Diabetes Mellitus Flashcards Preview

FAMILY MEDICINE > Diabetes Mellitus > Flashcards

Flashcards in Diabetes Mellitus Deck (30)

Different criteria for diagnosis of DM (name 4)

1. Fasting glucose greater than 126
2. Plasma glucose greater than 200 after 2 hour GTT (75 g glucose load)
3. Any plasma glucose over 200 + symptoms (polydipsia, polyuria, etc)
4. HbA1c 6.5% or more


What can you measure to differentiate between T1DM and T2DM

C-peptide and insulin levels


When does glucosuria occur?

When bood glucose level is greater than renal "threshold"; often at serum level of 180 which corresponds to HbA1c of 8%

So absence of glucose on urinalysis does not exclude DM!


What other physical symptoms are more consistent with T2DM

HTN, acanthosis nigracans, obesity...all overt signs of insulin resistance


Upon initial dx of DM, and regulary after dx, what testing?

fasting lipid profile, serum creatinine and creatinine ratio, U/A, urinemicroalbumin, annual dilated eye exams, regular foot exam, ECG and thyroid dx screening with TSH (in T1DM)


General approach to treatment of DM

aimed at secondary prevention of macrovascular (CAD, cerebral/peripheral vascular dx) and microvascular (retinopathy, nephropathy, and neuropathy) complications


Pathophysiology of T1DM (aka IDDM)

not entirely known, may be autoimmune that attacks pancreatic B cells, thereby rendering body unable to produce insulin...body is then unable to metabolize glucose and carbs, so must resort to metabolizing fats...leading to ketones



syndrome characterized by hyperglycemia, high levels of serum acetone, b-hydroxybutarate, and anion gap metabolic acidosis

usually happens under stress or when person forgets to take insulin


Treatment of DKA

emergent hospitalization for IV hydration with NS, correction of acidosis and electrolyte disturbances (give K), aggessive insulin mgmt, evaluation for underlying cause


Pathophysiology T2DM (NIDDM)

insulin resistance in peripheral tissues often due to visceral adiposity and obesity...may have hyperinsulinemia then eventually less insulin
majority of cases, stronger family component


Comlications of T2DM

cardiometabolic syndrome, hyperinsulinemia, HTN, dyslipidemia, hyperglycemia, central obesity


T2DM less prone to developing ketosis and acidosis, but is more prone to ________ states due to high blood sugar


aka hyperosmolar hyperglycemic non-ketotic syndrome (HHNS)


Characteristics of HHNS

blood glucose substantially elevated (often reaching up to 1000), with elevated serum osmolarity and large fluid deficit...severe coma or death may occur due to electrolyte abnormalities, dehydration, and toxic effects of metabolic acidosis


How to treat HHNS

similar to DKA;
hospitalization, aggresive rehydration, with NS and electrolyte correction; insulin and treatment of underlying disorder


GDM (gestational DM)

increased levels of human placental lactogen (hpL), estrogen and progesterone produced by placenta antagonize insulin -> insulin resistance and carb intolerance


Maternal complications of GDM

hyperglycemia, DKA, increased UTI, increased HTN/pre-eclampsia, retinopathy


Fetal complications of GDM

congenital malformations, macrosomia, RDS, hypoglycemia, hyperbilirubinemia, hpocalcemia, polycythemia, and hydramnios


What are mothers who have GDM more at risk of after pregnancy and how to mitigate this risk

T2DM, should be screened with GTT postpartum and annual diabetic screening


When to screen for GDM and how to screen

between 24-28 weeks
first with 1hr 50 g GTT....
then if that shows greater than 140, do 3 hr 100g GTT, which takes fasting, 1hr, 2hr, and 3hr measurements...
if 2 or more abnormal values (95,180,155,140)...then that is diagnosis


How to treat GDM

strict dietary mgmt, and if necessary oral diabetic agents with or without insulin.


Once GDM is diagnosed, what must be monitored for during pregnancy

Increased surveillance for UFD (uterine fetal demise)


Goals to achieve "controlled status" in diabetic patient

- strict glycemic control with goal a1c of less than 7


Treatment for T1DM

- insulin administration (usually short acting before meals + long acting basal insulin) via injection or pump (if labile sugar)
- strict glucose monitoring
- calorie restricted and low carb diet and exercise


First line medication of T2DM

biguanides (METFORMIN)


Biguanide mechanism

act on liver to decrease gluocse output during gluconeogenesis.

secondary: improved insulin sensitivity in liver and muscle; possible decrease in intestinal absorption of glucose


Other advatnages of metformin

no risk of hypoglycemia, good for weight loss, reduced serum insulin levels, reduction in triglycerides and LDL


Metformin side effects common and dangerous

common: nausea and diarrhea

dangerous: development of lactic acidosis caused by renal insufficency and CKD (contraindication in patients with Cr> 1.4-1.5)


Is metformin safe for pregnancy?

Yes; Cat B, also good for children older than 10


Examples of sulfonlyureas

glimepiride glyburide, glipizide


Mechanism of sulfonylureas

insulin secretagogues that stimulate pancreatic B cells to secrete insulin