Flashcards in Diabetes Mellitus Deck (68)
What is the pathophysiology of DM type 1?
An autoimmune disease (immune system mediates destruction of pancreatic beta-cells)
Is type 2 DM are pts insulin resistant or insulin dependant?
Insulin Resistant - d/t obesity
What are 3 risk factors of type 2 DM?
2. Genetics (maternal more so)
3. Age (insulin production decreases w/ age)
What is the onset, age at onset, body habitus and the chance of ketosis in type 1?
- Onset: Sudden (sometimes appear after an illness)
- Age: Any age, usually young
- Body Habitus: usually thin
- Ketosis: Common (DKA)
What is the onset, age at onset, body habitus and the chance of ketosis in type 2?
- Onset: Gradual
- Age: Adults (usually)
- Body Habitus: Obese
- Ketosis: Rare
What is the dawn phenomenon d/t and is it related to the Somogyi effect?
- D/t an increase in nocturnal secretion of GH
- Independent of the Somogyi effect
What is the Somogyi effect and what occurs when you are sleeping?
- Rebound response to nocturnal hypoglycemia
- Counterrefulatory systems are activated in response to hypoglycemia, leading to nocturnal hyperglycemia.
If pt checks blood glucose at 3 AM and glucose is elevated is it Dawn or Somogyi?
If pt checks blood glucose at 3 AM and glucose is low is it Dawn or Somogyi?
What is the recommended screening for type 2 DM? How often should you repeat screening?
- Adult w/ BMI > 25 and at least one risk factor
- Age 45 if normal BMI and no risk factors
- repeat screening q 3 yrs
What is the American Diabetes Association Dx criteria or DM?
- Sxs of DM + random BG [ ] of >200
- Fasting BG of >126 on 2 separate occasions
- BG of >200, 2 hrs after a 75g glucose load during OGTT
- Hgb A1c: >6,5% (repeat test should occur several months as opposed to next day)
What is the range of Hbg A1c in a pt with impaired fasting glucose?
5.7% - 6.4%
What are the 3 polys associated with DM?
What is polyuria and what does it cause?
Glucose in renal tubule causes osmotic retention of water causing diuresis
What is polydipsia?
A physiologic response to diuresis to maintain plasma volume
What is polyphagia?
A physiologic response to the inability for cells to take in and use glucose
Why does fatigue occur in DM?
Unknown but likely d/t increased glucose in plasma
What eye problem occurs in pts with DM and what is it d/t?
Blurred vision- swelling of lense d/t osmosis
What infections occur in DM pts? and where do the infections most commonly occur?
- Mouth and vaginal - Candida Albicans
What occurs to the extremities in pts with DM?
Neuropathy- Numbness, tingling of hands and feet
What are the causes of mononeuropathy and polyneuropathy?
- Mono: d/t microscopic vasculitis leading to axonal ischemia
- Poly: multifactorial
When should a pt monitor glucose after meals and why is that important?
90-120 min enables the pt to control postprandial hyperglycemia?
How often should you screen a pt for microalbuminuria and how do you tx for postie microalbuminuria?
- Screen 1x per yr w/ eGFR, in DM pts w/ no evidence of nephropathy
- Tx if positive: ACE or ARB
How often do you order eye screening for DM and who do you refer to Optometrist or Ophthalmologist?
Yearly by Ophthalmologist
How often do you check for peripheral neuropathy in DM pts? Who do you refer to and what type of pt would you need to refer?
Check feet every visit!
- refer to Podiatrist for high-risk pts (ulcers)
How often do you check Cholesterol? and when should you give statin therapy?
- Once a yr
- Give statin in LDL is > 100
How often do you check B/P and when should medication (ACE or ARB) be considered?
- Check at every visit
- Tx if >130/80
What vaccine should be UTD in all DM pts?
What should ideally be the only intervention in most type 2 DM pts?
Diet and Exercise