T2DM & Diabetes Canada Flashcards
T2DM & Diabetes Canada
Who to screen for DM
Age > 40
1st degree relative
member of high-risk household
Hx prediabetes/GDM/macrosomic infant
End organ damage (micro or CV)
Vascular risk (HTN, obesity, dyslipidemia, abdominal obesity, smoking)
Associated diseases (pancreatitis, PCOS, NAFLD, HIV, OSA, etc)
Medications (corticoids, atypical antipsychotics, statins, antiretroviral, etc)
T2DM & Diabetes Canada
T2DM etiology
*hint, there is a spectrum
- Ranges from predominant insulin resistance with relative insulin deficiency to predominant secretory defect with insulin resistance
- Strong genetic component
T2DM & Diabetes Canada
Define: Glycolysis Glycogenesis Glycogenolysis Gluconeogenesis
What is Insulin’s role on each?
Insulin inhibits gluconeogenesis (glucose formation from fat/protein) and glycogenolysis (breakdown glycogen –> glucose), stimulates glycolysis (glucose breakdown for cellular respiration –> decrease plasma glucose) and glycogenesis (glycogen synthesis –> decrease plasma glucose –> stores as fat)
T2DM & Diabetes Canada
Patho T2DM
1) Insulin resistance –> hyperglycemia –> pancreas stimulated to produce more insulin (hyperinsulinemia)
2) With persistent hyperglycemia: glucose in urine (glucosuria) results in osmotic diuresis (drags water with it as a solute) –> polyuria (loss of water and electrolytes) –> dehydration and hyperosmolar state
Dehydration stimulates brain to feel thirst –> polydipsia
Polyphagia stimulated due to organs not getting glucose
With prolonged hyperglycemia: beta cells will atrophy –> less insulin + insulin resistance –> disease progression
T2DM & Diabetes Canada
T2DM S & S
Recurrent infections (yeast, UTI)
Fatigue
Blurred vision
4 Ps: paresthesia, polydipsia, polyuria, polyphagia
T2DM & Diabetes Canada
T2DM Complications
Cardiac: Major adverse cardiovascular events (MACE)
Retinopathy: blurred vision
Neuropathy: peripheral (pain, loss of sensation, weakness, paresthesia) and autonomic (tachycardia, ED, constipation)
Nephropathy: edema, anemia, HTN, uremia, proteinuria
T2DM & Diabetes Canada
DM red flags
Hyperosmolar hyperglycemia (hyperglycemia and dehydration WITHOUT ketoacidosis): more insidious onset (may have 3 P's but more subtle) *high risk for VTE
Diabetic ketoacidosis less common, usually after severe infection/illness. Rapid onset (overt symptoms - 3 P’s + weight loss –> ALC –> death)
Severe hypoglycemia for pts on insulin or insulin secretagogues
T2DM & Diabetes Canada
Dx DM
FPG > or equal 7.0
A1C > or equal 6.5
- need two tests to confirm
- if symptomatic only need the first test
T2DM & Diabetes Canada
IPG
FPG 6.1-6.9
A1C 6.0 to 6.4
T2DM & Diabetes Canada
When to initiate Tx for DM
If symptomatic and/or metabolic decompensation –> start insulin
If A1C > or equal to 8.5 (or 1.5 over target), start metformin plus a 2nd agent
If A1C < 1.5 over target, lifestyle mod’s and recheck in 3 months
T2DM & Diabetes Canada
ABCDESSS
A A1C targets (< 7 for most)
Also BS 4-7 AC meals, 5-10
PC meals (5-8 if A1c not met)
B BP target (<130/80)
C Cholesterol LDL< 2.0 or 50% reduction
D Drugs
- ACE-I/ARB (if CVS or > 54 or complications)
- Statin (> 40)
- ASA (only if CVD)
- SGLT2/GLP1 if high risk for ASCVD, CHF, CVD or > 60 yrs with 2 CV risk factors
E Exercise/Eating
- 150 min, weight-bearing, strength training 2X/week
- Mediterranean, etc
S Screening
- ECG Q 3-5 yrs
- feet annually
- kidney annually
- retinopathy (T1 annual, T2 1-2 yrs)
S Smoking cessation
S self management
T2DM & Diabetes Canada
Lab monitoring for DM
- A1C q3 months (if not at target or adjusting meds)
- eGFR and ACR annually (more if abnormal)
- lipids at time of diagnosis
T2DM & Diabetes Canada
SADMANS
Sulfonylureas/secretagogues ACE-I Diuretics/renin inhibitors Metformin ARBS NSAIDS SGLT2
