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DM Cheat Sheet Cheat Sheet (DRAFT) by

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Diabetes Mellitus

Group of disease charac­terized by high blood glucose concen­tra­tions
Occurs by defects
-Insulin secretion
-Insulin action
Insulin
- Hormone produced by beta-cells of the pancreas
-Use/storage of macron­utr­ients insulin is necessary

Predia­betes

Prebia­betes is a health condition of high blood sugar levels. This can lead into type 2 diabetes if blood sugars levels get high enough.
Casues
Impaired glucose tolerance
Impaired fasting glucose
Risk factors
- Being overweight
- Being 45 years or older
- Having a family member with type 2 diabetes
- Lack of physical activity
Less than 3 times a week
-Ever having GDM or giving birth to a baby that weighed more than 9 pounds
- Race and ethnicity
African Americans, Hispan­ic/­Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.
Prev­enting type 2 diabetes
- Losing small amounts of weight
- Around 5-7% of weight loss. -10-14 lbs for 200 lbs person
- Regular physical activity
- About 150 minutes weekly

Type 2 Diabetes

90%-95% of all diagnosed cases of diabetes
Most people with type 2 diabetes are obese.
Obesity itself leads to insulin resistance

Type 2 Diabetes risk factors

Risk factors
Physical inactivity
First degree relative with DM
Member of high-risk population
Women delivering baby over 9 lbs or having GDM
Hypert­ensive
Low HDL, high LDL & trigly­ceride
Women with PCOS
Elevated A1C
History of CVD
Age
Family hx
Obesity
Risk factors in children
Very rare
Accounts for ~20-50% of newly diagnosed cases of DM in children
Obesity
Strong family history
Peak age is mid puberty

Methods of Diagnosis

Diag­nostic Criteria for Diabetes Mellitus
Test
Cutoff
Comments
A1C
> or = 6.5%
..
Fasting plasma glucose
> or = 126 mg/dL(7.0 mmol/L)
No calorix intake for >8 hours
2-hour plasma glucose
> or = 200 mg/dL(11.1 mmol/L)
After 75 g glucose in water
Random plasma glucose
> or = 200 mg/dL (11.1 mmol/L)
In a patient with symptoms of hyperg­lycemia

Type 1 Diabetes

5-10% Cases of dx'd DM
Exogenous insulin deoendent
Dx'd before 30
Usually
Children diagnosed with type 1 should be screened for celiac disease soon after diagnosis
Two forms
Immun­e-m­ediated
- Autoimmune destru­ction
-Destr­uction of beta-cells in the pancreas
-Celiac disease and autoimmune thyroid disease associated
Idiop­athic
-Has no known etiology
Only a few fall into this category
typically of African or Asian descent

Screened for Type 2 DM

All over weight adults
With one or more risk factor
>45 years; repeat every 3 years
Younger age
screened more frequently if high risk
-Should begin at age 10 or at onset of puberty, and the frequency is every 3 years.
-Family history in first or second degree relatives
-Race/ethnicity
-Signs of insulin resistance
-Maternal history of diabetes or GDM during the child’s gestation
Younger then 45 years old high risk
-BMI >25
-First-degree relative with diabetes
-High-risk ethnic population
-Delivered baby >9 lb or hx of GDM
-Hypertensive
-HDL <35 mg/dl or TG >200
-Prediabetes
-PCOS

Gestat­ional Diabetes

Glucose intole­rance with onset or first recogn­ition during pregnancy.
7% of all pregna­ncies
After delivery, 90% become normog­lycemic
high risk (35-60% chance) of developing T2DM within 5-10 years
Women should be screen at 24-28 weeks
Lifestyle modifi­cations aimed at reducing or preventing weight gain and increasing physical activity after pregnancy may reduce the risk of subsequent diabetes.
One step approach
3-hour 75 gram OGTT
-Fasting: >92 mg/dl
- 1-h: >180 mg/dl
-2-h >153 mg/dl
-Fasting >92, a 1-hr greater than 180, or a 2-hour greater than 153 is indicative of a gestat­ional
If patient is ≥ 140 after a 50-g test, they must follow-up with a 100-g 3 hour test
If ≥ 140 after 2 hours, GDM diagnosis is made
Two step approach
1-hr 50 g non-fa­sting screen followed by a 3-hour 100 g test for those with plasma glucose greater than or equal to 140
-GDM is made when the plasma glucose level measured 2 hours after the test is greater than or equal to 140
Diagn­osis

MNT Predia­betes

Importance of food choices should be emphasized that facilitate moderate weight loss
Reduced calories and reduced fat
Medite­rra­nea­n-style eating
Whole grain and dietary fiber
Assoc­iated with insulin sensit­ivity
High sugar-­swe­etened beverages
Sweetened beverages is associated with increased risk for type 2 diabetes and should be limited (Malik, 2010).
Goals
Weight loss of 7% of body weight
150 minutes of physical activity per week
Ongoing counseling that that is effective

DM Goals

Trea­tment
Attain & maintain optimal metabolic outcomes
Normal range of blood glucose levels
or as close as possible
Reduce the risk of macrov­ascular with lipid profile
Reduce the risk of vascular disease with blood pressure levels
Medi­cal
Glycemic goals for non pregnant adults
-A1C: < 7%
-Prepr­andial glucose: 70 to 130 mg/dL
-Peak postpr­andial glucose: < 180 mg/dL
Overt cardio­vas­cular
-Without
LDL-C < 100 mg/dL
-With
LDL-C < 70 mg/dL
Trigly­ceride levels
< 150 mg/dL
HDL-C
> 40 mg/dL in men and > 50 mg/dL in women

Type 1 MNT

Youth goals
Ensure normal growth and develo­pment by providing adequate energy
RDA for carboh­ydrate- 130 g/d
Integrate insulin regimens into usual eating & physical activity habits
Gesta­tional Diabetes Mellitus
For optimal outcome provide adequate energy and nutrients recomm­end­ations
-Slow weight gain down by modest energy restri­ction
- At least 175 g CHO p/d to provide adequate glucose to fetal brain
-Total kcals and CHO into smaller meals
Older adults
Older adults who are functi­onal, cognit­ively intact, and have signif­icant life expectancy should receive DM care using goals developed for younger adults.
Relax glycemic goal if needed
Hyperg­lycemia leading to symptoms or risk of acute hyperg­lycemic compli­cations should be avoided in all patients.
Adults Treated w/ Insulin
Self-m­ana­gement education should be given for treatment and prevention of hypogl­ycemia, acute illness, and exerci­se-­related blood glucose problems

Insulin Actions

Hormone regulation of blood glucose levels and metabolism
The liver, muscle, and fat cells are singled by insulin to take in glucose from the blood
- Used for energy
-Regulates the storage of glucose and fat
- Energy signaled to the liver when sufficient it store glucose as glycogen. The liver can store up to 5% of its mass as glycogen
Anti­cat­abo­lic
Stops lipolysis
Prevents excessive production of ketones
Still always some
Anab­olic
Facili­tates conversion of glucose to glycogen
Stimulates protein synthesis
Stimulates lipoge­nesis

DKA

Diabetic Ketoacidos
Distur­bances of CHO, fat, & protein metabolism
-Fat as E source
-Ketones formed
If left untreated can become fatal
Type 1 diabetes usually seen
Can occur within 24 hr
Symptoms
Excessive thirst, frequent urination, N/V, abdominal pain, fatigue, shortness of breath, fruity­-sc­ented breath, confusion
DKA vs Ketosis
Nutri­tional ketosis is NOT the same as diabetic ketoac­idosis
Ketosis
Insulin regulated process with some release of fatty acids d/t a food fast, or reduction in carb intake
DKA
Driven by lack of insulin, creates high levels of ketones, and leads to dangerous acid/base imbalance

Oral Glucose Lowering Medica­tions

Sulfon­ylureas
1st and 2nd genera­tion
- Promote insulin secretion from B cells
Nonsul­fon­ylureas secret­agogues
-Stimulate insulin secretion from B cells
Biguanides
-Decreased hepatic glucose production & increases insulin secretion
Alpha- glucos­idase inhibitors
-CHO absorption delay
Thiazo­lid­ine­diones
-Improves peripheral insulin sensit­ivity
 

Calcul­ation Insulin

Insu­lin­-to­-carb ratio
500 rule
500 ÷ total daily dose* = grams of carboh­ydrate covered by 1 unit of rapid-­acting insulin (ICR)
Example: Patient taking 50 units/day 500 ÷ 50 = 10
In this example, it’s estimated that 1 unit of rapid-­acting insulin will cover the rise in blood sugar after the patient has eaten 10 g of carboh­ydrate.
Based on body weight
2.8 x body weight (in pounds) ÷ total daily dose* = ICR
Example: 160-lb patient taking 50 units/­day   2.8 x 160 ÷ 50 = 9
In this example, it’s estimated that 1 unit of rapid-­acting insulin will cover the rise in blood sugar after the patient has eaten 9 g of carboh­ydrate.

Sensit­ivity Factor with 1700 Rule

1,700 ÷ total daily dose = sensit­ivity factor
Example: Patient taking 50 units/day
1,700 ÷ 50 = 34
In this example, it’s estimated that 1 unit of rapid-­acting insulin will lower the patient’s blood sugar by 34 mg/dL.

References

Dr. Amaya DM power point slide 2019 7, 8, 9 ,15, 19, 20, 25 , 26, 28, 35, 36, 38, 39, 45, 47, 48, 49, 51, 53, 54, 56, 61, 62, 63, 72, 73, 74, 75, 83, 84, 1088, 109
Type 2 Diabetes. (2019, May 30). Retrieved December 5, 2019, from https:­//w­ww.c­dc.go­v/d­iab­ete­s/b­asi­cs/­typ­e2.html
Predia­betes - Your Chance to Prevent Type 2 Diabetes. (2019, May 30). Retrieved December 5, 2019, from https:­//w­ww.c­dc.go­v/d­iab­ete­s/b­asi­cs/­pre­dia­bet­es.h­tml.