PTOGG

TRIAL is the most senc

ible for diagnosing

DM 2 identifies patients at

increased risk of

developing type 2

diabetes mellitus

Cardiovascular

Complications.

and 62% with

medications

this it is a form of primary

prevention in diabetes

this risk can be

reduced to 50% by modifying

the diabetogenic

lifestyle

Type 2 D.m

Is the GlodEstandar

the diagnosis of glucose intolerance

Veryrelevant cli

nicaldiagnosis

Kg 1.75cm

Not to exceed

75 mg total

8 to 14 hour

Avoid dietary restrictions during

the three days preceding

Avoid changes in habitual physical activity during the

preceding three days

During the test should remain at

rest and not smoking

It is better not to have an infection

stop taking medications that

could alter the values

The OGTT should not be practiced in HIV-

positive patientsreceiving protease

inhibitors

CRYTICAL

RISK

INCREASED

RISK

HIIGH

RISK

MILK

RISK

LOW

RISK

HBA1C

(%)

MEAN BLOOD

GLUCOSE

(MG/DL)

4 60

5 90

6 120

7 150

8 180

9 210

10 240

11 270

12 300

CATEGORIES WITH ELEVATED RISK

OF DIABETES

TRIAL

fasting glucose

glucose at 2 hours

postprandial

HbA1c

CUTOFF

100- 125 mg/dl

140 – 199 mg/dl

5.7-6.4 %

correspondence about the level

of HbA1c glucose levels

HbA1c glucose equivalent

5.6% 110

5.4% 100

6% 126

7% 154

POINTS

How old are you Less than 45 years

- 45 - 54

- 55 - 64

- More than 65 years

-(0 points)

- (2 points)

- (3 points)

- (4 points)

. What is your Body Mass - Less than 25 kg/m2

- Between 25 to 30 kg/m2

- More than 30 kg/m2

- (0 points)

- (1 point)

- (3 points)

3. Do you practice any physical

activity per day (any sport, walking

...) for at least 30 minutes a day?

- Yes

- No

(0 points)

- (2 points)

4. Measured with a tape measure the

circumference of the waist:

Man:

- Less than 94 cm

- Between 94 to 102 cm.

- More than 102 cm.

Women:

- Less than 80 cm.

- Between 80 - 88 cm

- More than 88 cm.

- (0 points)

- (1 point)

- (3 points)

Women:

- (0 points)

- (1 point)

- (3 points)

5. How often do you take fruits and

/ or vegetables?

- Every day

- From time to time (not daily)

- (0 points)

- (1 point)

POINTS

6. Do you have high blood pressure

or take or have ever taken

medication for hypertension?

- No

- Yes

- (0 points)

- (2 points)

7. Do you have detected elevated

levels of blood glucose during a

routine checkup, illness or

pregnancy?

-Yes

-No

-(5 points)

-(0 points)

8. Does anyone in your family have

diabetes?.

- No

- Yes, my grandfather / a, uncle / aunt,

cousin / a but my partner

- Yes, my father, mother, brother / my

son ao / a

Rating:

- (0 points)

- (3 points)

- (5 points)

Rating:

- Less than 8 points:

low risk of diabetes

- 9 to 13 points:

- More than 14 points:

slightly increased risk of diabetes.

very high risk of diabetes should

consult your doctor.

Family diabetic first degree relatives

Latest from rural and urban

DMG obstetric history

With hypertension and other risk factor

Impaired glucose prior

Diagnosis of metabolic syndrome

ITG

GGA

• PTOG

• 50%

• 62%

• PPPD

• Glucemia Fasting

• PTOG

Symptoms:

The problems found in metabolic syndrome include:

regulation of glucocorticoid and receptor levels—

impact on the metabolic syndrome

Dawn Phenomeno

n: Morning Hyper

glycemia secondar

y to elevated blood

glucose levels in

the last hours of

the

morning (whenthe

sun goes down)

Somogy Phenome

non: Morning Hy

perglycemia seco

ndary

tohypoglycemia

in the morning (3-

5 am)

Dawn Phenomenon: Morning Hyperglycem

ia secondary to elevated blood glucose

levels in the last hours of the

morning (whenthe sun goes down)

Somogy Phenomenon: Morning Hyperglyc

emia secondary tohypoglycemia in the

morning (3-5 am)

Hypoglycemia is defined as blood

sugar less than…

Acute onset

Remission

intensification

Total diabetes

RISK FACTORS FOR HYPOGLYCEMIA

Sudden reduction of steroid dose

Altered ability of patient to report symptoms

Vomiting

CAUSES: Too little food, too much insulin or diabetes medicine, or extra exercise.

ONSET: Sudden, may progress to insulin shock.

BLOOD SUGAR: Below 70 mg/dL. Normal range: 70-115 mg/dL

WHAT CAN YOU DO?

Drink a cup of orange juice or milk or eat several hard candies

Test Blood sugar

Within 30 minutes after symptoms go away, eat a snack e.g. sandwich,

and a glass of milk

Contact doctor if symptoms don’t stop

adrenergic symptoms

pallor sweat tremor

neuroglupenicos symptoms

headacheblurred or double vision

alteration of

behavior

ETIOLOGY

Causes of hypoglycemia can be classified

into three groups:

1. Medications or toxins.

2. Disorders associated with fasting

hypoglycemia.

3.Disorders associated postprandial

hypoglycemia.

TREATMENT OF

HYPOGLYCEMIA

An initial bolus, 20-50 ml 50% dextrose, should be given immediately, followed by

infusion of D5W to maintain blood sugar above 100 mg/dL.

yperosmolar

state are

nonketotic hyp

erglycemic

EHHNC

ketoacidosis

diabetic

CAD

FREQUENT IN DM 1 FREQUENT IN DM 2

↓ 2% IN DM 2 POSSIBLE IN DM1 poorly treated

Mild DKA Moderate DKA Severe DKA HHS

Plasma glucose

(mg/dL)

> 250 > 250 > 250 > 600

Arterial pH 7.25-7.30 7.00-7.24 < 7.00 > 7.30

Sodium Bicarbonate

(mEq/L)

15 – 18 10 - <15 < 10 > 15

Urine Ketones Positive Positive Positive Small

Serum Ketones Positive Positive Positive Small

Serum Osmolality

(mOsm/kg)

Variable Variable Variable > 320

Anion Gap > 10 > 12 > 12 variable

Mental Status Alert Alert/Drowsy Stupor/Coma Stupor/Coma

Pathophysiology of DKA

Role of Insulin

Hypoglycemia is defined as blood

sugar less than…

INSULIN DEFICIENCY IS THE PRIMARY

DEFECT

T h e r e i s

e x c e s s

s e c r e t i o

n o f

p r i ma r y

g l u c a g o n

a s w e l l

a s

c a t e c h o l

a mi n e s

g l u c o c o r

t i c o i d s

S t r e s s

h o r mo n e s

a c c e l e r a

t e a n d

e x a g g e r a

t e

t h e r a t e

a n d

ma g n i t u d

e o f

me t a b o l i

c

d e c o mp e n

s a t i o n

STANDARDS FOR ADA HDCA

Stressful precipitating event that results in increased catecholamines, cortisol, glucagon.

Causes

of DKA/HHS

PancreatitisInfection

(pneumonia, UTI)

Alcohol, drugs,Strok

e

Myocardial InfarctionTrauma

Medications (steroids, thiazide

diuretics)

Non-compliance with insulin

MANEJOPolyuria

Polydypsia

Abdominal Pain

Fatigue

Obtundation

Blurred vision Nausea/Vomiting

Confusion

Hydration!!!

– Even more important than in DKA

Find underlying cause and treat!

Insulin drip

– Should be started only once aggressive hydration

has taken place.

– Switch to subcutaneous regimen once glucose <

200 and patient eating.

Serial Electrolytes

– Potassium replacement.

Ultrasound is a

valuable tool in

evaluating fetal

growth, estimating

fetal weight, and

detecting

hydramnios and

malformations.

1..

2..

While the false-negative rate

with maternal monitoring of

fetal activity is low (~1

percent), the false-positive

rate may be as high as 60

percent.

Maternal hypoglycemia,

while generally believed to

be associated with decreased

fetal movement, may

actually stimulate fetal

activity.

3..

Done weekly at 28

weeks and Twice weekly

at 34 weeks

remains the preferred

method to assess

antepartum fetal well-

being in the patient with

diabetes mellitus

If the NST is

nonreactive, a

biophysical profile (BPP)

or contraction stress test

is then performed .