Diabetes Mellitus Part I Flashcards Preview

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Flashcards in Diabetes Mellitus Part I Deck (51)
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1

Leading cause of ESRD

DM

2

Causes of secondary diabetes

Genetic defects (monogenic DM or maturity onset diabetes of young and autosomal dom.)
Diseases of exocrine pancreas (CF)
Drug or chemical induced (steroids)

3

What secretes beta cells?

Insulin

4

What occurs in type 1 diabetes?

Destruction of pancreatic beta cells leading to absolute insulin deficiency
-requirement of insulin therapy

5

Causes of Type 1 DM

Autoimmune (glutamic acid decarboxylase GAD 65, islet cell antibodies)
Idiopathic

6

What is latent autoimmune diabetes of adults?

Form of slow onset type 1 DM (so think when they are older and do not respond to normal type 2 tx)

7

What are pts with type 1 prone to?

Other autoimmune disorders

8

Features of T1DM

Polyuria, polydipsia, polyphagia, DKA (classic)
Nocturia, weight loss, blurry vision, fatigue, paresthesias, infections

9

Most common type of DM

Type 2

10

What is type 2 DM?

Variable degrees of insulin deficiency and insulin resistance leading to hyperglycemia
Gradual onset

11

When does the prevalence for T2DM increase?

With obesity (b/c visceral obesity correlated with insulin resistance)

12

Pathophysiology of type 2

Insulin resistance (no glucose utilization and more glucose output)
Abnormal fat metabolism (fatty liver)
impaired insulin secretion b/c of beta cell burn out

13

What are you beginning to see with prediabetes?

Impaired glucose tolerance

14

What are most pts with type 2?

Asymptomatic

15

Features of type 2

3 Ps, nocturia and blurry vision with hyperglycemia
Paresthesias, fatigue, chronic skin infections, poor wound healing, vulvovaginitis, balanitis, hyperglycemia hyperosmolar state, DKA (lower frequency type 2)

16

What does acanthosis nigricans indicate?

Insulin resistance

17

Which one tends to have a FH of DM?

Type 2

18

Who should be tested for prediabetes or type 2?

Considered when overweight or obese (BMI>25 or >23 in Asian Americans) or adults who have one or more additional risk factors
Everyone else should start at 45

19

Risk factors for DM

First degree relative history
Race/ethnicity (AA, hispanic, indian, asian)
Hx of CVD
HTN
HDL<35 and/or TAG>250
Women with PCOS/GDM
Inactivity
Severe obesity and acanthosis nigricans

20

Test options for DM

Fasting plasma glucose
2 hr oral glucose tolerance test
HbA1c

21

What is HbA1c?

Indirect measure of avg blood glucose for past 3 mos
More convenient
Need to take some factors into consideration

22

What is a strong predictive value for DM complications?

HbA1c

23

Diagnostic criteria for prediabetes for all 3 tests

FPG: 100-125 (IFG)
OGTT: 140-199 (IGT)
HbA1c: 5.7-6.4

24

Diagnostic criteria for DM for all 3 tests

FPG >126
OGTT>200
HbA1c>6.5
*must always get a second test to confirm

25

What supports a diagnosis of DM when a pt has sxs of a hyperglycemic crisis?

Random plasma glucose >200

26

Qualifications for prediabetes

Impaired fasting glucose
Impaired glucose tolerance
HbA1c of 5.7-6.4%

27

What to do with a pt with prediabetes?

Educate
Lifestyle management
Counsel and maintenance
Metformin (to prevent type 2)
Test yearly for development of diabetes
Screen for and treat risk factors of ASCVD

28

What to do when the screen of the pt doesn't show prediabetes?

Repeat at minimum 3 yr intervals (but consider more frequent)

29

Important vaccinations for DM care

Hep B, influenza and pneumococcal

30

Common comorbidities of DM

Autoimmune when type 1
Fatty liver disease
Obstructive sleep apnea
Cancer
Fractures
HIV
Low testosterone in men
Periodontal disease
Hearing impairment
Cognitive impairment
Depresion