7_T1DM

Question 1

Definition of DM.

Answer 1

group of metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Question 2

What are the types of DM?

Answer 2

1) t1dm, 2) t2dm, 3) gestational, 4) adrenal

Question 3

What organizations have diagnostic guidelines for DM?

Answer 3

ADA & WHO

Question 4

What are the ADA diagnostic guidelines for DM?

Answer 4

1) symptoms AND glucose > 11.1 mmol/L at any time, OR 2) FPG > 7 mmol/L, OR, 3) glucose > 11.1 mmol/L 2h after 75g glucose po

Question 5

What are the WHO diagnostic guidelines for DM?

Answer 5

1) symptoms AND glucose > 11.1 mmol/L at any time, OR 2) FPG > 7.8 mmol/L, OR, 3) glucose > 11.1 mmol/L 2h after 75g glucose po

Question 6

Normal glucose is always below:

Answer 6

140 mg / 100 mL

Question 7

T1DM is otherwise known as:

Answer 7

IDDM

Question 8

T1DM makes up what percentage of total DM in the US?

Answer 8

5-10%

Question 9

What is the IDDM genotype?

Answer 9

class 2 HLAs on beta-cells

Question 10

What is IDDM genotype 2?

Answer 10

defective insulin

Question 11

What is IDDM 3 and IDDM 4?

Answer 11

nobody knows

Question 12

What are the symptoms of hyperglycemia?

Answer 12

1) sweet urine, 2) frequent urination, 3) thirst

Question 13

What are the symptoms of ketoacidosis?

Answer 13

1) SOB, 2) fruity breath, 3) N/V, 4) dry mouth

Question 14

What are the symptoms of IDDM?

Answer 14

1) hyperglycemia, 2) ketoacidosis, 3) hypoglycemia

Question 15

T1DM is an autoimmune disease dependent on what aspect of the acquired immune system?

Answer 15

T lymphocytes

Question 16

What is non-proliferative retinopathy?

Answer 16

when retinal capillary damage leads to ischemia and fluid damage ultimately causing macula edema and blurred vision

Question 17

What is proliferative retinopathy?

Answer 17

when the retina revascularizes (leaky) causing vitreous hemorrhage, scarring, and retinal detachment

Question 18

What causes diabetic coma?

Answer 18

blood pH < 7 especially if dehydrated

Question 19

How is diabetic coma treated?

Answer 19

immediate! 1) 60-80 U insulin/day, 2) rehydrate with Na and K over short timeframe, 3) correct acidosis with sodium bicarb/lactate

Question 20

What diabetic complication can cause acidosis? What kind of acidosis?

Answer 20

ketoacidosis, metabolic

Question 21

How is metabolic acidosis compensated?

Answer 21

increased RR and bicarb reabsorption

Question 22

What are complications of diabetes?

Answer 22

1) dehydration/polyuria, 2) retinopathy, 3) neuropathy, 4) vascular disease, 5) dyslipidemia, 6) ketoacidosis, 7) diabetic coma, 8) chronic renal disease

Question 23

What are the three steps to formation of vascular disease?

Answer 23

1) endothelial injury, 2) platelet adhesion and migration, 3) plaque formation

Question 24

What factors promote endothelial vascular injury?

Answer 24

hyperglycemia, dyslipidemia, HTN, abnormal flow

Question 25

What factors promote platelet adhesion and aggregation?

Answer 25

hyperglycemia, insulin, PGs

Question 26

What factors promote platelet formation?

Answer 26

1) insulin, 2) growth factors, 3) abnormal lipoproteins, 4) macrophage migration

Question 27

What are the metabolic complications of t1dm?

Answer 27

switch from glucose to fat & protein utilization

Question 28

Osmotic diuresis occurs above what blood glucose level?

Answer 28

180 mg/dL

Question 29

Where is aldose reductase expressed?

Answer 29

1) neurons, 2) lens, 3) retina, 4) glomerulus, 5) vessel wall

Question 30

What is the possible cause of neuropathy?

Answer 30

accumulation of sorbitol and depletion of myoinositol in Schwann cells

Question 31

What causes dyslipidemia in diabetes?

Answer 31

1) HSL activation causes FFA release from adipose, 2) TG, VLDL synthesis in liver, 3) beta-oxidation in liver generates acetyl coa, which generates ketone bodies