Professional Documents
Culture Documents
Types 1 & 2
Jessica Perini, MD
Sect. Endocrinology
WVU Dept of Internal Medicine
March 14, 2017
Diabetes definition
Outline
Classic symptoms
Diagnosis
Fundamental differences between DM types 1 & 2
Pancreatic failure
Relative insulin insufficiency
Insulin resistance
Therapies
Pre-Diabetes
Labs
Prevention
Risk Factors
Complications of diabetes
Microvascular
Macrovascular
Why we treat
Sugars help microvascular complications
BP and cholesterol help macrovascular complications
How we treat
Pills, injections, insulin, pumps, surgery, transplants
Monitoring, health maintenance
Is it working?
CBG
CGM
A1c, lipids, urine microalb/creat, eye exams
Clinical Pearls: When youre a resident
Diabetes
Means increased urine
Mellitus honey
Insipidus bland
Polyuria
Polydipsia
Polyphagia
Weight loss
Blurry vision
Diagnosis
4 methods
Diagnosis
HbA1c 6.5
5% = 97 7% = 154 9% = 212
6% = 125 8% = 183 10% = 240
2 Primary Types of DM
Type 1
Type 2
(others)
BP 98/68 P 88 RR 16 Ht 59
Wt 158 lbs
Pale, mild abdominal discomfort with
palp, no rebound, skin damp, areas of
vitiligo over abdomen and right hand
Case #1 BL contd
Labs:
DKA
Case #1 CS contd
He was admitted to ICU
Anti-islet Abs
Labs (fasting):
Na 137 K 4.0 BUN/Creat 12/1.2
Glucose 92
disconnect
Repeat labs (still fasting):
Glucose 91
A1c 7.5
A Disconnect ?
Insulin resistance
Diabetes Type 2
DM Type 2
Sugar floats around in the blood
Tries to clear into cells
Cells need to open
Insulin helps the cells open
Cells resist the insulin
DM Type 2
Then what?
Long-Term
Microvascular
Macrovascular
Microvascular Complications
Retinopathy
Nephropathy
Neuropathy
Retinopathy
Normal
Retinopathy
Diabetic Retinopathy
Affects 40-90% of people with DM
Loss of Sensation
Diabetic Peripheral
Neuropathy
Foot Ulcers
Diabetic Peripheral
Neuropathy
Charcot Foot
Diabetic Peripheral
Neuropathy
Charcot Foot
Diabetic Peripheral
Neuropathy
Affects up to 70% of people with DM
Heart disease
Macrovascular
Complications
How to help?
Exercise
150 minutes per week moderate
intensity aerobic exercise (this is the
minimum for maintanance)
resistance exercise 2x per week
Non-Sugar Treatment
BP control < 140/80
Cholesterol control LDL < 100,
near 70
Oral
Non-insulin injections
Insulin
Bariatric surgery
Pancreatic transplant
Oral DM Medications
byetta/exenatide
victoza/liraglutide
bydureon/exenatide
trulicity/dulaglutide
tanzeum/albiglutide
Case # 3 MJ contd
Confirm with repeat A1c
Diet
Exercise
Smoking cessation
Refer for DM education/nutrition
Add ACE-I
Add statin
Check urine microalbumin:creatinine ratio
Exam for neuropathy
Can wait 3 months and repeat a1c. Meds now or in 3
months. *I* would start metformin and liraglutide
now.
Insulin
The only option in treating Type 1
Typically added later in Type 2
Long-acting insulin
Short-acting insulin
Pre-Mixed insulin
Methods of Administering Insulin
Bottles/vials
Pens
Monitoring sugars
Sugar Goals
Normal fasting sugar is
Fasting
Pre-Meal
2 hours after Meal
Bedtime
If sensation of low sugar
When You are a Resident
Resident Situation # 1
You are called by nurse at 3 a.m.
because Ms. Smiths CBG is 300.
What do you do/ say/ ask next?
Resident Situation # 1
contd
What have her sugars been lately?
Is this an anomaly? Should we repeat the CBG?
Has she had any low sugars?
What medications is she on?
Steroids? Immunosuppressants?
Is she getting any insulin currently?
How much? 5 units per day? 100s of units per day?
Do we know if she is type 1 or type 2?
Is she thin or heavy? Young or old? How is her
kidney function?
Resident Situation #1
contd
Sliding scales are used all the time
For a given sugar, administer a given amount of
insulin
BE CAREFUL with sliding scales, especially in the
middle of the night in a patient you dont know