DMT2
Insulin resistance > pre-diabetes > T2DM
50% of IR go on to T2DM
Risk
FHx
Ethnicity
Obesity
Hx
Polyuria
Polydipsia
weight loss
blurred vision
Ex
Acanothosis nigricans
DKA
Ix
C-peptide is a byproduct of insulin production, high = insulin resistance, absence in T1DM
Used to differentiate T1 from T2
Insulin resistance
Fasting insulin
10-15mU/L (60-90pmol/L) = at risk
>15mU/L (90pmol/L) = insulin resistance
fasting insulin:glucose ratio also good indicator of resistance
Pre-diabetes
Impaired fasting glucose: 5.6-6.9mmol/L
Impaired glucose tolerance: 7.8-11.1mmol/L 2 hours post g of sugar
T2DM
Fasting BSL >6.9mmol/L
OGTT >11.1
Random BSL >11.1 + symptoms
Rx
Diet
Exercise
Metformin as soon as insulin resistant
Endocrine referral once T2DM
?Insulin
Monitor for:
dyslipidemia
HTN
retinopathy
nephropathy
CVS
hepatosteatosis
caries
50% of IR go on to T2DM
Risk
FHx
Ethnicity
Obesity
Hx
Polyuria
Polydipsia
weight loss
blurred vision
Ex
Acanothosis nigricans
DKA
Ix
C-peptide is a byproduct of insulin production, high = insulin resistance, absence in T1DM
Used to differentiate T1 from T2
Insulin resistance
Fasting insulin
10-15mU/L (60-90pmol/L) = at risk
>15mU/L (90pmol/L) = insulin resistance
fasting insulin:glucose ratio also good indicator of resistance
Pre-diabetes
Impaired fasting glucose: 5.6-6.9mmol/L
Impaired glucose tolerance: 7.8-11.1mmol/L 2 hours post g of sugar
T2DM
Fasting BSL >6.9mmol/L
OGTT >11.1
Random BSL >11.1 + symptoms
Rx
Diet
Exercise
Metformin as soon as insulin resistant
Endocrine referral once T2DM
?Insulin
Monitor for:
dyslipidemia
HTN
retinopathy
nephropathy
CVS
hepatosteatosis
caries