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CMN572 > unit 3: gen DM > Flashcards

unit 3: gen DM Flashcards

1
Q

DM1 cause

A

auto-immune B-cell destruction > absolute insulin deficiency

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2
Q

DM2 cause

A

progressive loss of B-cell insulin secretion frequently on the background of INSULIN RESISTANCE

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3
Q

gestational DM

A
  • dx’d in 2nd or 3rd trimester
  • could just have been DM not clearly manifested prior to gestation
  • BG can return to normal in non-DM pts but is a risk factor for DM2 later
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4
Q

other types of DM r/t specific causes

A

1) monogenic diabetes syndrome: neonatal DM, maturity-onset DM of the young
2) diseases of the exocrine pancreas: cystic fibrosis, pancreatitis
3) drug or chemical induced diabetes: glucocorticoids, HIV/AIDS tx, s/p organ transplant

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5
Q

consider screening for prediabetes & DM2 in asymptomatic adults w

A

ANY overweight or obese adult with 1+ additional risk factor

overweight BMI

  • american = 25-29.9
  • asian = 23-37.4

obesity BMI

  • american = 30+
  • asian = 27.5+
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6
Q

risk factors for DM/preDM in asymptomatic adults

A
  • first degree relative w DM
  • high risk race/ethnicity = AA, latino, native, asian, pacific islander
  • hx of CVD
  • hypertension 140/90+ or on treatment for HTN
  • HDL <35
  • triglycerides >250
  • women w PCOS
  • physical inactivity
  • other clinical conditions AW insulin resistance
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7
Q

an A1C of ____ is associated w

A

5.7+ prediabetes

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8
Q

pts w prediabetes, impaired glucose tolerance, or impaired fasting glucose should be tested every

A

year

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9
Q

women dx’d w GDM should have ______ testing every _____

A

lifelong, every 3y

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10
Q

at what age should pts without indications for DM testing begin testing

A

45

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11
Q

pts w ______ should be tested for DM

A

HIV (medications can induce)

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12
Q

if glucose testing results are normal at the 45y screen, when should you test again?

A

minimum of 3y w consideration of more frequent depending on initial results and risk tatus

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13
Q

In overweight or obese children with an additional RF for DM, when should you consider testing?

A

after onset of puberty or after 10y of age- whichever comes first

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14
Q

DM RF for asymptomatic children & adolescents (4)

A
  • maternal hx of DM or GDM during child’s gestation
  • 1st or 2nd degree relative w DM2
  • race/ethnicity: Native, AA, latino, asian, pacific islander
  • signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, small for gestational age birth weight)
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15
Q

what is required to dx DM?

A

*2 abnormal test results from the same sample
OR
*2 separate test samples

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16
Q

marked discrepancies between A1C and plasma glucose levels should prompt?

A

consideration that A1C may not be reliable for that individual…. one should consider using an A1C assay without interference or plasma BG

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17
Q

A1C for prediabetes dx

A

5.7-6.4%

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18
Q

A1C for diabetes dx

A

6.5% +

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19
Q

2h BG after 75g OGTT for prediabetes dx

A

140-199

20
Q

2h BG after 75g OGTT for diabetes dx

A

200+

21
Q

FBG for prediabetes dx?

A

100-125

22
Q

FBG for diabetes dx?

A

126+

23
Q

random plasma glucose for DM dx?

A

200+

24
Q

if a pt has borderline test results for either preDM or DM dx what do you do?

A

follow pt closely and repeat test in 3-6m

25
Q

what meds increase risk for DM?

A
  • glucocorticoids
  • thiazide diuretics
  • some HIV meds
  • atypical antipsychotics
26
Q

pts w prediabetes should strive to lose ____% of their initial body weight

A

7%

27
Q

150m/week of moderate-intensity physical activity in pts w prediabetes reduced incidence of DM2 by?

A

58% over 3y

28
Q

eating plans recommended for prediabetes pts

A
  • reduced calorie plan
  • mediterranean
  • low-carb
  • emphasis on whole grains, legumes, nuts, berries/fruits, vegetables, yogurt, coffee, tea
29
Q

Metformin therapy for prediabetes should be especially considered in pts w BMI ____, those under ____y, and women w _____

A
  • BMI 35+
  • <60y
  • women w prior GDM
30
Q

prediabetes is AW heightened risk for ?

A

CVD, HTN, dyslipidemia

*screen for & treat modifiable risk factors

31
Q

comorbidities that complicate DM mgmt

A
  • autoimmune (thyroid, celiac)
  • CA (liver, pancreas, endometrium, colon/rectum, breast, bladder)
  • cognitive impairment/dementia
  • non-alcoholic fatty liver
  • hip fracture
  • low T in men
  • OSA
  • periodontal disease
  • hearing impairment
  • psychosocial/emotional disorders
32
Q

in pts w DM1 what else should you consider screening for?

A

other Autoimmune disorders (CELIAC & THYROID)

33
Q

exercise reccs for kids/adolescents w DM1 or DM2

A

60m/day of moderate-vigorous intensity aerobic activity

*muscle & bone strengthening activities 3x/week

34
Q

exerciser reccs for adults w DM1 or DM2

A
  • > 150m of mod-vigorous intensity aerobic workout 3x/week with NO MORE THAN 2 consecutive days without activity*
  • 2-3x/w of resistance on nonconsec days (yoga)
35
Q

pts 65+ with DM need to be screened for what two things?

A
  • cognitive impairment

* depression screening

36
Q

what is diabetes distress?

A

significant negative psychological reaction RT emotional burdens and worries specific to having to manage a severe chronic disease like DM

37
Q

risk factors AW high levels of Diabetes distress

A
  • poor med taking behaviors
  • lower self-efficacy
  • poor dietary and exercise behavior
  • higher A1C
38
Q

in pts meeting treatment goals how often should you perform an A1C?

A

at least 2x/year

39
Q

what is the recommended A1C for a nonpregnant adult?

A

<7%

40
Q

what is the recommended preprandial glucose range for a nonpregnant adult?

A

80-130

41
Q

what is the peak postprandial glucose range for a nonpregnant adult?

A

<180

42
Q

post prandial BG measurements are taken when?

A

1-2h after beginning of meal

43
Q

how often would you run an A1C on a nonpregnant adult who is NOT meeting glycemic goals &/OR who’s therapy has recently changed?

A

quarterly or as needed

44
Q

level 1 hypoglycemia is considered any number under?

A

70

45
Q

level 2 hypoglycemia is considered any number under?

A

54

46
Q

level 3 hypoglycemia is considered?

A

any severe even characterized by altered mental or physical functioning *usually requires immediate action from another person for recovery.

CMN572 (13 decks)

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