Download - Diabetes fika
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 .