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diabetes mellitus Flashcards

1
Q

what is diabetes mellitus?

A

a group of disease characterized by high blood glucose concentrations (hyperglycemia) resulting from defects in…
- insulin secretion
- insulin action
- both

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2
Q

what is insulin?

A

a hormone produced ONLY by the beta cells of the pancreas
- it is necessary for the use or storage of body fuels (Carb, fat, protein)

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3
Q

diabetes mellitus contributed to a considerable increase in morbitity and _
- can be reduced through _________________

A

mortality
can be reduced through early diagnosis and treatment

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4
Q

correct labeling of a type of diabetes is less important than developing an understanding of the pathogenesis of _

A

hyperglycemia

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5
Q

what is prediabetes?

A

prediabetes is when someone has impaired fasting glucose (IFG) AND impaired glucose tolerance (IGT)

impaired fasting glucose = fasting plasma glucose between 6.1 and 6.9 mmol/L

impaired glucose tolerance = plasma glucose of 7.8 - 11.0 mmol/L 2 hours after an oral glucose test

Hgb A1C between 6.0 - 6.4%

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6
Q

people with prediabetes should be counselled in
.
.
to lower their risk of a diabetes diagnosis

A

consuming a blanced diet
getting adequate / increased physical activity

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7
Q

what are the symptoms of type 1 diabetes?

A

excessive thirst (polydipsia)
frequent urination (polyuria)
significant weight loss

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8
Q

what is the primary defect related to type 1 dm and what does it result in

A

primary defect is pancreated B-cell destruction, typically resulting in absolute insulin deficiency, which leads to:
- hyperglycemia
- polyuria
- polydipsia
- polyphagia (excessive hunger)
- unexpected weight loss
- dehydration
- electrolyte disturbance
- ketoacidosis

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9
Q

when does type 1 DM usually develop?

A

can develop at any age
- typically diagnosed before 30
- onset most common between 10 - 14

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10
Q

those with type 1 DM are dependent on…

A

exogenous insulin

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11
Q

there are 2 forms of T1DM

A
  1. immune mediated
    - results from autimmune destruction of the pancreas’ B-cells
  2. idiopathic
    - forms of the disease with no known cause
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12
Q

what two immune mediated diseases are more prevalent in people with T1DM?

A
  1. autoimmune thyroid disease
  2. celiac disease
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13
Q

explain the 4 markers of immune destruction of the B-cells)

A
  1. islet cell antibodies
  2. autoantibodies to insulin
  3. autoantibodies to proteins on the surface of B-cells
  4. autoantibodies to tyrosine phosphates
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14
Q

hyperglycemia and symptoms develop only after …

A

90% of the secretory capacity of B-cells has been destroyed

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15
Q

what is the honeymoon phase?

A

after diagnosis and the correction of hyperglycemia, metabolic acidosis and ketoacidosis, endogenous insulin secretion will frequently recover
- for a brief period (~1 year) exogenous insulin requirements may dramatically decline and optimal metabolic control may be easy to achieve

however, it is inevitale that increased exogenous replacement for insulin will ne needed

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16
Q

explain T2DM

A

it is a progressive disease
- frequently present before it is diagnosed
- hyerglycemia develops gradually and is often not severe enough in early stages for an individual to notice any classic symptoms of diabetes

most with T2DM have BMIs of 30 or higher
- higher weight may increase insulin resistance and contribute to B-cell destruction

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17
Q

what are the risk factors of T2DM

A
  • family history of DM
  • older age
  • physical inactivity
  • prior history of gestational DM
  • HTN
  • prediabetes
  • dyslipidemia ( high cholesterol)
  • race/ethnicity
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18
Q

combination of insulin resistance and B-cell failure leads to _

A

hyperglycemia

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19
Q

hyperglycemia is first exhibited as increased _ _ _
followed by an increase in _ _ concentrations
then begin to see increased _ _ _ levels

A

postprandial blood glucose (post meal)
fasting glucose concentrations
pre-prandial blood glucose levels

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20
Q

degenerative nature of T2DM means that…

A

over time, the individual will require more medication to maintain the same level of glycemic control
- eventually exogenous insulin will be required
- insulin will also likely be required sooner for control during periods of stress-induced hyperglycemia, such as during illness or surgery

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21
Q

gestational diabetes increases a mothers risk of _ during pregnancy and having a _ baby, requiring C-section

A

hypertension
large (macroscopic) baby

22
Q

GDM also increases the baby’s risk of:

A
  • premature labour
  • having low blood sugar
  • developing DM later in life
23
Q

15-25% of women with prior GDM will develop T2DM within _ - _ years post pregnancy

A

1-2 years

24
Q

treatment of GDM includes

A
  • checking blood sugar regularly
  • eating a balanced diet
  • being active
  • monitoring babys development and growth

most dont require medication to achieve optimal blood glucose ranges

25
Q

Those diagnosed in the first trimester of pregnancy are diagnosed with _ not _

A

DM not GDM

26
Q

when does GDM screening occur? and when is it diagnosed

A

between 24-48 weeks of gestation
-most often diagnosed in the 2nd and 3rd trimester due to:
increased insulin-antagonist hormone levels
insulin resistance

27
Q

what are the 2 strategies for screening for GDM? Explain them

A
  1. one step: 75 G oral glucose tolerance test
    - considered positive if
    (fasting glucose is 5.1 mmol/L or higher
    1 hour after is 10 mmol/L or higher
    2 hours after is 8.5 mmol/L or higher)
  2. two step: 1 hour 50 g (non fasting screen)
    (if plasma glucose at 1 hour post is higher than 11.1 then GDM is diagnosed
    if between 7.8 and 11.0 at 1 hour after, follow with a 75 gram oral glucose tolerance test
    - this is considered positive in diagnosing GDM if:
    fasting glucose is 5.3 mmol/L or higher
    at 1 hour fasting glucose is 10.6 mmol/L or higher
    at 2 hours fasting glucose is 9.0 mmol/L or higher)
28
Q

extra glucose from the mother crosses the fetal placenta and the fetus’ _ responds by releasing extra _ to cope with the excess glucose

excess glucose is converted to fat resulting in large baby

A

pancreas
insulin

29
Q

what is neonatal hypoglycemia?

A

baby is conditioned to produce excess insulin in utero, which becomes unnecessary when disconnected from mom
- the baby may require extra glucose through IV for the first few days to keep blood glucose levels normal

30
Q

those with GDM should be screened for DM _ - _ weeks post partum and should have lifelong screening for prediabetes / diabetes every _ years

A

4-12 weeks
3 years

31
Q

Screening for DM should be considered in all adults who are overweight AND have 1 or more of the following:

A
  • physical inactivity
  • 1st degree relative with DM
  • member of a high risk population
  • hypertensive (bp of 140/90 or higher)
  • HDL less than 0.9 and or triglycerites higher than 2.82)
  • diagnosed with PCOS
  • history of cardiovascular disease
32
Q

besides being over weight with the addition of 1 or more other factors to be considered for DM screening, what else makes one a candidate for DM screening?

A
  • patients with prediabetes (A1C of 6.0) should be tested yearly
  • women diagnosed with GDM should be tested every 3 years
  • for all others, begin testing at 45, if results are normal test every 3 years
33
Q

criteria for risk based screening for T2DM or prediabetes in asymptomatic children

A

overweight plus one of the following:
- family history in 1st or 2nd degree relatives
- race/ethnicity
- signs of insulin resistance
- maternal history of GDM or DM

34
Q

what is the most reliable measure of chronic glucose levels?

A

A1C assay

35
Q

what is the only drug that should be considered for prevention of diabetes?

A

metformin

36
Q

MNT for prediaebets recommends to limit intake of:
.
.
.

A
  • sugar sweetened beverages
  • saturated fatty acids
  • trans fatty acids
37
Q

achieving glycemia as close to the nondiabetic range as safetly as possible reduces all _ and _ complications of diabetes

A

microvascular and cardiovascular

38
Q

good control of _ _ decreases long term complications in T2DM

A

blood pressure

39
Q

medical management of diabetes includes:
.
.
.
.
.
.

A
  • MNT
  • physical activity
  • blood glucose monitoring
  • medications
  • self-management education
  • self management support
40
Q

medical team should provide individuals with diabetes with the necessary tools to achieve the best control of:
.
.
.

A

glucose
lipids
blood pressure

41
Q

ongoing monitoring of blood glucose involves:
.
.
.
.

A
  • self-monitoring of blood glucose
  • urinalysis for ketones
  • assessment of blood ketones
  • Hbg A1C (longer term)
42
Q

what blood pressure reading should we aim for

A

less than 140/90

43
Q

what should we aim for (TG and HDL) to prevent dyslipidemia?

A

TG 1.7 mmol/L or less
HDL 1.0 mmol/L or more for men
HDL 1.3 mmol/L or more for women

44
Q

effect of MNT on A1C will be known within _ weeks to _ months

A

6 weeks to 3 months

45
Q

what are the goals of MNT for adults with DM?

(4)

A
  1. promote and support healthy eating patterns
  2. address nutrition needs based on preferences ,health literacy and availability
  3. maintain pleasure of eating
  4. provide tools for day to day meal planning
46
Q

for type 1 and type 2 DM how much should A1C levels be reduced?

A

T1DM = reduce by 1 - 1.9%
T2DM = reduce by 0.3 - 2%

47
Q

for children with T1DM, what should be monitored at every visit?

A

height and weight

48
Q

when recommending one eating pattern vs another, consider:
.
.

A

personal preferences
metabolic goals

49
Q

one carb choice or serving is a portion of food containing _ g of carbs

A

15

50
Q

what are the 2 main types of plans incorporating carb counting?

A
  1. insulin to carb ratios to adjsut premeal insulin dose for variable carb intake
  2. consistency ( with fixed amounts of carbs at meals and snacks) to accommodate fixed insulin / medication regimes
51
Q

what does glycemic index do?

A

ranks CHO foods by how they are presumed to effect blood glucose levels
- compared the physiologic effects of CHO on glucose
( does NOT measure how rapidly blood glucose levels increase )

clinical exam (3 decks)

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