Flashcards in Endocrine Deck (16)
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1
Recommendations for screening
Entire population > 45 every 3 years
Annual screening BMI >25 and one or more risk factors for DM
2
DM risk factors
Age greater than 45
BMI > 25
Family history
Physical inactivity
HTN
HDL 250
Women with PCOS
Hx vascular disease
Large infant
3
ADA Dx criteria for IIDM
1. AIC > 6.5
2. FBG > 126
3. 2 hour plasma glucose > 200 during OGTT
4. Random > 200 with sx of hyperglycemia
Criteria 1-3 needs to be confirmed with repeat testing
4
Prediabetes
fasting BG 100-125
5
acanthosis nigricans
Indicates insulin insensitivity
6
Common eye problems with diabetes
Microaneurysms - Red dots. Can leak and reduce vision.
Hemorrhages
Exudates - fatty deposits
7
Target AiC
< 7%
< 6% in pregnancy
< 7% with co-morbitities and limited anticipated lifespan
8
Target glycemic goals
Preprandial 70-130
Postprandial - < 180 (1-2 hours after eating)
9
Action of metformin
Reduces hepatic glucose production and enhances action of insulin
10
Sulfonylurea agents
(glimeperide, glipizide)
Potentiate insulin secretion
May cause hypoglycemia
Weight gain
Ideal use - insulinopenic patents, non-obese or mild obesity
Use in combo or monotherapy
11
Insulin (basal or NPH)
Sx weight gain, hypoglycemia
Stop sulfonylureas when initiating meal time insulin
12
When should you consider insulin
A1C > 10%
Fasting glucose > 250
Maxed out orals
Sx hyperglycemia
Pregnant patients
13
Initiating basal insulin
Total daily insulin needs for adults 1-1.2 u/kg/day
Start 0.2 u/kg as bolus or 10 units
Measure AM fasting glucose if FBG > 130 then increase basal insulin by 2-3 units every 2-3 days until at goal
14
Normal TSH
0.5-4.5 mU/L
Elevated = hypo
decreased = hyper
15
Primary hypothyroidism - replacement principles
Adults need 1.6mcg/kg/day
16
