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33 Cards in this Set
- Front
- Back
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Diagnostic Criteria for both Type 1 and Type 2 Diabetes
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FPG: > 126 mg/dL x 2
2 hr OGTT (75-gm): > 200 mg/dL Casual: > 200 mg/dL with classic symptoms A1c: (new as of 2010) > 6.7% |
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Lab levels that indicate type 2 PRE-DIABETES
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Impaired Fasting Glucose: FPG: 100-125 mg/dL
Impaired Glucose Tolerance: 2 hr OGTT (75-gm): 140-199 mg/dL A1c range: (new as of 2010) 5.7% - 6.4% Monitor at least every 3 years |
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what are other additional labs used to support diagnosis of type 1 DM?
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Islet Cell antibodies
Insulin autoantibodies C-peptide levels |
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Management of Type 1 Diabetes
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-Monitor blood glucose at least 4x/day
-Ketone testing if BG>300 or illness -Medication: insulin -Eat appropriate calories for normal growth and development -Exercise- prevent hypoglycemia |
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Risk factors for developing type 2 Diabetes
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-Age: > 45 yrs of age
-1st degree relative with DM -High-risk ethnicity -GDM or delivered baby > 9lb -Insulin resistance, clinical markers: (NCEP ATP III) -Obesity ( BMI > 25 kg/m2) -WC: > 40” men; >35” women -HTN: B/P > 130/85 -Dyslipidemia |
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Risk factors for developing type 2 Diabetes in children and adolescents
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-Overweight or obese
-1st or 2nd degree relative with type 2 DM -High-risk ethnicity -SGA, low birth weight -Higher levels of amniotic fluid insulin @33-38 weeks gestation -Born to mother with GDM |
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how does the Type 2 DM OLDER adult present?
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diminished thirst, increase dehydration
renal threshold, may not see glucouria at usual levels |
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Screening of type 2 DM in children
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-if child is overweight
-any 2 of the following: *family hx of type 2 DM in 1st or 2nd degree relative *signs of insulin resistance -start at age 10 or onset of puberty -screen q 2 yrs -fasting plasma glucose preferred |
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how does the Type 2 DM adult present?
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-Older, usually > 40 yoa
-Often ASYMPTOMATIC found on “screening” or “routine” labs. -Usually chronic hyperglycemia with vague, non-specific complaints -Complaints of: several weeks to months hx of polyuria, polydipsia, polyphagia and weight |
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how does the Type 2 DM child/adolescent present?
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-Glycosuria without ketonuria
33% will 5-25% ketoacidosis unrelated to stress, illness, infection -Mild thirst -Some increase in urination -Little-to-no weight loss -Confusing Clinical Picture (age, +ketones etc) -NEGATIVE antibody tests -Insulin |
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Management of Type 2 DM
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-Medical Nutrition Therapy
-Physical activity/exercise -Monitor Gluocse- at least once a day -Medication (Metformin, TZDs, non-insulin injections, insulin) |
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what are complications of pre-existing Diabetes in pregnancy?
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Maternal
-pre-existing:retinopathy, nephropaty, HTN, DKA, Obesit -during pregnancy: hypertensive d.o., pyelonephritis, polyhydramnios, oligohydramnios Fetal: Congenital malformations, macrosomia, neonatal hypoglycemia at birth, IUFD, RDS preterm, third tri hypocalcemia, hyperbili, polycythemia |
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High risk factors for developing Gestational DM
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High Risk: Screen at 1st visit, if normal, GTT 24-28 weeks
Hx of LGA Hx of GDM or IGT Obese (BMI>30) +Fam hx of T2DM Non-white |
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Screening for Gestational DM
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-1-step approach
75 or 100 gm, OGTT between 24-28 weeks gestation 2-step approach -50 gm, 1-hr GCT any time of day, initial visit (80% will have GDM)>140 mg/dL 1 hour later -100 gm, 3-hr OGTT scheduled + for GDM if >2 results are equal to or > than |
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when is the the best time to exercise for a Type 2 Diabetic?
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30-90 minutes after meals
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How do you avoid exercise-induced hypoglycemia?
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-15-30 Gm CHO prior to exercise
-Check BG before, during and after exercise -Avoid exercising at insulin peak times -Decrease insulin by 30-50% when exercising -Allow 2-3 days for patterns to appear -Inject insulin into less active site -Carry fast |
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Oral Antihyperglycemic Agents:
Thiazolidinediones: rosiglitazone, ploglitazone |
-Decrease insulin resistance in skeletal muscle and adipose tissue
-Decrease excess hepatic glucose output special value in insulin-resistant, overweight patients, who have dyslipidemia or who have renal impairment |
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Oral Antihyperglycemic Agents:
Biguanide (metformin) |
-Decrease hepatic glucose output
-Decrease insulin resistance in skeletal muscle special value in obese patients who have fasting hyperglycemia |
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Oral Antihyperglycemic Agents:
Sulfonylureas and Meglitinides |
-Stimulate pancreatic insulin secretion
-Sulfonylureas are of special value in patients who are lean and have insulinopenia -Meglitinides are of special value in patients with postprandial hyperglycemia |
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Oral Antihyperglycemic Agents:
a-Glucosidase inhibitors (acarbose, miglitol) |
-Delays intestinal absorption of carbohydrates
-special value in patients with postprandial hyperglycemia |
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Clinical presentation of a patient with DKA
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1-2 days
Younger, lean T1DM Polyuria, polydipsia Abd pain, N/V (acidosis) MS changes Warm skin temp (acidosis) Kussmaul Respirations, fruity breath Dehydration |
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Clinical presentation of a patient with HHS
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1-2 weeks
Older, obese T2DM Polyuria, polydipsia Abd pain, N/V (decreased mesenteric perfusion) MS changes (lethargy/confusion) Normal/elevated temp > INFECTION!! PROFOUND dehydration: Hypotension, tachycardia, dry mucous membranes, poor skin turgor |
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Laboratory Diagnostic Criteria for DKA
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Initial Testing:
Hyperglycemia >250 mg/dL + Ketones: mod/large (blood/urine) Confirmatory: pH <7.3 OR serum bicarb <16 mEq/L) |
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Laboratory Diagnostic Criteria for HHS
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Hyperglycemia >600, usu. >1000 mg/dL
No/trace ketones Hyperosmolarity >320 mmol/kg (275-295 nl) Normal serum bicarb pH >7.3 (usu. Normal) |
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Treatment Goals for DKA
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-Rehydration
-Insulin (glucose metabolism) -Correct electrolytes & acidosis K+, PO4 NaHCO3 -Provide glucose source -Prevent starvation -Prevent cerebral edema -Prevent complications of tx Hypo/hyperglycemia, hypokalemia, cerebral edema |
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Treatment Goals for HHS
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-Rehydration
-Drop BG 80-200 mg/dL/hour -Correct electrolytes K+, Na+, PO4, mag -Insulin (glucose metabolism) -Glucose falls < 50 mg/dL/hour -Prevent complications -Underlying atherosclerosis -Insulin until euglycemia -Treat underlying condition |
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Hypoglycemia S/S of Early (<60), Late (<55), and too Late (<30)
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Early: (<60)
Adrenergic or Cholinergic: pallor, tremor, nervous anxiety, irritability, paraesthesia, tachycardia, diaphoretic, weak, hungry Late: (<55) Neuroglycopenic: head-ache, slurred speech, diploplia, inability to concentrate, delayed reaction time, confusion, behavior change Too late: (<30) Seizure, coma, death |
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what is hypoglycemia unawareness?
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-Impaired /deficient glucagon secretion
-Impaired epinephrine response -No early warning symptoms -Recurrent hypoglycemia -Up-regulation of glucose transport to the brain -Altered glycemic thresholds -Autonomic neuropathy |
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what are approaches to prevent hypoglycemic emergencies?
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-Test BG >4 times daily, record, analyze
-Test BG immediately when feeling hypoglycemic -Immediately and precisely treat hypoglycemia -Identify the earliest signs of hypoglycemia and pay attention to them -Test BG immediately before driving and do not |
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what are chronic complications of diabetes?
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macrovascular disease: MI, stroke, death
Microvascular disease: rentinopathy, nephropathy, neuropathy (peripheral and autonomic) |
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What happens with each hypoglycemic episode?
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Increased chance for another episode.
Decreased ability to respond. |
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How long after BG < 50 for a cognitive recovery?
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45-75 minutes
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Diabetic Retinopathy
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#1 cause of new blindness
Higher incidence of mac edema, cataract & glaucoma Annual Dilated Exam Tx with laser therapy |
