MSN 622 TYPE 2 DIABETES
What is type 2 diabetes mellitus? - Answers :insulin resistance
What is LADA diabetes? - Answers :Late onset autoimmune diabetes
Patients with diabetes mellitus most commonly present with - Answers :increased thirst,
increased urination, lack of energy and fatigue, bacterial and fungal infections, and
delayed wound healing. Some patients can also complain of numbness or tingling in
their hands or feet or with blurred vision.
Women diagnosed with gestational diabetes mellitus (GDM) should have lifelong testing
at least - Answers :every three years
when should testing begin for diabetes? - Answers :at age 45 and then if normal every 3
years
what tests diagnose diabetes? - Answers :Hba1C, or plasma glucose concentration
(fasting or 2-hour plasma glucose).
Fasting Plasma Glucose (FPG) - Answers :A blood sample is taken after an 8 hour
overnight fast. As per ADA, fasting plasma glucose (FPG) level of more than 126 mg/dL
(7.0 mm/L) is consistent with the diagnosis.
Two-Hour Oral Glucose Tolerance Test (OGTT - Answers :In this test, the plasma
glucose level is measured before and 2 hours after the ingestion of 75 gm of glucose.
DM is diagnosed if the plasma glucose (PG) level in the 2-hour sample is more than 200
mg/dL (11.1 mmol/L). It is also a standard test but is inconvenient and more costly than
FPG and has major variability issues. Patients need to consume a diet with at least 150
g per day of carbohydrates for 3 to 5 days and not take any medications that can impact
glucose tolerance, such as steroids and thiazide diuretics.
Glycated Hemoglobin (Hb) A1C - Answers :This test gives an average of blood glucose
over the last 2 to 3 months. Patients with a Hb A1C greater than 6.5% (48 mmol/mol)
are diagnosed as having DM.
In patients with classic symptoms of hyperglycemia (increased thirst, increased hunger,
increased urination), random plasma glucose more than ________ is also sufficient to
diagnose DM - Answers :200
one step strategy for screening and diagnosis of GDM - Answers :5 gm OGTT is
performed after an overnight fast. Blood samples are collected at fasting for 1 hour and
2 hours. GDM is diagnosed if fasting glucose meet or exceed 92 mg/dl (5.1 mmol/l), 1-
hour serum glucose of 180 mg/dl (10.0 mmol/l) or 2-hour serum glucose of 153 mg/dl
(8.5 mmol/l).
, two step strategy for screening and diagnosis of GDM - Answers :Step one: Perform a
50-gram glucose challenge test irrespective of the last meal. If PG at 1-hour after the
load is greater than or equal to 140mg/dl (7.8 mmol/l), proceed to step 2.
Step 2: 100 g glucose OGTT is performed after overnight fasting. Cut off values are
fasting PG 95 or 105 mg/dl (5.5/5.8 mmol/l), 1-hour PG of 180 or 190 mg/dl (10.0/10.6
mmol/l), 2-hour PG of 155 or 165 mg/dl (8.6/9.2 mmol/l) or 3-hour PG of 140 or 145
mg/dl (7.8/8.0 mmol/l). GDM is diagnosed if two or more PG levels equal to or exceed
these cutoffs.
what are symptoms of hypoglycemia - Answers :such as tachycardia, sweating,
confusion (treat with 15-20gm carbs)
what types of patients is metformin contraindicated in? - Answers :heart failure and CKD
bc can elevate lactic acid (lactic acidosis)
metformin can deplete vit. ______levels leading to - Answers :B12- anemia
for type 2 dm what is normal tx besides lifestyle changes? - Answers :metformin start
with 500mg once a day with evening meal, if tolerated may add 500mg to breakfast as
well.
doses can increase by 1 tablet every 1-2 weeks up to a dose of 1500 to 2000mg a day
A1C needs to be done every 3 months= goal <7%
if A1C is still higher than 7% after being on metformin for 3 months what is done? -
Answers :a second hypoglycemic med is used
type depends on :
overweight
ckd
hf (severe)
ASCVD
sulfonoureas what are they and who are they given to/not given to - Answers
:glimiperide and glyburide
increase insulin that pancreas naturally releases
may cause hypoglycemia and weight gain
take 30 min before meal
NO for CKD
okay for heart failure
Thiazolidinediones - Answers :pioglitazone
decreases insulin resistance, and causes liver to make less glucose while fasting
can cause weight gain
NO FOR HEART FAILURE
Could improve ASCVD
What is type 2 diabetes mellitus? - Answers :insulin resistance
What is LADA diabetes? - Answers :Late onset autoimmune diabetes
Patients with diabetes mellitus most commonly present with - Answers :increased thirst,
increased urination, lack of energy and fatigue, bacterial and fungal infections, and
delayed wound healing. Some patients can also complain of numbness or tingling in
their hands or feet or with blurred vision.
Women diagnosed with gestational diabetes mellitus (GDM) should have lifelong testing
at least - Answers :every three years
when should testing begin for diabetes? - Answers :at age 45 and then if normal every 3
years
what tests diagnose diabetes? - Answers :Hba1C, or plasma glucose concentration
(fasting or 2-hour plasma glucose).
Fasting Plasma Glucose (FPG) - Answers :A blood sample is taken after an 8 hour
overnight fast. As per ADA, fasting plasma glucose (FPG) level of more than 126 mg/dL
(7.0 mm/L) is consistent with the diagnosis.
Two-Hour Oral Glucose Tolerance Test (OGTT - Answers :In this test, the plasma
glucose level is measured before and 2 hours after the ingestion of 75 gm of glucose.
DM is diagnosed if the plasma glucose (PG) level in the 2-hour sample is more than 200
mg/dL (11.1 mmol/L). It is also a standard test but is inconvenient and more costly than
FPG and has major variability issues. Patients need to consume a diet with at least 150
g per day of carbohydrates for 3 to 5 days and not take any medications that can impact
glucose tolerance, such as steroids and thiazide diuretics.
Glycated Hemoglobin (Hb) A1C - Answers :This test gives an average of blood glucose
over the last 2 to 3 months. Patients with a Hb A1C greater than 6.5% (48 mmol/mol)
are diagnosed as having DM.
In patients with classic symptoms of hyperglycemia (increased thirst, increased hunger,
increased urination), random plasma glucose more than ________ is also sufficient to
diagnose DM - Answers :200
one step strategy for screening and diagnosis of GDM - Answers :5 gm OGTT is
performed after an overnight fast. Blood samples are collected at fasting for 1 hour and
2 hours. GDM is diagnosed if fasting glucose meet or exceed 92 mg/dl (5.1 mmol/l), 1-
hour serum glucose of 180 mg/dl (10.0 mmol/l) or 2-hour serum glucose of 153 mg/dl
(8.5 mmol/l).
, two step strategy for screening and diagnosis of GDM - Answers :Step one: Perform a
50-gram glucose challenge test irrespective of the last meal. If PG at 1-hour after the
load is greater than or equal to 140mg/dl (7.8 mmol/l), proceed to step 2.
Step 2: 100 g glucose OGTT is performed after overnight fasting. Cut off values are
fasting PG 95 or 105 mg/dl (5.5/5.8 mmol/l), 1-hour PG of 180 or 190 mg/dl (10.0/10.6
mmol/l), 2-hour PG of 155 or 165 mg/dl (8.6/9.2 mmol/l) or 3-hour PG of 140 or 145
mg/dl (7.8/8.0 mmol/l). GDM is diagnosed if two or more PG levels equal to or exceed
these cutoffs.
what are symptoms of hypoglycemia - Answers :such as tachycardia, sweating,
confusion (treat with 15-20gm carbs)
what types of patients is metformin contraindicated in? - Answers :heart failure and CKD
bc can elevate lactic acid (lactic acidosis)
metformin can deplete vit. ______levels leading to - Answers :B12- anemia
for type 2 dm what is normal tx besides lifestyle changes? - Answers :metformin start
with 500mg once a day with evening meal, if tolerated may add 500mg to breakfast as
well.
doses can increase by 1 tablet every 1-2 weeks up to a dose of 1500 to 2000mg a day
A1C needs to be done every 3 months= goal <7%
if A1C is still higher than 7% after being on metformin for 3 months what is done? -
Answers :a second hypoglycemic med is used
type depends on :
overweight
ckd
hf (severe)
ASCVD
sulfonoureas what are they and who are they given to/not given to - Answers
:glimiperide and glyburide
increase insulin that pancreas naturally releases
may cause hypoglycemia and weight gain
take 30 min before meal
NO for CKD
okay for heart failure
Thiazolidinediones - Answers :pioglitazone
decreases insulin resistance, and causes liver to make less glucose while fasting
can cause weight gain
NO FOR HEART FAILURE
Could improve ASCVD
