Type 2 Diabetes

Front 1

Type 2 Diabetes: Risk Factors, Screening, Prevention, Management Priorities, Treatment of Hyperglycemia

Back 1

1. Risk Factors: age >40, family history, high risk population, history of IGT or IGF, presence of diabetes complications, vascular disease, history of gestational diabetes, HTN, high lipids, overweight/central obesity, PCOS, acanthosis nigricans, schizophrenia
2. Screening: annual evaluation of risk factors (everyone), blood glucose every 3 years (>40 no risk factors), blood glucose every 1-2 years (risk factors)
3. Prevention: treat prediabetes
(lifestyle/diet changes, metformin, acarbose, rosiglitazone, orlistat)
4. Management Priorities: excellent glycemic control, address CV risk factors (HTN, high lipids, smoking, weight), screen for complications (microvascular, macrovascular)
5. Treatment of Hyperglycemia: metformin (wt neutral, low risk hypoglycemia, can't use in kidney disease), sulfonlyurea (hypoglycemia, wt gain), meglitanides (for postprandial hyperglycemia), thiazolidinedione (cardiovascular SE's), alpha-glucosidase inhibitor, DPP-4 inhibitor (prevents breakdown of GLP, wt neutral, low risk of hypoglycemia), liraglutide (GLP analog, wt loss, little hypoglycemia), insulin

Front 2

Screening/Preventing Complications: Targets, Nephropathy, Retinopathy, Neuropathy

Back 2

1. Targets: HBA1c <7.0, Blood Pressure <130/80 (ACEi and ARBs first line), LDL <2.0 + total cholesterol/HDL <4.0 (statins first line)
2. Nephropathy: screen by albumin:creatinine ratio, beware of false positives (exercise, fever, UTI, CHF, menstruation, acute HTN, acute hyperglucemia), prevent by intensive glucose control and ACEi/ARB for BP control and/or microalbuminuria
3. Retinopathy: Screen with eye exam, screen because it encourages management of risk factors and there are good treatments available, treatment is panretinal laser photocoagulation
4. Neuropathy: many types, screen with 10g monofilament, screen to prevent foot ulcers, treatment is symptomatic only (amitriptyline, gabapentin, pregablin)

Front 3

Blood Glucose Targets

Back 3

1. HBA1c: <7.0% (6.0% if safe)
2. Fasting/preprandial glucose: 4.0-7.0
3. 2hr postprandial: 5.0-10.0

Front 4

Definitions: IFG, IGT, Diabetes

Back 4

1. IFG: fasting glucose 6.1-6.9
2. IGT: 2hr OGTT 7.8-11
3. Diabetes: fasting glucose >7.0, random glucose >11.1 with symptoms of metabolic syndrome, 2hr OGTT >11.1, HbA1c >6.5%

Front 5

Insulin Therapy: Available Preparations, Daily Requirements, Common Regimens, Adjusting Dose

Back 5

1. Available Preparations: rapid (Aspart,Lispro,Glulisine), short acting (Humulin R, Novolin Toronto), intermediate acting (Humulin N/Novolin NPH), long acting (Detemir,Glargine)
2. Daily Requirements: 0.5U/Kg/day, give 50% as bolus and 50% as basal
2. Common Regimens: basal insulin only (50% long acting in am/50% intermediate acting in pm), fixed split/premixed, multiple daily injections (1/3 of 50% rapid with meals (3)/50% long or intermediate acting in pm)
4. Adjusting Dose: if glucose to high for particular meal/time (am,lunch,dinner,evening), increase dose of insulin for the time before