Flashcards in Diabetes Mellitus Part I Deck (51)
Leading cause of ESRD
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)
What secretes beta cells?
What occurs in type 1 diabetes?
Destruction of pancreatic beta cells leading to absolute insulin deficiency
-requirement of insulin therapy
Causes of Type 1 DM
Autoimmune (glutamic acid decarboxylase GAD 65, islet cell antibodies)
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)
What are pts with type 1 prone to?
Other autoimmune disorders
Features of T1DM
Polyuria, polydipsia, polyphagia, DKA (classic)
Nocturia, weight loss, blurry vision, fatigue, paresthesias, infections
Most common type of DM
What is type 2 DM?
Variable degrees of insulin deficiency and insulin resistance leading to hyperglycemia
When does the prevalence for T2DM increase?
With obesity (b/c visceral obesity correlated with insulin resistance)
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
What are you beginning to see with prediabetes?
Impaired glucose tolerance
What are most pts with type 2?
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)
What does acanthosis nigricans indicate?
Which one tends to have a FH of DM?
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
Risk factors for DM
First degree relative history
Race/ethnicity (AA, hispanic, indian, asian)
Hx of CVD
HDL<35 and/or TAG>250
Women with PCOS/GDM
Severe obesity and acanthosis nigricans
Test options for DM
Fasting plasma glucose
2 hr oral glucose tolerance test
What is HbA1c?
Indirect measure of avg blood glucose for past 3 mos
Need to take some factors into consideration
What is a strong predictive value for DM complications?
Diagnostic criteria for prediabetes for all 3 tests
FPG: 100-125 (IFG)
OGTT: 140-199 (IGT)
Diagnostic criteria for DM for all 3 tests
*must always get a second test to confirm
What supports a diagnosis of DM when a pt has sxs of a hyperglycemic crisis?
Random plasma glucose >200
Qualifications for prediabetes
Impaired fasting glucose
Impaired glucose tolerance
HbA1c of 5.7-6.4%
What to do with a pt with prediabetes?
Counsel and maintenance
Metformin (to prevent type 2)
Test yearly for development of diabetes
Screen for and treat risk factors of ASCVD
What to do when the screen of the pt doesn't show prediabetes?
Repeat at minimum 3 yr intervals (but consider more frequent)
Important vaccinations for DM care
Hep B, influenza and pneumococcal