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22 Cards in this Set
- Front
- Back
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DM Diagnostic Criterion
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Symptoms + Casual PG >= 200
or Fasting PG >= 126 or 2-hr post-load PG >= 200 |
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Impaired Glucose Tolerance Diagnostic Criterion
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Fasting PG < 126
and 2-hr post-load PG 140-199 |
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Impaired Fasting Glucose Diagnostic Criterion
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Fasting PG 100-125
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DM A1c testing schedule
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2/yr if stable control, 4/yr if suboptimal (caution if RBC turnover is altered)
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DM Glycemic control: fasting/preprandial glucose
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Normal < 100, goal 70-130
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DM Glycemic control: bedtime/postprandial glucose
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Normal < 120, goal 100-160
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DM Glycemic control: A1c
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Normal < 6, goal < 7
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DM HTN BP goals/schedule
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Check each visit.
Goal: SBP < 130, DBP < 80. Sched: Trial lifestyle only < 3 mo, then ACEi/ARBs, then others. |
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DM Lipids goals/schedule
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Check at least annually.
Goal: TC < 200, LDL < 100 (<70 if frank CAD), HDL > 50, TG < 150. Sched: Trial lifestyle only, then statins for high LDL (+/- ezetimibe), niacin/fibrates for bad HDL/TG (niacin can ↑Glu at ↑dose). |
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DM Nephropathy goals/schedule
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Check urine albumin/GFR yearly. Tx ACEi/ARBs for albuminuria (check K/creatinine). If CKD/albuminuria progresses, refer.
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DM Retinopathy goals/schedule
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Dilated eye exam by opthalmologist at dx + yearly. Tx: laser photocoagulation if needed. RR of glaucoma, cataracts, etc higher in DM.
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DM Neuropathy goals/schedule
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Annual screen.
Distal polyneuropathy: 10g monofilament/vibration. Autonomic neuropathy: resting tachy, orthostatic hypo, constipation, gastroparesis, ED. Tx for DPN: glycemic control, TCAs/anticonvulsants/5HT+NE reuptake inhibitors Tx for gastroparesis: Metoclopramide, erythromycin Tx for ED: PDE5is, PGs, pumps. |
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DM overall best therapy
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MNT (Medical Nutrition Therapy), better than metformin!
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DM prevention
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Education, immunization (flu, 1x pneumococcus, revax >= 65 in nephrotic, CRD, immunosuppression), stop smoking, antiplatelet tx.
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DM microvascular complications
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Retinopathy > Nephropathy > Neuropathy
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DM management
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Step 1: Lifestyle + metformin (titrate dose over 1-2 mo)
Step 2: Add second agent within 2-3 mo (sulfonylurea, TZD, insulin, DPP-IV agonist) Step 3: Insulin start/increase (discontinue secretagogues), try 3rd oral agent if A1c < 8.5%, check A1c x 3mo until < 7%, then x 6mo. |
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Dx of Hyperglycemic Hyperosmolar Syndrome
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Glu > 600
Osm > 320 No ketoacidosis |
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HHS Risk Factors
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Age > 70 y/o, nursing home, infection, MI, CVA, un-dx/tx DM2, drugs (steroids, diuretics, b-blockers).
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HHS mental status
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Alert: ~315 mOsm/kg
Drowsy: ~325 mOsm/kg Stupor: ~340 mOsm/kg Coma: ~350 mOsm/kg |
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HHS Mortality Risk Factors
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Coma, age, osm, Na, BUN.
NOT SIG: glu, HCO3. |
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HHS management
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FLUIDS! 1L/hr isotonic saline, continue until volume deficit corrected, then change to half-saline until free water deficit corrected, then add 5% dextrose when glu <= 300.
INSULIN! 0.15 bolus, then 0.1 infusion, double infusion rate if glu doesn't drop by at least 50/hr, when glu <= 300 lower rate to 0.05-0.1 and adjust PRN to keep glu at 250-300 until osm is <= 315. POTASSIUM! if K < 3.3, give 40 mmol (2/3 KCl, 1/3 KPO4) until K > 3.3, then reduce to 20-30. if K > 5.0, monitor every 2 hr. if 3.5 < K < 5.0, 20-30. |
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DM2 insulin resistance + therapy concept
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DM2 has both insulin resistance and relative lack of insulin. Loss of b-cell function progressive; therapy needs to intensify with time.
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