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Endocrine Clin med > Diabetes > Flashcards

Diabetes Flashcards

(96 cards)

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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
What is the biggest problem with type 2 DM
They have inadequate production of insulin to compensate for their insulin resistance
26
What does glycated hemoglobin (HbA1c) measure
Non-enzymatic glycation of proteins and lipids
27
What does glycation lead to
microvascular damage in retina, kidney, and peripheral nerves ultimately leading to diabetic retinopathy and nephropathy
28
What will be seen on physical exam with hyperglycemia
fatigue poor skin turgor distinctive fruity odor on their breath +/- DKA Macular hemorrhages
29
If a patient is in DKA, what symptoms should you expect
Kussmal's breathing N/V
30
What other things on PE help differentiate between Type 1&2
Type 2 is usually overwheight -blurry vision -frequent yeast/fungal infections -numbness/neuropathic pain -acanthosis nigricans
31
What is the most sensitive and best test for DM
OGTT (oral glucose tolerance testing)
32
What are the types of tests can you do for diabetes
Fasting plasma glucose (FPG) Glycosylated HB (HbA1C) OGTT
33
What is the diagnostic criteria for diabetes type 1&2
FPG >126 Random glucose >200 w/ symptoms 2hr plasma glucose >200 during 75g OGTT
34
What HbA1C indicated type 2 DM
>6.5%
35
What is the pre diabetic criteria
FPG >100-125 2hr OGTT plasma glucose 140-199 HbA1C 5.7-6.4%
36
What are some factors that can effects the HbA1C
Hemoglobinopathies iron deficiency hemolytic anemia thalassemia spherocytosis severe hepatic/renal disease
37
When is screening for diabetes recommended by the USPSTF
starting at 35 regardless of risk factors
38
What is home glucose testing useful for
trends of hyper/hypo glycemia
39
What is HbA1C useful for
extent of glycation due to hyperglycemia over previous 100 days
40
What is urine albumin useful for
Identification of diabetic neuropathy
41
What is serum lipid monitoring useful for
at time of diagnosis and continued ASCVD surveillance
42
What is critical for effective diabetes management
Diabetic education and patient engagement
43
What does diabetes management always start with
Diet and exercise (>150min weekly)
44
What are the glucose maintenance levels
HbA1C <7% or Time in range >70% and time below range <4% in adults
45
What is a major treatment complication for diabetes
Hypoglycemia
46
What are some signs of hypoglycemia
Hangry confused dizzy sweaty shaky
47
What is a BG of someone who is hypoglycemic
BG<50
48
How do you treat hypoglycemia
Glucose Conscious: candy and complex carb meal Coma: Glucagon 1mg IM or IV D50
49
How long does it take glucagon to take effect
10min
50
What are the 3 most common and most devastating microvascular disease
retinopathy nephropathy neuropathy
51
What does treatment of diabetic retinopathy start with
intensive glycemic and blood pressure control
52
What is diabetic retinopathy
Retinal micro aneurysms then neovascularization and macular edema
53
What are some symptoms of diabetic retinopathy
focal blurring vitreous/retinal detachment partial/total vision loss
54
What are intensive treatments for diabetic retinopathy
Photocoagulation vitrectomy VEGF inhibitor
55
What is the leading cause of CKD in the US
Diabetic nephropathy
56
How is diabetic nephropathy diagnosed
detection of urinary albumin
57
What is diabetic nephropathy
thickening of glomerular basement membrane mesangial expansion glomerular sclerosis all leading to glomerular hypertension and progressive decline in GFR
58
What is advanced diabetic nephropathy
albumin secretion >300mg/day
59
When is a urine dipstick positive
protein excretion >300-500mg/day
60
How do you treat diabetic nephropathy
ACE/ARB intensive glycemic & BP control
61
What is diabetic neuropathy
nerve ischemia which is a direct effect of hyperglycemia and intracellular metabolic changes impairing nerve function
62
What are some examples of diabetic neuropathy
Symmetric polyneuropathy Autonomic neuropathy Radiculopathy Cranial neuropathy Mononeuropathy
63
What is the most common diabetic neuropathy
Symmetric polyneuropathy which affects the distal feet and hands (stocking-glove distribution)
64
What small-fiber symptoms will occur with symmetric polyneuropathy
pain numbness loss of temp sensation *preserved vibration & position sense
65
What large-fiber symptoms will occur with symmetric polyneuropathys
Muscle weakness loss of vibration & position sense lack of DTRs Atrophy of intrinsic foot muscles *foot drop common
66
Where is the most common area for diabetic neuropathy in the ANS occur
L2-L4 nerve roots (diabetic amyotrophy)
67
What symptoms will occur with cranial neuropathies
diplopia ptosis anisocoria
68
What are some common causes of atherosclerosis of large vessels
hyperinsulinemia dyslipidemia hyperglycemia
69
Which type of diabetes is at higher risk of nonalcoholic fatty liver disease
type 2 *tx with diet/exercise/weight loss
70
What are rheum complications of DM
Dupuytrens CTS Adhesive capsulitis sclerodactyl
71
How often should a foot exam be preformed with diabetes
at least 1x/year (more is preferred)
72
How often should retinal exams be preformed with DM
Annually w/ retinopathy min every 2yr w/o retinopathy
73
When should Spot or 24hr urine be completed with DM
annual with serum creatinine
74
What is DKA
Diabetic ketoacidosis *random BG >200mg/dL symptoms will progress rapidly
75
What is the advantage of basal insulin
it controls glucose production between meals and overnight
76
What is the advantage of bolus insulin
Limits hyperglycemia after meals
77
What is the dosing for insulin
.4 - 1.0 units/kg/day
78
In what instances does the total daily insulin need to be increased
Puberty pregnancy medical illness
79
How does insulin concentration in an injection effect the absorption rate
The higher the concentration number, the longer it will take the insulin to absorb
80
What are some adverse reactions to insulin
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
How much glucose is the preferred treatment for hypoglycemia
15-20g
82
What is the diagnostic criteria of DKA
Diabetic (Glucose >200) Keto (Ketonuria) Acidosis (PH <7.3)
83
What things can induce DKA
Infection infarction iatrogenic incision intoxication initial insulin
84
If a patient in DKA is also in shock, what type of fluid management do you give
Bolus 2-3 liters of normal saline STAT
85
What is the IV fluid management in someone with DKA NOT in shock
1 liter Normal saline over 1 hour
86
What are the steps of treating DKA
Fluid replacement Electrolyte replacement (Na+, K+) Insulin drip *Once glucose is <200, switch to D5 to prevent hypoglycemia
87
What is the leading cause of death in children presenting with DKA
Cerebral edema
88
Which diets are effective strategies at trying to manage glucose intolerance
mediteranean and DASH
89
When does insulin resistance generally start before a clinical diagnosis of DM is given
4-7 years
90
What are some common risk factors for DM2
obesity + FH hx HTN Dyslipidemia
91
Who should be screened for T2DM and when
People >35 and at risk Q3 years and labs are normal
92
What tests are ordered to screen for T2DM
FPG HbA1C plasma glucose
93
How do those with T2Dm present
Usually asymptomatic *may present with hyperglycemia or other diabetic complications that have been present for a while
94
What are the signs and symptoms of T2DM
Polyuria, Polydipsia, orthostatic hypotension, dehydration
95
What is the criteria for diagnosing someone with T2DM
*ONE of the following FPG >126 Random glucose >200 2hr plasma glucose >200 HbA1C >6.5%
96
Is HbA1C something that can be used to diagnose gestational diabetes or T1DM
no

Endocrine Clin med (6 decks)

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