Type I DM ✔️Ans - Absolute insulin deficiency caused by beta cell
destruction; immune mediated; 95% have genetic marker of human
leukocyte antigen DR3 and/or DR4
Type 2 DM ✔️Ans - 90-95% of all diabetes; insulin resistance with
progressive insulin secretory defect (insulin deficiency); 50% of adults
have diabetes related complications when diagnosed;
Type 2 DM Risk Factors ✔️Ans - Overweight (BMI 25-29) or Obese (BMI
> 30), AA, hispanic, Native American; physically inactive; hx of gestational
DM opr birth of child > 9 lbs; having pre-diabetes / HTN / high TG (more
than 250) / low HDL (less than 35) / hx of PCOS / hx of cardiovascular dz
DM - diagnosis ✔️Ans - Fasting glucose > 126 on 2 different days OR Sx
of DM with random glucose > 200 OR A1C 6.5% or greater OR 2 hour OGTT
of 200 or more
Gestational Diabetes ✔️Ans - If no risk factors, screen at 24-28 weeks;
screen at first visit if even 1 risk factor (if normal repeat at 24-28 weeks).
Women with hx of Gestational Diabetes should be screened 6-12 weeks
postpartum
Diabetes Type 2- Screening ✔️Ans - Test all adults age 45 and older;
consider testing earlier if risk factors
PRE-Diabetes ✔️Ans - A1C 5.7-6.4%. Recommend weight loss of 7%,
increase in physical activity to at least 150 minutes/week. Use metformin
in those at very high risk of diabetes
Metformin ✔️Ans - Inhibits hepatic glucose production, improves
peripheral insulin resistance, may decrease intestinal absorption of glucose
in small intestine. No hypoglycemia when used as monotherapy, positive
effects on lipids, weight neutral
Metformin - efficacy ✔️Ans - Reduces A1C 1-2%
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