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Med Path Fall 2020 > Diabetes I > Flashcards

Diabetes I Flashcards

1
Q

When is insulin released and what are its two roles?

A

High glucose levels in the blood triggers insulin release from the pancreas. Insulin has two actions that help the body control the blood glucose levels:

  1. Helps insulin travel from bloodstream to inside cells. Can be used for energy.
  2. Stops the liver from releasing more glucose into the blood from its stores of glycogen.
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2
Q

Define Diabetes Mellitus

What two things cause it?

A

Hyperglycemia. Elevated blood glucose levels due to:

  1. Failure of the pancreas to produce sufficient amounts of insulin.
    AND/OR
  2. Resistance of the body’s cells to the action of insulin.
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3
Q

What is the defining feature of diabetes

A

Hyperglycemia causes tissue injury= vascular damage is the primary pathology that happens all over the body

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4
Q

What two things can cause hyperglycemia?

A

Excessive glucose production by the liver (insulin usually tells liver to stop releasing glucose)
Impaired glucose clearance (cells can’t absorb blood glucose)

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5
Q

Normal blood glucose ranges

  1. Fasting
  2. Random
  3. A1C
  4. Oral glucose (OGTT)
A
  1. 70-99
  2. less than 140
  3. Less than 5.7%
  4. less than 140
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6
Q

What two blood glucose tests do we do in clinic?

A

Random and A1C

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7
Q

Diagnostic criteria for diabetes by single reading

  1. Fasting
  2. Random
  3. A1C
  4. Oral glucose (OGTT)
A
  1. 126+
  2. 200+
  3. 6.5% +
  4. 200+
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8
Q

Pre diabetes criteria

  1. Fasting
  2. Random
A
  1. 100-125

2. 140-199

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9
Q

What is hemoglobin A1C

A

Minor component of hemoglobin that binds glucose.
Tells average blood glucose conc over 2-3 months (lifespan of RBC)
More blood sugar= higher A1C

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10
Q

Normal, average pt with diabetes and goal for A1C levels

A

Normal- less than 5.7
Average for pt with diabetes- 8.5
Goal is less than 6.5 for newly diagnosed

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11
Q

What blood glucose reading predicts the likelihood of disability and death

A

A1C. Leads to more complications in the body.

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12
Q

Only __% of people know their last A1C reading

A

24%

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13
Q

How to estimate average glucose (eAG) based on A1C

A

A1C of 6%= 125 mg/dl glucose level in blood

Add 30 mg/dl for every 1% over 6%

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14
Q

Oral glucose tolerance test (OGTT)

A

Measurement after fasting
Ingest 75-100mg of glucose
Measure blood glucose at 1, 2, and 3 hours later.

Body should be able to clear it. If not, could indicate gestational diabetes.

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15
Q

Most common endocrine disorder in the US:

A

Diabetes Mellitus
9-11% of the pop
Rates are increasing

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16
Q

Race, gender, location, age that are more likely to get diabetes

A

Race: Native americans, AA, hispanic
Gender: Females
Location: South
Age: 65+

Overweight and sedentary lifestyle are main risk factors

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17
Q

Diabetes is the #__ cause of death in the US

A

7

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18
Q

3 major diabetic complications that we care about

A
  1. Retinopathy
  2. Cerebrovascular disease- stroke
  3. Neuropathy. CN palsy
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19
Q

Diabetes is the leading cause of which 3 complications?

Major contributor to which 2 things?

A 
Kidney failure (will need dialysis to filter blood)
Non traumatic lower limb amputation
New cases of blindness in adults due to retinopathy

Major contributor to:
Heart disease
Stroke

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20
Q

Diabetes symptoms

A

Polyuria
Polydipsia
Polyphagia- cells not uptaking glucose. Will signal that body is still hungry.
Blurred vision
Weight loss - Body may break down muscle/fat to get energy since not getting energy from blood glucose
Extreme fatigue
Slow healing sores- blood vessels not working
Frequent infections
Tingling of numbness in hands/feet- neuropathy

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21
Q

Glucosuria

A

Glucose in the urine. Occurs if levels are above 200mg/dl. Kidney cannot keep up and will cause frequent urination–> Dehydration –> polydipsia.

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22
Q

Absolute or significant deficit of insulin

A

Type 1

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23
Q

Most common form of diabetes

A

Type II (95%)

24
Q

Peripheral insulin resistance and insufficient insulin production

A

Type II

25
Q

3 types of “other” diabetes

A
  1. Surgery induced. Ex: remove pancreas
  2. Medications (cortisol, corticosteroids)
  3. LADA, MODY
26
Q

Pre-diabetes

  • Symptoms
  • Underlying problem
  • Increased risk of ___
  • 50% risk over 10 years of developing __
A
  • Asymptomatic
  • Insulin resistant in periphery.
  • Cardiovascular pathology
  • Type II
27
Q

Prediabetes risk factor

A

*overweight
*sedentary life style
Older than 45
Family Hx of type II
Race
BMI over 25
Gestational diabetes
Having baby over 9lbs
Polycistic ovary syndrome- attack insulin
HTN
Hyperlipidemia (TG over 150 or HDL under 40)

28
Q

How many people have Type I

A

5-10%

29
Q

Cause of Type I

A

Pancreatic atrophy and loss of beta cells (80-90-100% beta cell loss)

30
Q

When does Type I develop

A

Childhood or early adulthood

31
Q

Two types/causes of Type I diabetes

A
  1. *Immune mediated. Can be due to body attacking normal beta cells (molecular mimicry due to viral infection) or body attacking abnormal cells due to damage.
  2. idiopathic.
32
Q

Tx of Type I

A

Injectable insulin or pump

*Insulin cannot be given orally- it is a protein that would be broken down in GI

33
Q

Type I risk factors

A 
M=F
Illness in early infancy
Family History 
Older mom at birth 
Mom had pre-eclampsia 
Have other autoimmune diseases: Graves, addisons, MS, hashimotos. Body already primed to attack itself.
34
Q

% of diabetes type II

A

90-95%

35
Q

What causes diabetes type II

A

Polygenic disorder
*Insulin resistance
Decreased insulin production occurs too.

36
Q

Type II clinical manifestations

A 
Cardiovascular damage
Vision probs
Neuropathy 
Recurrent infections
Renal failure
37
Q

Type II risk factors

A 
Sedentary lifestyle
Obesity 
Family hx of diabetes
History of gestational diabetes
Impaired glucose metabolism 
Age
Race
38
Q

Type 2 tx

A

Diet
Excercise
Tx obesity
Meds- oral or injectable

39
Q

What is gestational diabetes. How many pregnancies does it complicate?

A

Glucose intolerance that develops during pregnancy due to increased estrogen and progesterone that antagonizes insulin. Therefore, insulin does not work as well and causes a higher blood sugar level.

Complicates 2-10% of pregnancies, usually temporary

40
Q

Gestational diabetes increases the risk of type II diabetes by how much

A

50% over next 10-20 years

41
Q

Gestational diabetes risk factors

A

Race: AA, hispanic, native americans
Obesity
Family Hx of diabetes

42
Q

Gestational diabetes dx and tx

A

Dx: By OGTT
Tx:
-insulin is DOC
-Oral meds are second choice: metformin, glyburide (category B-safe)

43
Q

LADA (latent autoimmune diabetes of adults)

  • Due to what
  • Age onset
  • Tx?
A

Type 1.5 diabetes

  • Slowly progressive B cell failure of the pancreas
  • Onset around 30 years, slim and fit
  • Oral meds initially, insulin eventually needed once all B cells fail
44
Q

MODY (maturity onset diabetes of the young)

  • What type of genetic transfer
  • Due to what
  • Age onset
  • How many % have it
  • Tx
  • Often misdiagnosed as
A

Early onset of type II

  • Autosomal dominant. Do genetic testing
  • Due to ineffective insulin production/release.
  • Late teens or early 20s
  • Rare (1-5%)
  • Oral meds effective for most, insulin maybe later
  • Misdiagnosed as type 2. lots of similarities.
45
Q

diabetes plays a role in what syndrome

A

Metabolic

46
Q

What is metabolic syndrome

A

A cluster of conditions that occur together.

47
Q

How to diagnose metabolic syndrome

A

Requires 3 or more fo the following:

Fasting over 100
TG over 150 (or on meds for TG)
HDL under 40 (or on meds for HDL)
Blood pressure over 135/85 (or on meds for HTN)
Large waistline
-Women (35+)
-Men (40+)
-Apple shape
48
Q

Metabolic syndrome affects how much of the population

A

23-25%

49
Q

3 facts that metabolic syndrome SIGNIFICANTLY increases the risk of

A

CHD (2x)
Diabetes (5x)
Stroke

50
Q

Metabolic disease is associated with

A

Obesity
Sedentary lifestyle
Insulin resistance

51
Q

Metabolic disease is preventable with

A

Diet, exercise, meds.

52
Q

Can take oral meds for which types

A

Type II

MODY

53
Q

Can take insulin for which types

A

Type I
Type II
MODY
LADA

54
Q

What 3 activities can increase insulin sensitivity?

A
  1. Cardio + strength training
  2. Cardio alone (40-60 mins)
  3. Strength training alone.
55
Q

Questions to ask all diabetic pts

A

When did you last PCP, when are you going back?
BG reading- when, what is it, what’s normal range?
Last A1C?
Any vision changes

Med Path Fall 2020 (20 decks)

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