pt has an ASA allergy?
- Clopidogrel (Plavix) 75mg po qd
When is dual antiplt therapy indicated?
Use dual antiplatelet therapy after an acute coronary syndrome or stent placement
Why is smoking esp. deleterious for diabetic pts?
1. Smoking is a major risk factor for both microvascular disease & CVD
2. Include smoking cessation counseling & other forms of treatment as a routine component of care at each visit
3. Do not use e-cigarettes
4. Nicotine patch, gum, NS, inhaler, lozenges; Zyban (Bupropion); Chantix (verenicline)
What is the number one cause of blindness? How can risks be reduced?
A. Annual dilated eye exams by specialist
B. Glycemic & BP control most important
What is the number 1 cause of end stage renal dz? How can risk be reduced?
A. Follow GFR & urine microalbumin
B. Glycemic & BP control most important
What is the number 1 cause of atraumatic amputation? How can risk be reduced?
A. Ask about symptoms of neuropathy
B. Good exam & foot care are crucial
C. Glycemic control most important
What are the ADA guidelines/goals for diabetes?
1. Annual dilated eye exam
2. Lipid profile at least yearly
3. BP checks - goal < 140/90
4. Urine microalbumin check annually
5. HbA1c goal < 7% (q 3-6 mo)
6. Foot exam/Dentist yearly/Hygiene
7. ASA therapy per indications
8. Smoking cessation
9. Healthy dietary guidelines
10. Daily physical activity
11. Annual flu vaccine
12. Pneumococcal vaccination
How is DM managed?
4. Oral hypoglycemics
5. ACEI or ARB
6. Lipid lowering agents
7. ASA or antiplatelet Tx if indicated
What are the key facts about insulin?
1. Used in Type I & Type II DM
2. Natural hormone, not a drug
3. Available in vial or pen device
4. Risk of hypoglycemia / weight gain
5. Know onset, peak and duration of a patient’s insulin
6. Understand timing with meals
What are the 2 ways insulin pumps supply doses?
1. Steady measured & continuous dose ("basal" insulin)
2. As a surge ("bolus") dose, at your direction, around mealtime.
What type of insulin is used by insulin pumps? Why?
1. Insulin pumps use rapid-acting insulins
A. Lispro, aspart and glulisine
2. Because the pump delivers tiny amounts of insulin every few minutes, longer-acting insulins are not necessary
What are the key nutrition points for diabetics?
1. Portion control
2. Total carbohydrate (CHO) per serving
3. Even distribution of CHO across the day
4. Low fat intake
5. Discuss cultural preferences
6. All CHO are not created equal
7. No 1 “diet for diabetes”
8. Food diaries: helpful tool
9. People w/ DM can have dessert w/ planning & moderation
How can hypoglycemia be managed acutely?
1. 15 gms of carbohydrates
A. 3-4 glucose tablets
B. 15gm tube of glucose gel
C. 1/2 cup fruit juice
D. 1/2 cup regular soda
2. Wait 15 mins, then check blood sugar
3. If <70, repeat glucose intake
4. If after three checks, hypoglycemia persists, call 911
What are the benefits of activity for diabetics?
↓ blood glucose, ↑ BP & pulse; ↑ HDL; helps weight loss
What is the goal of activity for children?
Goal - 60 minutes daily
What is the goal of activity for adults?
1. Adults: 30 minutes (10-10-10, break it up) most days of week = 150 min/wk of moderate-intensity aerobic activity
2. Use ADL’s for physical activity: garden, mow lawn, wash car, walk dog, dance
What is needed for foot care for diabetic pts?
1. All patients w/DM should receive an annual comprehensive foot exam
2. Patient with insensate feet, foot deformities, & ulcers should have their feet examined at every visit*
3. Provide foot self-care education
What are the carb recommendations for women trying to lose weight?
What are the carb recommendations for women trying to maintain weight?
What are the carb recommendations for men trying to lose weight?