Flashcards in Endocrine - Online MedEd - outpatient diabetes Deck (17):
Type 1 diabetes is
autoimmune destruction of pancreas
Type 2 diabetes need to be screened early to stop micro and macro complications of diabetes... who should be screened?
>45 yo (old)
How to screen for diabetes?
Random Blood glucose with symptoms of diabetes
Better way: fasting blood glucose, 2x for confirmation (no diabetes --> pre diabetes --> diabetes)
If pre diabetes --> can do 2 hour oral glucose tolerance test - simulate post-prandial glucose. If diabetic, cannot handle glucose load
*If infected, on steroids, can have elevated glucose!
Preferred method: HgbA1c (considered the best test)
In between is prediabetes
Avg blood sugar x 3 months
How much RBCs and sugars are around, get stuck
Capture what's actually happening in 3 months
Type 1 diabetes - presentation
BG is very high
Not called juvenile or insulin dependent
This is autoimmune destruction
Can be in both children and adults
Type 1 diabetes measure antibodies
GAD is better
*If Ab positive, then meds won't work
Will need to treat with insulin
When to check antibodies/suspect Type 1?
Not necessarily young ppl
Do so in rapidly progressive and obvious S/S of diabetes
Diagnosis of pre diabetes --> need to do what?
Lifestyle and metformin
How to treat Type 2 diabetes?
1) Lifestyle + metformin
Come back 3 months and check A1c
2) If not at target, add a second agent
Come back 3 months, check A1C
3) Add insulin!
*Metformin is always first
Metformin is contraindicated... in
*Cause lactic acidosis
No good evidence stating which second agent is better than other... classes... how to pick?
1) Biguanide - metformin - side effect: diarrhea - be careful in CHF, CKD
2) Sulfonylureas - gliclazide and glyburide, used to be the second agent to use - increase expression of insulin! Side effect: hypoglycaemia - be careful in CKD
3) TZDs - glitazones - increase insulin sensitivity - side effect: cause weight gain, CHF - people scared to used them!
4) DDP-4s - gliptins - useful because weight neutral
5) GLP-1s - utides - cause weight loss
6) Alpha-glucosidase inhibitors - acarbos - blocks intestinal absorption of sugar - terrible diarrhea, gas
7) SGLT-2 inhibitors - euglycemic DKA! stay away from this
*Pick from: metformin (always use), sulfonyureas, then choose between TZDs, DDP4s, GLP1s
After 2 oral agents... failure to control means go to
Oral agents decrease HgbA1C by 3%, insulin by 7%
If HgbA1c is greater than what.... do you start with insulin right away?
What to do in clinic with DM patient?
1) A1C every 3 months, goal <7% (older patient don't need such tight control). If super low A1C like <5.7%, can get hypoglycaemic events (fatal)
2) Eyes - retinopathy
3) Kidneys - nephropathy
4) Feet - neuropathy
*Need annual screen for each
Need laser ablation
Micro albumin/Cr ratio
Proteinuria - need ACEi