living with diabetes

Question 1

define diabetes

Answer 1

Diabetes is defined as a blood glucose that is increased to a point that it could cause microvascular disease: 1. Kidneys: proteinuria, progressing to end stage renal failure requiring dialysis. 2. Eyes: proliferative retinopathy, bleeding, potentially progressing to blindness. 3. Nerves: pain, numbness, propensity to injury, potentially leading to amputation.

Question 2

diabetes fasting glucose

Answer 2

Fasting (no caloric intake for >8hrs) glucose: >126 mg/dl

Question 3

diabetes 2 hr plasma glucose during oral glucose tolerance test

Answer 3

2-hr plasma glucose >200 mg/dl during a 75 gram oral glucose tolerance test

Question 4

A1C levels in diabetes

Answer 4

> 6.5% on 2 occassions in absence of medical illness

Question 5

What is pre-diabetes

Answer 5

peopl have increased risk for macrovascular dz (coronary artery dz, cerebrovascular dz, etc) but not microvascular.

Question 6

Pre-diabetes fasting glucose, glucose tolerance and A1C

Answer 6

1. Impaired fasting glucose (IFG): 100-125 mg/dl. 2. Impaired glucose tolerance (IGT): 2-hr glucose 140-199 mg/dl during an OGTT. 3. An HbA1C: 5.7-6.4% is also indicative of “pre-diabetes” or “at risk for diabetes”

Question 7

List the signs and symptoms that a person with new onset diabetes might experience.

Answer 7

1. Polyuria: frequent urination, and nocturia: urination at night. 2. Polydipsia: the osmotic diuresis caused by hyperglycemia produces excessive thirst and drinking. 3. Blurry vision: osmotic shifts cause swelling of the lens of the eye. 4. Weight loss: increased gluconeogenesis produces loss of muscle mass, increased lipolysis causes loss of fat mass.

Question 8

List 4 types of diabetes

Answer 8

type 1, type 2, gestational and pancreatic

Question 9

What causes type 1 diabetes and how is insulin affected

Answer 9

autoimmune destruction of beta cells in the pancreas. The result is insulin deficiency, but presumed normal insulin sensitivity

Question 10

Features of type 1 diabetes

Answer 10

Childhood dz, low C peptide (insulin deficiency), genetic contribution low, positive GAD antibodies against islet antigens, normal weight, predisposed to ketoacidosis, insulin sensitive

Question 11

What causes type 2 diabetes

Answer 11

Insulin resistance then a reduction in insulin secretion

Question 12

type 2 diabetes features

Answer 12

More common in adults, hispanics, african americans, native americans and pacific islanders, usually overweight, strong genetic component, usually no ketoacidosis, no autoimmunity

Question 13

treatment of type 1 vs type 2 diabetes

Answer 13

type 1: insulin always necessary and not responsive to oral hypoglycemic drugs. Type 2: responsive to oral hypoglycemic drugs, diet, exercise, insulin may or may not be necessary

Question 14

what causes gestational diabetes

Answer 14

Hormone changes and weight gain cause insulin resistance

Question 15

Gestational diabetes adverse outcomes

Answer 15

Macrosomia (big babies), complications for mother at birth, child and mother are at risk for type 2 diabetes later in life

Question 16

what causes pancreatic diabetes

Answer 16

surgical removal of the pancreas or injury to the pancreas from pancreatitis- glucose levels are high b/c insulin deficiency from beta cell destruction. Similar to type 1 diabetes

Question 17

Pancreatic diabetes symptoms

Answer 17

pancreatic malabsorption causing diarrhea and steatorrhea (fat in the stool), and fat soluble vitamin deficiency, Underweight, predisposed to hypoglycemia b/c lack of glucagon

Question 18

What dz is associated with pancreatic diabetes

Answer 18

alcoholism- predisposes to hypoglycemia b/c alcohol also impaires gluconeogenesis and peripheral neuropathy b/c combined neurotoxicity of alcohol and diabetes