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What isa test ofglucose tolerance(OGTT)?

1

Kg1.75cmNot to exceed75mg total2

CONDITIONSTO BE MET

CRYTICAL RISKINCREASED RISKHIIGH RISKMILK RISKLOW RISK

GLYCOSYLATED HEMOGLOBINGLYCOSYLATED HEMOGLOBINHBA1C (%)MEAN BLOOD GLUCOSE (MG/DL)4 605 906 1207 1508 1809 21010 24011 27012 300CATEGORIES WITHELEVATED RISK OFDIABETESTRIAL

fasting glucoseglucoseat 2 hourspostprandial

HbA1c

CUTOFF

100- 125 mg/dl140 199 mg/dl

5.7-6.4 %correspondenceaboutthe level ofHbA1cglucose levels

HbA1cglucoseequivalent5.6%1105.4%1006%1267%154

WHAT IS THE BESTSCREENINGTEST FORDM?

QUESTIONAIREPOINTSHow old are youLess than45 years- 45 -54 - 55 -64 - More than65 years-(0points)- (2points)- (3points)- (4 points).What is yourBody Mass- Less than25 kg/m2- Between25 to 30kg/m2- More than 30kg/m2-(0points)- (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)

POINTS6.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.

WHO ISSHE SHOULD HAVE ASCREENING TEST FORDM?Familydiabeticfirstdegree relativesLatestfrom ruraland urbanDMGobstetric historyWith hypertension andotherrisk factorImpairedglucosepriorDiagnosisof metabolic syndrome

WHAT ISTHE "INTERMEDIATEHYPERGLYCAEMIA'?

PTOG50%62%PPPDGlucemia FastingPTOG

WHAT ISMETABOLIC SYNDROME?

Symptoms:The problems found in metabolic syndrome include:

regulation of glucocorticoid and receptor levelsimpact on the metabolic syndrome

DawnPhenomenon:MorningHyperglycemiasecondaryto elevatedblood glucose levelsin the last hoursof the morning(whenthe sun goes down)SomogyPhenomenon:MorningHyperglycemiasecondary tohypoglycemia inthe morning(3-5am)

DawnPhenomenon:MorningHyperglycemiasecondaryto elevatedblood glucose levelsin the last hoursof the morning(whenthe sun goes down)

SomogyPhenomenon:MorningHyperglycemiasecondary tohypoglycemia inthe morning(3-5am)Hypoglycemia is defined as blood sugar less than

REMISSIONOR HONEYMOON

AcuteonsetRemissionintensificationTotaldiabetes

SEVERE ACUTECOMPLICATIONSOF T2DM

RISK FACTORS FOR HYPOGLYCEMIA

Sudden reduction of steroid doseAltered ability of patient to report symptomsVomiting

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/dLWHAT CAN YOU DO?Drink a cup of orange juice or milk or eat several hard candiesTest Blood sugarWithin 30 minutes after symptoms go away, eat a snack e.g. sandwich, and a glass of milkContact doctor if symptoms dont stopadrenergicsymptoms

pallorsweattremorneuroglupenicossymptoms

headacheblurred or doublevisionalterationof behavior

ETIOLOGYCauses 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.

SEVEREHYPERGLYCAEMICFREQUENTIN DM 1 FREQUENTINDM 22% INDM 2 POSSIBLE INDM1poorly treated Mild DKAModerate DKASevere DKAHHSPlasma glucose (mg/dL)> 250> 250> 250> 600Arterial pH7.25-7.307.00-7.24< 7.00> 7.30Sodium Bicarbonate (mEq/L)15 1810 - 15Urine KetonesPositivePositivePositiveSmallSerum KetonesPositivePositivePositiveSmallSerum Osmolality (mOsm/kg)VariableVariableVariable> 320Anion Gap> 10> 12> 12variableMental StatusAlertAlert/DrowsyStupor/ComaStupor/ComaDiagnostic Criteria for DKA and HHS

CRITERIO ADA PARA CA

CLINICAL PITUREPathophysiology of DKARole of 2 Hormones

Lack of insulin stimulates hyperglycemiaLack of insulin stimulates fat & muscle breakdownIncrease in fatty acids to liver stimulates ketosisFluid loss stimulates hyperosmolarity

Role of InsulinHypoglycemia is defined as blood sugar less than

Pathophysiology Counter-Regulatory Hormones :., STANDARDSFORADAHDCA

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

MANEJO

PolyuriaPolydypsiaAbdominal PainFatigueObtundationBlurred visionNausea/VomitingConfusionSYMPTOMS OF

DKA/HHS

Hydration!!!Even more important than in DKAFind underlying cause and treat!

Insulin dripShould be started only once aggressive hydration has taken place.Switch to subcutaneous regimen once glucose < 200 and patient eating.

Serial ElectrolytesPotassium replacement.

ANTEPARTUM FETAL EVALUATION

Ultrasound is a valuable tool in evaluating fetal growth, estimating fetal weight, and detecting hydramnios and malformations. 1..

ultrasound antepartum fetal 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..The nonstress test (NST(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 mellitusIf the NST is nonreactive, a biophysical profile (BPP) or contraction stress test is then performed .