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Diabetes week Flashcards

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1
Q

What are the Causes of Secondary diabetes(4)

A 
Med or drug-related
exocrine pancreas related
endocrinopathy-related
infection 
other
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2
Q

Drugs that interfere with B cell release of insulin

A

cyclosporine
phenotoin
thiazides

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3
Q

Drugs that cause insulin resistance

A

glucocorticoids
niacin
antiviral phase inhibitor (HIV art therapy )

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4
Q

What drugs cause weight gain and beta-cell dysfunction (1)

A

antipsychotics

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5
Q

can blocking inhibitors of the autoimmune system cause diabetes
PD1 inhibitor
CILA-4 inhibitor

A

Yes

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6
Q

What are some causes of exocrine pancreatic related disease (genetic)

A

CF

hemochromatosis

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7
Q

What are some causes of exocrine pancreatic related disease (acquired) (5)

A 
Pancreatectomy
pancreatic cancer
infection 
trauma
pancreatitis
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8
Q

What are some endocrinopathy related diabetes(5)

A

1) acromegaly-> excessive growth hormone
2) Cushing’s syndrome
3) Cushings disease
4) topic crushing sign
5) pheochromocytoma

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9
Q

When do we do a T2D screen (3)

A

1) over 40 years old -> every 3 yrs
2) High risk individual (over a 33% change over 10 yrs)-> every 3 yrs
3) Very high risk and over 40 years old -> 6-12 months

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10
Q

Reasons to screen for T2D (7)

A

1) 40 or older
2) 1st degree relative with T2D
3) high-risk pop (not white)
4) History pre diabetes
5) hx of a macrosomic infant
6) Hx of GDM
7) if you see end organ damage

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11
Q

What are some vascular risk factors for T2D (6)

A

1) Smoker
2) HDL less than 1 in male fo less then 1.3 in female
3) triglycerdes are 1.7 or more
4) hypertension
5) overweight
6) abdominal obesity

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12
Q

Associated diseases with Diabetes (4)

A

PCOS (Polycystic ovarian syndrome)
HIV
OSA (Obstructive sleep apnea )
CF

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13
Q

What is CANRISK

A

Canadian diabetes risk assessment questions help assess risk of diabetes

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14
Q 
What are the diagnostic criteria for diabetes:
FPG
A1C
OGTT
Random PG
A

A1C over =6.5
FPG over =7.0
2hPG in a 75 g OGTT equal to or greater than 11.1 mol/L
RANDOM PG equal to or greater than 11.1 mol/L

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15
Q

draw chart for Sugars and A1c

A

see notes

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16
Q

What are the early manifestation fs of Hypoglycemia

A

1) tachycardia, palpitations
2) diaphoresis, anxiety
3) weakness hunger and nausea

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17
Q

What are the long term manifestations of hyperglycemia

A

1) coma, confusions hallucinations seiers

hypothermia

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18
Q

What are the early manifestations of hyperglycemia

A

1) Polydipsia, polyuria
2) altered vision
3) decrease wieght mild dehydration

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19
Q

What are the stages of progression of Diabetic nephropathy

A

1) Hyperfiltration with increased GFR
2) silent
3) Microalbumnia->1st sign of diabetic nephropathy (urine acr)
4) macro albuminuria

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20
Q

Screening of nephropathy

A

1) creatine and GFR-> 1 time a year
increase to 3-6moths is abnormal
2) Spot ACR once a year -> if positive need to do a lot

T1D -> start within 5 yrs of diagnosis
T2D -> Right away

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21
Q

What are the 2 types of Diabetic retinopathy ?

A

1) non-proliferative microvascular changes
thicking of the basement membrane,per cycle loss
altered vascular tone proliferation f not hial cells
2) Proliferative DR
severe hypoxia
new vessles

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22
Q

Classes of Retinopathy

A

1) Diabetic retinopathy

2) diabetic macular edema

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23
Q

Diagnosis of retinopathy

A 
fundoscopy 
- cotton wool spots
hard exudates
neovascualrition 
microanuerism

Optical coherence tomography for diabetic macular edema

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24
Q

What is Optical coherence tomography

A

Optical coherence tomography for diabetic macular edema thing in eye see an increase edema

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25
retinopathy treatment
1) anti vEGF antibodies 2) photocoagulation for DME 3) Vitrectomy (removal of citrus humour)
26
Diabetic neuropathy types
1) distal symmetric polyneuropathy (stocking-glove) 2) radiculopathy plexopathy 3) mononeuropathy 4) autonomic neuropathy
27
What kind of test can you do for Diabetic neuropathy
monofiliments 10 g | tuning fork
28
treatment Diabetic neuropathy
gabapetniods snri antidepressants tireyelic antidepresesent
29
What are the ABCDES of preventing the microvascular
``` A- keep A1C <= 7% B-Blood pressure below 130/80 mmHg C- Cholesterol keep LDL below 2 mmol/L D- Drugs to protect heart and kidneys E- Eat healthily and exercise S- Stop smoking ```
30
What are the macrovascular complication of diabetes (3)
1) Cardiovascualr 2) Cerebrovascualr 3) Periferla vasculr
31
what is the goal of prevention of T2D goals for a prediabetic- (3)
1) Delay the onset of T2D 2) prevent microvascular complications 3) preserve your b cells
32
Prediabetes recommendations
1) moderate weight loss 2) 150 mins/week 3) mediterian diet 4) metformin
33
Effects of epinephrine
``` promote glucose uptake increase glycogenolysis and gluconeogenesis promotes glycolysis inhibits insulin secretion promotes lipolysis helps realize GLUT4 without insulin stimulates glucagon ```
34
What are some methods of measuring glucose (5)
1)intermittently canned continue sccanned glucose->free style libre-> needs - 2) rt CGM -> Dexcom gives real-time on the phone 3)Capillary glucose montior 4) bionic pancreas 5) urine test
35
A1C targets Adults with T2D to reduce the risk of CKD and retionpathy if at low risk of hypoglycemia
below 6.5
36
A1C targets Adults with T2D and T1D
equal to 7 or less
37
end of life A1C targets
7.1-8.5 we don't really care
38
Diagnositc critrea for pre diabets
A1C 6.0-6.4 | FPG 6.1-6.9
39
Diagnostic critirea for metabolic disorder
1) Waist circumfernce -> M:102 cm F:88 cm 2) Triglycrides >=1.7 3) HDL below M1.0 F1.3 4) hypertension 5) elevated FPG >=5.6
40
What test do you do for Diabetie neropapthy
tuning fork and microfiliment
41
When do we do ECG for diabetes
every 3-5 yrs
42
What is Charcot foot
Broken/deformed diabeteic foot for diabetes patient
43
Red foot Ddx
1) Cellulits/osteomyletis 2) charchot arthopy 3) inflammatoru gouty artihits 4) DVT 5) inflamitory arthitius
44
Beta cells what do they seceerte and precentage
Insulin | 80%
45
alpha cells what do they seceerte and precentage
glucagon | 15-20%
46
Delta cells what do they seceerte and precentage
Somatostatin | 3-10%
47
What does somatostatin do?
Inhibits insulin and glucagon
48
PP cells what do they seceerte and precentage
pancretic poly peptide | 3-5%
49
What is the parasympathetic innervation of the islet cells and what is the neurotransmitter
vagus ach increase insulin release
50
What is the sympathetic innervation of the islet cells and what is the neurotransmitter
postganglionic fibres of the celiac ganglion | noreepinephrene
51
What stimulates insulin release
``` Hormones 1) GLP-1 2) GIP 3) Ach 4) Glucagon nutrients 1) Glucose 2) Arg and lys 3) FFA ```
52
What inhibits insulin release
Noreepinephrine/epinephrine somatostatin tomuch sugar or ffa Glucocorticoids and growthhormone
53
How is insulin released stimulated pathway
glucose flows into cell- increase in ATP/ADP inhibits k plus channel-> Ca influx-> depolrizaiton Insulin release
54
Roles of insulin (3)
Promotes energy storage anabolic target muscule fat and liver large role in growth and developemnt
55
How does insulin stim glucose uptake
hits tyrosine kinase receptor GlUT4 release
56
What stimulates glucagon release
``` Nutrients 1) Arg ala 2) lack of glucose Hormones 1) CCK 2) GIP 3) Noreephrene, ach , epinerphreine ```
57
What inhibits glucagon release
Somatostatin insulin GLP-1
58
What are three features of DKA
1) Hyperglycemia 2) ketones 3) acidosis ph less then 7.35, aniongap
59
What are the 6 sings and symptoms we would see with DKA
1) prodrome of polydipsia,weakness,polyureia,nausea vomiting abdo pain 2) Volume dpletion 3) kussmalt breathing 4) Acetone breath 5) Myalgia 6) normal temp or hypothermia
60
In DKA will we see and anion gap and waht is a normal anion gap
yes | Normal-10-14
61
What are 4 precipitating causes of DKA
1) acute illness 2) New onset of diabetes 3) Insulin under dose 4) Drugs ->cocaine,
62
6 steps to manage DKA
1) Volume repletion 2) Insulin bolus to stop acidosis 3) K plus repletion 4) decrease plasma glucose with insuiln 5) Fix percitpating cause 6) monitor everything
63
What is there a risk of in pediatirc DKA
Cerebreal edema
64
Signs and symptoms of Cerebreal edema (6)
1) decreased mental statues 2) age inapportpe incontinace 3) focal neurological defects 4) headaches 5) cushings triade 6) hypoxemia
65
What are the 3 features of cushings triad
1) hypertension 2) bradycardia 3) irregular resp
66
Managment of Cerebreal edema (4)
1) Hypertonic saline or manitol 2) elevate head 3) decrease iv fluid by 1/3 4) might need intubation
67
Are you hyponatrimec or hypernatrimeic in DKA
hyponatrimic
68
Potasium loss in DKA
can be either hypokalemic or hyperkalemics but overal in a k plus depleted state increased rasas and osmotic dirises of k+ Insulin defiencty leads to less k plus uptake in cells k plus hplus exchange in acidosis also decrease volume so it increase
69
Anion gap equation
Na-cl--HCO3
70
what are features hyperglycemic hyperosmolar state? (3)
1) severe hyperglycemia 2) hyperosmolity 3) volumdelpeted
71
Clincal features of HHS
Old 60plus poor fludi intake prodonre polydyipsia and polyuria weakness confuisin
72
What can cause HHS other then being old
1) acute illnesss | 2) drugs
73
How can u monitro Blood glucose
Capillary blood glucose interminttenly scanned flash coninue saccaned glucose continues glusoce monitor =realtime glucose monitor-> dexcoem on phone
74
Moleculre mech of glucose toxity
1) polyol aldose reducates pathway acivation 2) ADvanced glycosltyion end product ACE formation 3) Protien kinace C activation 4) hexosamine pathway
75
polyol aldose reducates pathway acivation
sugar overwhelms aldose reducates and ROS builds up leads to cell damage
76
Advanced glycosltyion end product ACE formation
increase glucos eleads to increase glycoslytino bad signaling
77
Protien kinace C activation
PKC is an intracellular messenger increase glucosse increases PKC cause leackage o blood vessles and clots increase vasoconstriction
78
hexosamine pathway
alternate oathway for glucose alters mrna expresion and protien production

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