Med Eval of CoMorbidities Flashcards
Given a patient with diabetes, identify the symptoms consistent with hyperglycemia
- increased thirst that is not normal
- increased need to urinate, especially at night
- unintended weight loss
- repeated vaginal yeast infection (2-3+ in 6 months) or yeast/fungal infections on other body parts (ex: otitis media)
- repeated UTIs
- sores that do not heal
- erectile dysfunction
- blurred vision
Given a patient with diabetes, select the diagnostic modality
- Fasting plasma glucose (commonly done)
- 2-hour plasma glucose value after 75g oral glucose tolerance test (OGTT)-not very common
- Fasting blood glucose (no caloric intake for the past 8 hours)
- Fasting plasma glucose (venous blood draw)
- Fingerstick blood glucose (definitive, inexpensive)
- Hemoglobin A1c (doesn’t required fasting, less influenced by day-to-day changes, results in 6 minutes)—most affected by what happened in the last 30 days
Select the diagnostic criteria for prediabetes
-fasting blood glucose
≥ 100 mg/dL and < 125 mg/dL
Select the diagnostic criteria for prediabetes
-A1c
5.7%-6.4%
Select the diagnostic criteria for prediabetes
-OGTT
140-199 mg/dL
Select the diagnostic criteria for diabetes
-fasting blood glucose
> 126 mg/dL
Select the diagnostic criteria for diabetes
-A1c
> 6.5%
NOTE: a 1% increase in A1c = 25-35mg/dL increase in blood glucose
Select the diagnostic criteria for diabetes
-OGTT
≥ 200 mg/dL
Explain why A1c is used to diagnose diabetes/prediabetes in adults
- does not require fasting
- less influenced by day-to-day changes in blood glucose
- less sensitive that fasting blood glucose
- get results in 6 minutes
Identify the conditions that impact the interpretation of A1c testing
- hemoglobinopathies
- abnormal hemoglobin turner rate (sickle cell, hemolytic anemia)
- conditions associated with increased cell turnover (pregnancy)
- hemodialysis
- recent blood loss/transfusion
- erythropoietin therapy
Explain the role of autoantibodies in the diagnosis in type 1 diabetes
Autoimmune markers include: 1. islet cell autoantibodies
- autoantibodies to GAD65
- insulin antibodies
- tyrosine phosphatases IA-2 and IA-2β
- and ZnT8
Given a pregnant woman who is 24-28 weeks gestation, outline the two-step approach to screening for gestational diabetes
- 50g non-fasting screen: plasma glucose measurement at 1 hour
- if glucose is ≥140 mg/dL then perform 100g OGTT
- 100g OGTT for those that screen positive
- Measure fasting, 1h, 2h, 3h, after OGTT
- Diagnosis made if 2+ measurements exceed:
- -Fasting 95 mg/dL
- -1 hour 180 mg/dL
- -2 hour 155 mg/dL
- -3 hour 140 mg/dL
What patient meets the criteria for testing for pre-diabetes or diabetes?
- everyone ≥ 45 years: screen at 45 and then every 3 years
- 20% of prediabetics turn into diabetics every year (test every year)
Criteria for testing for pre-diabetes or diabetes for anyone that’s overweight and has 1+ of…
- Physically inactive
- 1st degree relative with diabetes
- Member of high-risk ethnic population (AA, Hispanic, Native American, Asian American, Pacific Islander)
- Hypertensive ≥ 140/90 or on therapy for HTN
- Impaired glucose tolerance or impaired fasting glucose (b/w 100-125 mg/dL) or A1c ≥5.7% on previous testing
- Women with PCOS
- Other clinical conditions associated with insulin resistance (severe obesity or Acanthosis nigricans)
- H/o CVD
Determine whether or not the child meets the criteria for testing for type 2 diabetes
Overweight (BMI >85th percentile or weight >120% ideal) and 2+ of:
- Family history in 1st or 2nd degree relative
- Member of an at-risk ethnic group
- Signs of insulin resistance conditions associated with insulin resistance:
- -HTN
- -PCOS
- -Dyslipidemia
- -Acanthosis nigricans
- -Small for gestational age/birth weight
- H/o maternal diabetes/gestational diabetes
Outline the recommended screening for prediabetes/diabetes in patients with HIV treated with an antiretroviral agent
- screen with fasting glucose level every 6-12 months before starting antiretroviral therapy and 3 months after starting/changing therapy
- if normal, check annually
- if prediabetes found, measure every 3-6 months to monitor for progression to diabetes
Given a patient with diabetes, identify the appropriate information to gather regarding their eating patterns
- How often they eat
- Times they eat
- Home versus eating out
- Food insecurity
- Who prepares/purchases the food?
- Do they live in a food desert?
- Do they have transportation to get to the grocery store?
- When do they take their glucose lowering medication in relation to eating a meal?
Given a patient with diabetes, identify the appropriate information to gather regarding their physical activity/exercise regimen
- Activity versus exercise
- Type of activity – aerobic vs. anaerobic
- Frequency
- Duration
- Intensity
- Time spend during sedentary, working at computer, watching TV, playing video games
Given a medication history, identify the areas to assess the medication regimen
Medications to lower blood glucose:
- Results of glucose monitoring and patient use of data
- Hypoglycemia episodes, awareness, frequency, causes
- Satisfaction with glucose lowering regimen
- Does it fit their lifestyle?
- Blood pressure lowering medication: response
- Dyslipidemia: lipid levels and response
- Contraceptive use in women: contraception plans (need for preconception planning)
- Complementary/alternative medicine use
- Herbal products
Identify the co-morbid diseases that are covered in the medical history of a person with new onset diabetes
- HTN, lipid disorder
- CV/peripheral vascular disease
- Chronic renal insufficiency
- H/o gestational diabetes, h/o PCOS
- Fatty liver disease
- Depression, dental disease
- H/o tobacco/alcohol/substance use: type/amount/etc
- Microvascular complications: retinopathy, nephropathy, neuropathy (sensory- h/o foot lesions; autonomic- sexual dysfunction, gastroparesis)
- Macrovascular complications: coronary heart disease, cerebrovascular disease, peripheral arterial disease
Indicate the immunizations recommended for people with diabetes
- Routine vaccinations for children/adults based on age-related recommendations
- Influenza vaccine annually
- Pneumococcal polysaccharide vaccine PPSV23
- Hepatitis B 3 vaccine series
Identify the lab evaluation to include in the work-up a person with new onset diabetes
- A1c (if it’s been >3 months or patient had serious illness/trauma/rapid onset of symptoms): diagnosis, glycemic control
- Fasting lipid profile (total cholesterol, LDL, HDL, triglycerides): dyslipidemia, monitor response to medications
- Spot urinary albumin-to-creatinine ratio: screen for nephropathy
- Serum creatinine and estimated glomerular filtration rate: screen for renal impairment
- Thyroid-stimulating hormone in patients with type 1 diabetes: common concomitant condition
Identify the parts of a comprehensive foot examination
- Inspection
- Palpation of dorsalis pedis and posterior tibial pulses
- Presence/absence of patellar/Achilles reflexes
- Determination of proprioception, vibration and monofilament sensation
Given a person with new onset diabetes, indicate the appropriate referrals for the patient
- Eye care professional for annual dilated eye exam
- Registered dietitian for medical nutrition therapy
- Diabetes self-management education
- Family planning for women of reproductive age
- Dentist for comprehensive dental/periodontal exam
- Mental health professional
