What is the cause of type 1 diabetes?
- Destruction of pancreatic beta cells
- NO INSULIN MADE
What is the cause of type 2 diabetes?
-Insulin is made, but cells don’t react to it
What are 3 ways to check glucose?
- Plasma
- Whole blood
- Interstitial fluid
What is the preferred method of checking glucose and how is it done?
- Plasma glucose
- Done in the lab
- Can be 10-15% higher than whole blood measurement
What is a normal FASTING glucose?
70-100 mg/dL
What is a normal glucose after eating?
<125 mg/dL
How do you check a whole blood glucose?
- Finger stick using a glucometer
- Less accurate than plasma glucose
What is the least accurate way to measure glucose and how is it done?
- Interstitial fluid
- Measured using a continuous glucose monitor
- Measuring the tissue glucose NOT the blood glucose level
What is interstitial fluid good for when checking glucose?
Sometimes can be helpful to find patterns of overall glucose control
What can cause increased glucose levels?
- Carbohydrates
- IV fluids with dextrose
- Glucocorticoids
- Inflammation
What is hemoglobin A1c?
- Measure of average blood glucose for 3-4 months
- Identified as the subtype which correlates with glycemic control
What is the normal range of HgbA1c?
Up to 6%
What can cause A1c to be falsely low? (conditions that reduce the life span of RBCs)
- Acute anemia
- Blood transfusions
- Presence of chronic renal or liver disease
What can cause A1c to be falsely high?
RARE
-In theory, conditions that increase the # of RBCs
What is a lower A1c associated with?
-Decreased risk for microvascular complications associated with diabetes (kidney’s, eyes, extremeties)
How do you interpret A1c?
A1c = 6, mean BG = 120 7, 150 8, 180 9, 210 10, 240 11, 270 12, 300 *A1c of 9 means their average sugar over 3-4 months was 210
What are two categories of increased risk for diabetes? (pre-diabetes)
- IFG = impaired fasting glucose (100-125)
- IGT = impaired glucose tolerance (140-199 after a 75g oral glucose load)
- A1c = 5.7-6.4
What four things could diagnosis someone with diabetes???
- A1c > 6.5%
- Fasting Plasma Glucose > 126
- Two-hour plasma glucose >200
- A patient with classic symptoms of hyperglycemia or hyerglycemic crisis with a random plasma glucose of >200
- If two different tests and one positive and one negative for diabetes, repeat the POSITIVE TEST
What is a microalbumin test?
- If high, it means there is protein in your urine WHICH IT SHOULD NOT BE –> this is a sign of kidney disease
- Initial test at the time of diagnosis for DM2
- Initial test after 5 years for DM1
What are normal values for pH, PCO2, and bicarb?
pH = 7.4 PCO2 = 40 Bicarb = 24
What is someones pH if they are in metabolic acidosis?
pH <7.35
What are the two types of metabolic acidosis?
- Non-anion gap acidosis
2. Anion gap acidosis (look at the BMP, decreased bicarb)
What does MUDPILES stand for?
Methanol Uremia Diabetic Ketoacidosis Paraldehyde Lactic Acid (elev. sepsis) Isoniazid Ethylene glycol Salicylates (aspirin)
What are the clinical presentations of diabetic ketoacidosis?
- Abdominal pain
- Nausea/vomiting
- Altered mental status
