Endocrine
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| DM dx criteria | [A1c ≥6.5% ; FPG ≥ 126 mg/dL; 2 hour GTT ≥ 200 mg/dL (75g load); or RPG ≥ 200 mg/dL] PLUS DM sxs (polyuria, polydipsia, wt loss, blurred vision)
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| Alert Values: FBS (female) | < 40 and > 400 mg/dL
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| Prediabetes / impaired fasting glucose (IFG) lab value: | FPG 100 - 125 mg/dL
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| Values assoc w/ diabetic retinopathy | FBS 126 mg/dL; 2 hr GTT 200 mg/dL; HgbA1c of 7%
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| Created when proinsulin splits into insulin & this product | C-peptide (connecting peptide); used mostly in newly diagnosed diabetics
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| C-peptide: Type 1 diabetes: | decreased levels
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| C-peptide: Type 2 diabetes: | normal or high levels
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| C-peptide: can be used to identify: | gastrinoma spread or malingering (low C-peptide with hypoglycemia may reflect abuse of insulin)
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| Glucose Testing: Urine: Requires: | normal renal glucose threshold
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| Fasting blood glucose (FPG or FBS): lab testing requires: | No caloric intake for at least 8 hours
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| Types of stress that increase glucose | trauma, acute illness, general anesthesia, burns
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| 2 hour GTT Interp: FPG (mg/dL) | Normal GTT <100; Impaired Glucose Tolerance 100-125; DM ≥ 126
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| 2 hour GTT Interp: 2 hrs after glucose load | Normal GTT <140; Impaired Glucose Tolerance 140-199; DM ≥ 200
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| 3 hour GTT Interp: Normal | Fasting <95 mg/dL ; 1 hr <180 mg/dL; 2 hr <155 mg/dL; 3 hr <140 mg/dL
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| 3 hour GTT Interp: Abnormal = | 2 or more values above reference range
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| Diabetic control correlates highly with: | pt education & motivation
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| HbA1c: In normal people: | 3-6% of hemoglobin is glycosylated in the form A1c
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| HbA1c: Normalizes within: | within 3 weeks of normoglycemic levels
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| HbA1c & RBCs: | Older RBCs have higher HbA1c levels; pts w/ episodic or chronic hemolysis who have larger proportion of young RBCs might have spuriously low levels
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| If HbA1c if > 7% : | adjust therapy
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| HbA1c: If good DM control: | check HbA1c 1-2 times yearly
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| HbA1c: If suboptimal DM control: | check HbA1c every 3 months
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| Fructosamine = | glycated albumin / serum protein (1.5-2.4 mmol/L when serum albumin is 5 g/L)
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| Fructosamine reflects: | hyperglycemic period within the last few weeks
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| Fructosamine gives info about: | short term glycemic control
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| Fructosamine: useful for: | patients with chronic hemolytic anemias that cause shortened RBC life span; Limited utility in pts w/ low serum albumin (nephrotic state or hepatic disease): poss falsely low
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| DKA: lab values | Hyperglycemia > 250 mg/dL or glycosuria 4+ ; Acidosis with blood pH < 7.3; Serum bicarb < 15 mEq/L; Serum positive for ketones
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| Test for DM Nephropathy: | urine microalbumin; more sensitive than dipstick protein
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| Urine microalbumin: May use: | albumin:creatinine (A:C) ratio
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| Urine microalbumin: Correlates with: | nocturnal systolic blood pressure
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| T1DM ID’d by: | sero autoimmune markers of pancreatic islet dysfn and genetic markers
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| impaired fasting glucose = | FBS = 100 - 125 mg/dL
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| impaired glucose tolerance (at 2 hrs) = | 140-199 mg/dL 2 hrs after OGTT (75 g oral glu)
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| Polyuria can be caused by what abnormal labs? | Hyperglycemia. Hypokalemia
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