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Flashcards in Diabetes Deck (17)
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1

what are risk factors for Type 2 DM

obesity - BMI > 95
Fhx of type 2 DM
female
specific ethnic groups
signs of insulin resistancen - PCOS, acanthosis

2

How can type 2 DM present

asymptomatic
polyuria/polydipsia without ketoacidosis
DKA
hyperglycemic hyperosmolar state - no ketones, serum osmolality >330 mOsm/kg,

3

Canadian - recommends testing asymptomatic children for T2DM at what age and who?

Screening q2 yrs with FPG if any of A,B,C:
A) ≥3 RF in nonpubertal or ≥2 RF in pubertal
- Obesity (BMI ≥95th)]
- High-risk ethnic group
- Family history of type 2 diabetes and/or GDM
- Signs or symptoms of insulin resistance (including acanthosis nigricans, hypertension, dyslipidemia, NAFLD [ALT >3X upper limit of normal or fatty liver on ultrasound], PCOS)
B) Impaired fasting glucose or impaired glucose tolerance
C) Use of atypical antipsychotic medications

4

How do you Dx DM

1) FPG ≥ 6.9 mmol/L
or
2) OGTT - Plasma glucose ≥ 11.1 mmol/L
or
3) symptoms + random BG ≥11.1

5

How do you Dx impaired fasting glucose

1) FPG ≥5.6 mmol/L to 6.9 mmol/L
and
2)OGTT - Plasma glucose ≥7.8 mmol/L to 11.0 mmol/L

6

insulin resistance syndrome CF

aka =metabolic syndrome which consists of:
insulin resistance
compensatory hyperinsulinemia
obesity
dyslipidemia of the high TGL or low- or high-density lipoprotein type, or both
HTN

7

what do you need to ensure before starting metformin

No significant hepatic dysfunction
No impaired renal fct - leads to lactic acidosi

8

for type 1DM, when do you screen for nephropathy?

if had DM> 5 yrs and are > 12
yearly screen
albumin creat ratio

9

for type 1 DM, when do you screen for retinopathy?

if DM > 5 yr and are > 15
yearly

10

what does low TSH mean

hypERthyroidism

11

what does a high TSH

hyPOthyroidism

12

If you see a neonate with a goiter, what are possible causes

1) exposure to maternal antithyroid meds-methimazole, propylthiouracyl
2) inborn error of metabolism - incorporating iodine
or issue with hormone biosynthesis
3) severe iodine def

13

when do you want to start treating congenital hypothyroidism?

as soon as possible
good IQ outcome if treat before a month-6 weeks

14

what are CF that make you think of congenital hypothyroidism?

late for gestation
BW > 4 kg
prolonged jaundice
poor feeding
large fontanelles
edema
delayed MEC
delayed osseus dev

15

what BW done on a " healthy" term baby makes you worry for congenital hypothyroidism?

High TSH and high prolactin
Low FT4

16

if you get a call that a newborn failed the NBS for hypothyroidism, what should you do?

1. confim by doing TSH and free T4 but don't delay treatment
2. start L-thyroxine at 10-15 microgram/kg
3. repeat FT4 and TSH 2 weeks later
4. no soy formula

17

how should you monitor an infant with congenital hypothyroidism

FT4 and TSH monthly in the first 6 mo of life, and then every 2-3 mo between 6 mo and 2 yr