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Endocrine Clin med > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What does the first step of energy production require

A

insulin

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2
Q

What type of cells excrete insulin

A

beta cells from pancreas

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3
Q

What is the role of the pancreas when the blood sugar level starts to drop too low

A

excretes glucagon

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4
Q

What population is most affected by Diabetes type 1

A

children and adolescents

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5
Q

What population is more effected by type 2 diabetes and why

A

middle age - older adults from prolonged hyperglycemia from poor lifestyle and diet

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6
Q

What are some early symptoms of diabetes

A

polydipsia
polyphagia
polyuria
blurred vision

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7
Q

How do you diagnose diabetes

A

plasma glucose

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8
Q

what is the leading cause of mortality in diabetics

A

heart disease

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9
Q

Where is the islets of langerhans found and what do they contain

A

pancreas
Alpha and beta cells

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10
Q

What is the job of beta cells

A

insulin producing

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11
Q

What is the job of alpha cells

A

glucagon secreting

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12
Q

What is type 1 diabetes

A

destruction of pancreatic beta cells- generally from an autoimmune process

*leave insulin levels extremely low

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13
Q

What is type 2 diabetes

A

Insidious onset of imbalance between insulin levels and insulin sensitivity causing a functional deficit

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14
Q

What is a common cause of insulin resistance

A

obesity and aging

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15
Q

Which type of diabetes is associated with HLA antigens

A

Type 1

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16
Q

What influences a persons risk for developing type 1 DM

A

Polymorphins (MHC and HLA)

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17
Q

Which type of diabetes is more effected by genetics

A

type 2

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18
Q

What is MODY

A

Non-insulin dependent diabetes diagnosed at a young ago (<25y/o)
-autosomal dominant (no autoantibodies)

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19
Q

What is gestational diabetes

A

diabetes during pregnancy

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20
Q

What is the etiology of diabetes

A

people who have endocrinopathies
-cushings, acromegaly, hyperthyroidism etc

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21
Q

Which ethnicity is at an increased risk of DM type 1

A

Hispanic youth

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22
Q

Which socioeconomic area is most effected by type 2 diabetes

A

low to middle income and a higher prevalence in other ethnicities besides whites

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23
Q

At what serum glucose level are you likely to experience symptoms of polyuria and polydipsia

A

> 250mg/dL

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24
Q

What is insulin resistance

A

excess fatty acids and pro inflammatory cytokines leads to impaired glucose transport and increased fat breakdown

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25
Q

What is the biggest problem with type 2 DM

A

They have inadequate production of insulin to compensate for their insulin resistance

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26
Q

What does glycated hemoglobin (HbA1c) measure

A

Non-enzymatic glycation of proteins and lipids

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27
Q

What does glycation lead to

A

microvascular damage in retina, kidney, and peripheral nerves ultimately leading to diabetic retinopathy and nephropathy

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28
Q

What will be seen on physical exam with hyperglycemia

A

fatigue
poor skin turgor
distinctive fruity odor on their breath
+/- DKA
Macular hemorrhages

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29
Q

If a patient is in DKA, what symptoms should you expect

A

Kussmal’s breathing
N/V

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30
Q

What other things on PE help differentiate between Type 1&2

A

Type 2 is usually overwheight
-blurry vision
-frequent yeast/fungal infections
-numbness/neuropathic pain
-acanthosis nigricans

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31
Q

What is the most sensitive and best test for DM

A

OGTT (oral glucose tolerance testing)

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32
Q

What are the types of tests can you do for diabetes

A

Fasting plasma glucose (FPG)
Glycosylated HB (HbA1C)
OGTT

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33
Q

What is the diagnostic criteria for diabetes type 1&2

A

FPG >126
Random glucose >200 w/ symptoms
2hr plasma glucose >200 during 75g OGTT

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34
Q

What HbA1C indicated type 2 DM

A

> 6.5%

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35
Q

What is the pre diabetic criteria

A

FPG >100-125
2hr OGTT plasma glucose 140-199
HbA1C 5.7-6.4%

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36
Q

What are some factors that can effects the HbA1C

A

Hemoglobinopathies
iron deficiency
hemolytic anemia
thalassemia
spherocytosis
severe hepatic/renal disease

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37
Q

When is screening for diabetes recommended by the USPSTF

A

starting at 35 regardless of risk factors

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38
Q

What is home glucose testing useful for

A

trends of hyper/hypo glycemia

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39
Q

What is HbA1C useful for

A

extent of glycation due to hyperglycemia over previous 100 days

40
Q

What is urine albumin useful for

A

Identification of diabetic neuropathy

41
Q

What is serum lipid monitoring useful for

A

at time of diagnosis and continued ASCVD surveillance

42
Q

What is critical for effective diabetes management

A

Diabetic education and patient engagement

43
Q

What does diabetes management always start with

A

Diet and exercise (>150min weekly)

44
Q

What are the glucose maintenance levels

A

HbA1C <7%
or
Time in range >70% and time below range <4% in adults

45
Q

What is a major treatment complication for diabetes

A

Hypoglycemia

46
Q

What are some signs of hypoglycemia

A

Hangry
confused
dizzy
sweaty
shaky

47
Q

What is a BG of someone who is hypoglycemic

A

BG<50

48
Q

How do you treat hypoglycemia

A

Glucose
Conscious: candy and complex carb meal

Coma: Glucagon 1mg IM or
IV D50

49
Q

How long does it take glucagon to take effect

A

10min

50
Q

What are the 3 most common and most devastating microvascular disease

A

retinopathy
nephropathy
neuropathy

51
Q

What does treatment of diabetic retinopathy start with

A

intensive glycemic and blood pressure control

52
Q

What is diabetic retinopathy

A

Retinal micro aneurysms then neovascularization and macular edema

53
Q

What are some symptoms of diabetic retinopathy

A

focal blurring
vitreous/retinal detachment
partial/total vision loss

54
Q

What are intensive treatments for diabetic retinopathy

A

Photocoagulation
vitrectomy
VEGF inhibitor

55
Q

What is the leading cause of CKD in the US

A

Diabetic nephropathy

56
Q

How is diabetic nephropathy diagnosed

A

detection of urinary albumin

57
Q

What is diabetic nephropathy

A

thickening of glomerular basement membrane

mesangial expansion

glomerular sclerosis

all leading to glomerular hypertension and progressive decline in GFR

58
Q

What is advanced diabetic nephropathy

A

albumin secretion >300mg/day

59
Q

When is a urine dipstick positive

A

protein excretion >300-500mg/day

60
Q

How do you treat diabetic nephropathy

A

ACE/ARB
intensive glycemic & BP control

61
Q

What is diabetic neuropathy

A

nerve ischemia which is a direct effect of hyperglycemia and intracellular metabolic changes impairing nerve function

62
Q

What are some examples of diabetic neuropathy

A

Symmetric polyneuropathy
Autonomic neuropathy
Radiculopathy
Cranial neuropathy
Mononeuropathy

63
Q

What is the most common diabetic neuropathy

A

Symmetric polyneuropathy which affects the distal feet and hands (stocking-glove distribution)

64
Q

What small-fiber symptoms will occur with symmetric polyneuropathy

A

pain
numbness
loss of temp sensation
*preserved vibration & position sense

65
Q

What large-fiber symptoms will occur with symmetric polyneuropathys

A

Muscle weakness
loss of vibration & position sense
lack of DTRs
Atrophy of intrinsic foot muscles
*foot drop common

66
Q

Where is the most common area for diabetic neuropathy in the ANS occur

A

L2-L4 nerve roots (diabetic amyotrophy)

67
Q

What symptoms will occur with cranial neuropathies

A

diplopia
ptosis
anisocoria

68
Q

What are some common causes of atherosclerosis of large vessels

A

hyperinsulinemia
dyslipidemia
hyperglycemia

69
Q

Which type of diabetes is at higher risk of nonalcoholic fatty liver disease

A

type 2

*tx with diet/exercise/weight loss

70
Q

What are rheum complications of DM

A

Dupuytrens
CTS
Adhesive capsulitis
sclerodactyl

71
Q

How often should a foot exam be preformed with diabetes

A

at least 1x/year (more is preferred)

72
Q

How often should retinal exams be preformed with DM

A

Annually w/ retinopathy

min every 2yr w/o retinopathy

73
Q

When should Spot or 24hr urine be completed with DM

A

annual with serum creatinine

74
Q

What is DKA

A

Diabetic ketoacidosis
*random BG >200mg/dL
symptoms will progress rapidly

75
Q

What is the advantage of basal insulin

A

it controls glucose production between meals and overnight

76
Q

What is the advantage of bolus insulin

A

Limits hyperglycemia after meals

77
Q

What is the dosing for insulin

A

.4 - 1.0 units/kg/day

78
Q

In what instances does the total daily insulin need to be increased

A

Puberty
pregnancy
medical illness

79
Q

How does insulin concentration in an injection effect the absorption rate

A

The higher the concentration number, the longer it will take the insulin to absorb

80
Q

What are some adverse reactions to insulin

A

lipoatrophy (loss of fat at injection site - may cause intramuscular injection)

hypertrophy (increase fat mass at injection site leading to variable absorption)

resistance (needing larger amount of insulin)

81
Q

How much glucose is the preferred treatment for hypoglycemia

A

15-20g

82
Q

What is the diagnostic criteria of DKA

A

Diabetic (Glucose >200)
Keto (Ketonuria)
Acidosis (PH <7.3)

83
Q

What things can induce DKA

A

Infection
infarction
iatrogenic
incision
intoxication
initial
insulin

84
Q

If a patient in DKA is also in shock, what type of fluid management do you give

A

Bolus 2-3 liters of normal saline STAT

85
Q

What is the IV fluid management in someone with DKA NOT in shock

A

1 liter Normal saline over 1 hour

86
Q

What are the steps of treating DKA

A

Fluid replacement
Electrolyte replacement (Na+, K+)
Insulin drip
*Once glucose is <200, switch to D5 to prevent hypoglycemia

87
Q

What is the leading cause of death in children presenting with DKA

A

Cerebral edema

88
Q

Which diets are effective strategies at trying to manage glucose intolerance

A

mediteranean and DASH

89
Q

When does insulin resistance generally start before a clinical diagnosis of DM is given

A

4-7 years

90
Q

What are some common risk factors for DM2

A

obesity
+ FH
hx HTN
Dyslipidemia

91
Q

Who should be screened for T2DM and when

A

People >35 and at risk
Q3 years and labs are normal

92
Q

What tests are ordered to screen for T2DM

A

FPG
HbA1C
plasma glucose

93
Q

How do those with T2Dm present

A

Usually asymptomatic
*may present with hyperglycemia or other diabetic complications that have been present for a while

94
Q

What are the signs and symptoms of T2DM

A

Polyuria, Polydipsia, orthostatic hypotension, dehydration

95
Q

What is the criteria for diagnosing someone with T2DM

A

*ONE of the following
FPG >126
Random glucose >200
2hr plasma glucose >200
HbA1C >6.5%

96
Q

Is HbA1C something that can be used to diagnose gestational diabetes or T1DM

A

no

Endocrine Clin med (6 decks)

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