Diabetes lecture 1 Flashcards
1
Q
What is type I diabetes
A
- destruction of pancreatic beta cells -> absolute insulin deficiency
- autoimmune: defined by autoimmune markers
- idiopathic
2
Q
Which type of Diabetes is more associated with diabetic ketoacidosis (DKA)
A
type I
3
Q
exogenous insulin is REQUIRED in what type of diabetes
A
type I
4
Q
What are the 2 autoimmune markers associated with autoimmune type I diabetes
A
- islet cell autoantibodies
- autoantibodies to insulin
5
Q
What test is used to diagnose acute onset of type I diabetes
A
blood glucose
6
Q
clinical presentation
- Polyuria
- Polydipsia
- Polyphagia
- nocturia
- weight loss
- fatigue
- blurry vision
- paresthesias
- DKA
A
type I DM
7
Q
What causes type II diabetes
A
- variable degrees of insulin deficiency and resistance -> hyperglycemia
- genetic and environmental influences
8
Q
type 2 diabetes prevalence increases with what type of obestiy
A
- visceral or central obesity
9
Q
list the 4 characteristics of type 2 DM
A
- insulin resistance
- impaired insulin secretion
- excessive hepatic glucose production
- abnormal fat metabolism
10
Q
insulin resistance causes
A
- impaired glucose tolerance -> hyperglycemia
11
Q
List the stages leading to type 2 diabetes
A
- peripheral insulin resistance -> hyperinsulinemia -> impaired glucose tolerance -> increased hepatic glucose production -> overt diabetes -> fasting hyperglycemia -> B-cell failure
12
Q
Clinical presentation
- Polyuria
- Polydipsia
- blurry vision
- chronic skin infections
- paresthesia
- poor wound healing
- vulvovaginitis
A
type II DM
13
Q
Having a family history of DM is more common in type I or type 2 DM
A
- type 2 DM
14
Q
Who should be screened for DM
A
- asymptomatic adults of any age who are overweight or obest (BMI >25) and who have one or more additional risk factors
- all adults beginning at age 45, regardless of weight
15
Q
what ethnicities are at a higher risk for diabetes
A
- african american
- latino
- native american
- asian american
- pacific islander
16
Q
Name the risk factors: criteria for testing for DM or prediabetes in asymptomatic adults
A
- physical inactivity
- first degree relative with DM
- high risk ethnicity
- woman who delivered a baby > 9lbs or diagnosed with GDM
- HTN
- HDL < 35; Triglyceride level >250
- women with PCOS
- severe obesity
- CVD
17
Q
What are the 4 criteria for diagnosing diabetes
A
- FPG > or = 126 mg/dl*
- 2-hr plasma glucose > or = 200 mg/dl during 75 g OGTT (oral glucose tolerance test)*
- A1C > or = 6.5% *
- in a patient with classic sx of hyperglycemia with a random glucose > or = 200 mg/dl
* in absence of unequivocal hyperglycemia, results should be confirmed by repeat testing
18
Q
What are the 3 diagnostic criteria for prediabetes
A
- impaired fasting glucoseFPG 100-125 mg/dl
- impaired glucose tolerance: 2-hr plasma glucose after 75 g OGTT 140-199 mg/dl
- increaed average blood glucose level: A1C 5.7-6.4%
19
Q
if tests are normal, current recommendation is to rescreen every
A
3 years
20
Q
managment of prediabetes
A
-
prevention
- lifestyle modification
- counseling
- metformin therapy ?
- annual monitoring
21
Q
What are common comorbidities with DM
A
- fatty liver disease
- obstructive sleep apnea
- low testosterone
- periodontal disease
- hearing impairment
22
Q
physical exam for a diabetic patient must include
A
- BMI
- BP
- fundoscopic exam
- thyroid
- skin exam
- comprehensive foot exam
23
Q
What does the A1C measure
A
- the average blood glcose for the past 2-3 months
- no fasting required
24
Q
how often should A1C be checked
A
- performed at least twice a year for those who meet tx goals
- every 3 months when therapy has changed or not meeting glycemic goals
25
Only blood glucose, not A1C, should be used to dx people with
* conditions associated with increased RBC turnover
* **hemoglobinopathies**
* **anemia**
26
a jump of 1 A1C (e.g. 6-7) means what
* mean plasma glucose has increased 30 mg/dl
* A1C of 6% =\> mean plasma glucose 126 mg/dl
27
recommendations for A1C, preprandial plasma glucose, and peak postprandial glucose for nonpregnant adults with DM
* A1C: \< 7.0%
* preprandial plasma glucose: 80-130
* peak postprandial glucose: \<180
28
insulin level is helpful in evaluating a patient with
* hypoglycemia
* would normally see insulin levels low, but if insulin excess is present =\> insulinoma?
29
what is C-peptide
fragment of endogenously produced proinsulin -\> split from proinsulin as insulin is formed
30
low or undetectable levels of plasma C-peptide means
little or no insulin secretion
* helpful in differentiating type 1 from type 2 DM
31
What are the 3 microvascular complications of DM
1. retinopathy
2. neuropathy
3. nephropathy
32
What are the macrovascular complications of DM
atherosclerotic cardiovascular disease
33
diabetic retinopathy can result in
* glaucoma, cataracts or blindness
34
what are the two types of diabetic retinopathy
1. **nonproliferative**: retinal hemorrhage, lipid exudates, cotton wool spots
2. **proliferative**: neovascularization at the disc
35
nonproliferative diabetic retinopathy is associated with
* retinal hemorrhage
* lipid exudates
* cotton wool spots
36
what are the 2 main categories of diabetic neuropathy
1. diabetic periphearl neuropathy
2. diabetic autonomic neuropathy
37
clinical presentation
* **"stocking-glove" sensory loss**
* impairment of pain, light touch, and temp
* burning
* tingling
* numbness
* loss of vibratory sensation
* decreased ankle reflexes
* loss of protective sensation
diabetic peripheral neuropathy
38
complications of diabetic peripheral neuropathy
* ulceration
* amputation
39
what foot deformity puts a person at risk for developing ulcers or amputations
charcot foot
40
what clinical tests can be done to assess for diabetic neuropathy
* 10-g **monofilament test**
* temp
* vibration sensation
* ankle-brachial index
41
clinical manifestations
* hypoglycemia unawareness
* resting tachycardia
* orthostatic hypotension
* gastroparesis
* constipation
* diarrhea
* ED
* neurogenic bladder
* increased or decreased sweating
* **diabetic autonomic neuropathy**
* can affect CV, GI, GU, or neuroendocrine systems
42
who is at risk for developing ulcers or amputations
* h/o foot ulcer or amputation
* charcot foot
* peripheral neuropathy
* callus or corn
* visual impairment
* diabetic nephropathy
* cigarette smoking
* PAD
43
What is the leading cause of ESRD
diabetic kidney disease
44
how is diabetic kidney disease screened for
* **albuminuria**
* ****urinary albumin-to-creatinine ratio (UACR)
* 2-3 specimens collected within 3-6 month period
* albuminuria \> or = 300 are likely to -\> ESRD
45
tx diabetic kidney disease
* glycemia and BP control
* ACE-I/ARB
46
What conditions fall under atherosclerotic cardiovascular disease
* ACS
* h/o MI
* stable/unstable angina
* stroke/ TIA
* PAD
47
what is the leading cause of morbidity and mortality for those with diabetes
atherosclerotic cardiovascular disease
48
risk factors for atherosclerotic cardiovascular disease
* dyslipidemia
* HTN
* smoking
* FH premature coronary dz
* albuminuria
