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PAEP Endo & Metabolism > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Is T1DM an absolute insulin deficiency? Explain answer

A

Yes
Panc beta cell destruction by autoantibodies results in no endogenous insulin production

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2
Q

What susceptibility genes are involved in T1DM?

A

HLA-D (>90% of T1DM pts)

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3
Q

Explain the trigger(s) for T1DM and pathophysiology

A

In genetically susceptible individuals, environmental triggers like a viral infection and diet can lead to immune-mediated beta-cell destruction

viral infection ➔ destroy beta cells ➔ expose autoantigens to immune system ➔ continued destruction

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4
Q

What does the islet pathology look like in T1DM?

A

Insulitis, shows immune cell infiltrates around and within the islets

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5
Q

Define T2DM

A

A relative insulin deficiency due to a insulin resistant cells

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6
Q

What are 5 key risk factors for developing T2DM?

A
  1. Obesity/metabolic syndrome
  2. First-degree relative with DM
  3. HTN
  4. Hyperlipidemia
  5. PCOS
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7
Q

What causes T2DM?

A

Not fully understood!

Thought that excess adipose tissue ➔ lipolysis ➔ adipokines ➔ inflammation ➔ related to insulin resistance

There seems to be a genetic factor ➔ twin studies, having a twin with T2DM increases the risk of developing T2DM

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8
Q

Explain the progression of T2DM with insulin resistance

A

hyperglycemia develops when insulin cannot compensate for insulin resistance

  1. Cells not responsive to insulin ➔ no glucose intake
  2. pancreas attempts to compensate, so beta-cells produce more insulin
  3. beta cells can no longer compensate and start shrinking (this takes a long time)

rare: beta cells cannot produce any insulin

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9
Q

Age of onset for T1DM vs T2DM

A

<25 yrs vs usually older adults

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10
Q

Weight for T1DM vs T2DM

A

usually thin vs >90% are at least overweight

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11
Q

What is c-peptide and how would this lab result differ for T1DM vs T2DM

A

c-peptide: connecting protein in proinsulin ➔ only present in endogenous insulin

undetectable/low in T1DM – not producing endogenous insulin because beta cell destruction

normal/high in T2DM – producing more insulin than normal from beta cells that are trying to compensate for the insulin resistance

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12
Q

how frequent do T1DM and T2DM have a family history of DM?

A

T1DM: infrequently (5-10%)
T2DM: frequent (75-90%)

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13
Q

What are the 3 P’s for hyperglycemia s/s (list them)

A

polyuria, polydipsia, polyphagia

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14
Q

p/p for polyuria

A

increased glucose in plasma ➔ increased glucose excretion + water following in urine bc glucose is a solute ➔ increased frequency of urination

increased osmolarity in urine ➔ increased fluid excretion because water is drawn to areas of higher osmolarity

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15
Q

p/p for polydipsia

A

bc of polyuria ➔ dehydration ➔ signal for thirst and to drink

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16
Q

p/p for polyphagia

A

cellular need for energy ➔ glucose not being transported into cells ➔ signals to eat

*not typically a main pt concern

17
Q

what are some s/s of dehydration you’d see in DM? some specifically in peds?

A
  1. increased thirst
  2. dry mucous membranes
  3. dark coloured urine
  4. dizziness/light-headedness
  5. decreased pulses, prolonged capillary refill

peds:
1. irritable/altered mental status
2. sunken eyes/fewer tears
3. sunken fontanelle

18
Q

Why are UTIs common in DM pts?

A

Because increased excretion of high glucose sugar ➔ makes it inflamed and dry and prone to infection

19
Q

What is the dawn phenomenon?

A

morning hyperglycemia due to increased insulin antagonist hormones (growth hormone, cortisol, and catecholamines) during the night to release more sugar

they have normal blood sugar during the night

20
Q

What is somogyi phenomenon?

A

Evening hypoglycemia due to the insulin or oral diabetic medication taken before bed, and a rebound morning hyperglycemia due to the body’s response to increased stress hormones like cortisol and epi

21
Q

What does first presentation of T1DM look like?

A

usually with symptomatic hyperglycemia (polyuria, polydipsia, polyphagia) and sometimes in DKA (hyperglycemia, ketoacidosis)

22
Q

What does first presentation of T2DM look like?

A

May have hyperglycemic s/s (polyphagia, polyuria, polydipsia)

May be incidentally found w/ routine testing

May initially present w/ diabetic cx (retinopathy, nephropathy, or neuropathy) or HHS

23
Q

What are 2 signs of insulin resistance (T2DM)

A

acanthosis nigricans: darkened skin in the armpit/back and sides of neck

skin tags in the same area

24
Q

What ix can we use specifically to differentiate between T1DM and T2DM?

A

Autoimmune markers will tell us if its T1DM
- Anti-glutamic acid decarboxylase (more commonly ordered)
- anti-islet cell (less commonly ordered

Consider ketones - if first presentation with s/s of severe hyperglycemia ➔ potentially DKA
- urine dipstick for acetoacetate
- serum for Beta-hydroxybutyrate

25
Q

What tests can we use according to the Diabetes Canada 2018 Clinical Practice Guidelines to diagnose DM?

A
  • Fasting plasma glucose
  • Oral Glucose tolerance test - mainly gestational diabetes
  • HbA1C
  • Random plasma glucose
26
Q

What lab work values would you consider to be diabetic for the Diabetes Canada Guidelines for all 4 tests?

A

A1C: >= 6.5%
FGP: >=7 mmol/L
OGTT: 11.1 mmol/L
Random GP: 11.1 mmol/L

27
Q

Why is knowing you’re pre-diabetic important?

A

because 50-80% of ppl can revert to normal glucose tolerance with proper wt loss and lifestyle modifications ➔ so they never progress to DM or have to take meds

28
Q

What is pre-diabetes?

A
  • impaired glucose tolerance
  • these indiv are at a high risk of developing DM and its cx
29
Q

what lab values would show you pre-diabetes according to the guidelines?

A

A1C: 6-6.4%
FGP: 6.1-6.9 mmol/L
OGTT: 7.8-11 mmol/L

30
Q

What kind of follow-up/monitoring tests would you want to organize for DM patients?

A
  1. regular clinic visits
  2. A1C + blood glucose tests every 3 months
  3. Lipid profile with every bloodwork ➔ if older than 40yrs/higher risk factors, or has T2DM
  4. serum creatinine ➔ to calculate eGFR
  5. urine analysis ➔ for albumin to creatinine ratio ➔ monitoring nephrophathy cx)
  6. annual eye exam ➔ monitoring retinopathy
  7. diabetic foot exam w/ every visit
31
Q

What is the target range for HbA1c according to the guidelines?

A

<7.0%

32
Q

What is the target range for FPG according to the guidelines?

A

4-7 mmol/L

33
Q

What is the target range for OTT according to the guidelines?

A

5-10 mmol/L

34
Q

What is the target range for LDL-C according to the Diabetes guidelines?

A

< 2.0 mmol/L

35
Q

What is the target range for BP according to the diabetes guidelines?

A

<130/80

36
Q

What are the ABCDES of Diabetes Care?

A

A1C target <7%
Blood pressure <130/80
Cholesterol LDL<2.0 mmol/L
Drugs for CVD risk reduction
Exercise goals and healthy eating
Smoking cessation and screening for complications

PAEP Endo & Metabolism (13 decks)

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