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NR667 Endocrine: Questions With Complete Solutions
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NR667 Endocrine: Questions With Complete Solutions
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NR667 Endocrine: Questions With Complete SolutionsClinical Presentation: subjective & objective findings
How to diagnose
DDx
Management - pharm & nonpharm
F/u care
Normal course vs Complications
When to refer
ADA DM Screening Recommendations Annual screening: BMI > or = 25 AND 1
or more risk factors
Q 3 years: All patient > or = 45 years old w/ normal screening
DM Risk Factors Age > or = 45 years
BMI > or = 25 kg/m2 (Asians: BMI > or = 23 kg/m2)
1st degree FH/o T2DM
Sedentary lifestyle
HTN: > or = 140/90
Cholesterol: HDL < or = 35 mmHg and/or Triglycerides > or = 250 mg/dL
Women: PCOS; gestational DM
PMH/o CVD
Hgb A1C (Q 90 days) PreDM: 5.7% - 6.4%
T2DM: > or = 6.5%
Can help to confirm a dx of DM vs impaired fasting glucose
As Hgb A1C decreases, triglyceride levels also decrease
ADA Suggested A1C Goals By Age Most adults: A1C < 7%
Healthy older adults: A1C < 7.5%
Older adults w/ comorbidities: A1C < 8 - 8.5%
T1DM and Pregnancy: A1C: < 6%
, Fasting Plasma Glucose [FPG] PreDM: 100-125mg/dL
T2DM: > or = 126mg/dL
Values that equal of exceed 126mg/dL on different days constitute a + dx of
DM
Random Plasma Glucose T2DM: > or = 200mg/dL PLUS S&S of DM (i.e. 3 P's)
Oral Glucose Tolerance Testing (Gest DM & PCOS) PreDM: 140-199mg/dL
T2DM: > 200mg/dL
Gestational DM Typically diagnosed in 2nd or 3rd trimester
Impaired Fasting Glucose [aka PreDM] Can be diagnosed when 2 FPG values
are btw 100mg/dL and 125mg/dL on different days
Initial Management of IFG Lifestyle modifications are 1st line
Initiate Metformin if
~elevated A1C
~BMI > or = 35
~ younger than 60
~h/o gestational DM
T1DM Not producing insulin
d/t autoimmune destruction of the beta-cells of pancreas
T2DM Fasting glucose > or = 126mg/dL & confirmed on a subsequent day
Random glucose > 200mg/dL PLUS 3P's & confirmed on a subsequent day
A1C > or = 6.5% & confirmed on a subsequent day
Insulin Resistance
d/t progressive loss of Beta cell insulin secretion
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