B2.039 Big Case Mrs. Dolan Flashcards Preview

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Flashcards in B2.039 Big Case Mrs. Dolan Deck (17)
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1

what are the diagnostic criteria for diabetes mellitus?

fasting plasma glucose <126 mg/dl
two hour plasma glucose of >200 mg/dl during oral glucose tolerance test
A1C value >6.5%

2

characterize type 1 diabetes

10% of cases
autoimmune destruction of pancreatic beta cells
absolute insulin deficiency
DKA initial presentation in 25% of adults

3

what are the classic symptoms of DM1?

polyuria, polydipsia, nocturia, blurred vision

4

characterize type 2 diabetes

most common, greater than 90% of cases
majority are asymptomatic
may present w classic symptoms
hyperglycemia and insulin deficiency and resistance

5

how does insulin act on adipose?

increase glucose uptake
increase lipogenesis
decrease lipolysis

6

how does insulin act on muscle?

increase glucose uptake
increase glycogen synthesis
increase protein synthesis

7

how does insulin act on the liver?

decrease gluconeogenesis
increase glycogen synthesis
increase lipogenesis

8

what are 3 symptoms of obesity that contribute to insulin resistance?

increased adipokines
increased FFAs (free fatty acids)
inflammation

9

what are 2 causes for autoimmune mediated islet cell destruction in DM1 patients?

failure of self tolerance in T cells
anti insulin antibodies

10

what are some effects of insulin resistance in DM2 patients?

initially B cell hyperplasia to compensate
eventually B cell failure
role of excess FFAs
role of inflammation

11

what is macrovascular disease?

accelerated atherosclerosis affecting large arteries
myocardial infarction
peripheral vascular disease

12

what is microvascular disease?

diffuse thickening of vascular membranes

13

what organs experience major complications of microvascular disease?

eyes: vessel damage causing retinopathy, cataracts, and glaucoma
kidney: HBP and excess glucose damages small vessels and overworks kidneys, nephropathy
NS: hyperglycemia damages nerves in PNS

14

what organs experience major complications of macrovascular disease?

brain: increased risk of stroke and cerebrovascular disease
heart: HBP and insulin resistance increase risk of CHD
extremities: narrowing of blood vessels increases risk of reduced blood flow

15

what is the second leading cause of death in diabetes?

diabetic nephropathy

16

for management of DM, what needs to be done frequently?

eye exam
foot exam
BP
dental exam
smoking cessation
CVD prevention
screening from increased urinary albumin

17

what are important lab studies in diabetes?

hemoglobin A1C
serum creatinine
urinary albumin-to-creatinine ratio
TSH
fasting lipid profile