DM is 3rd leading cause of death due to....
80 perc due to accelerated atherosclerosis
DM is a syndrome of hyperglycemia due to....
- insulin resistance and/or - insulin def.
Normal BS before breakfast?
normal BS one hour after meals?
less then 140
normal BS 2 hour after meals OR before lunch, dinner, beadtime
less then or equal to 120
normal BS 2 hours into a glucose tolerance test
less then 140
What is considered a FBS that means prediabetic?
What is considered a 2h GTT that means prediabetic?
3 facts about HbA1C?
- Reflects average blood glucose level over past 8-12 weeks −Used for initial diagnosis of diabetes −Used for monitoring response to therapy
What is considered a normal HbA1C?
Normal 4.0-5.6 percent
what is considered a prediabetic HbA1C?
Prediabetes 5.7-6.4 percent
What is considered a diabetic HbA1C?
Diabetes ≥6.5 percent
What are the 4 ways to Dx Dm?
1. fasting plasma glucose greater then 126 on 2 sep 2. 2 hour plasma glucose greater then 200 during OGTT on 2 sep 3. HbA1C greater then 6.5 percent on 2 sep 4. random plasma glucose greater then or equal to 200 WITH sx
Sx are considered....
polyuria, polydypsia, unexplained weight loss
Type 1 Dm is.....
a lack of insulin.... 80 perc. desruction of beta cells
causes of type 1 DM
Autoimmune Genetic factors Environmental factors (Viruses, Exogenous antigens, Toxins)
Causes of type 2 DM
Genetic factors Obesity Environmental factors (Nutrition, physical activity)
what are 5 components of metabolic syndrome?
1. Insulin resistence (with ot without increase in glucose) 2. central obesity 3. HTN 4. accelerated CVD 5. High TG (low HDL; small dense LDL)
Diseases of the exocrine pancreas that are secondary causes of DM
pancreatitis, cancer, pancreatectomy, cystic fibrosis, hemochromatosis
Endocrinopathies that are secondary causes of DM
acromegaly, Cushing’s syndrome, hyperthyroidism, pheochromocytoma
drugs that are secondary causes of DM?
glucocorticoids (prednisone), niacin, thiazide diuretics, thyroid hormone (excess), protease inhibitors
time frame onset of DKA?
What are the 6 symptoms of DKA?
1. Polydipsia 2. polyuria 3. Lethargy 4. N/V 5. Abd Pain 6. SOB
Physical signs of DKA
1. dehydration 2. tachypnea 3. fruity breath 4. abd. tenderness
What are the signs assoc with dehydration?
- low BP - Tachycardia - poor skin turgor - dry MM
Laboratory signs of DKA? (9)
1. Blood glucose greater then or equal to 250-600 mg/dL 2. Glycosuria 4+ 3. Serum osmolality 300-320 mOsm/kg 4. High anion gap metabolic acidosis 5. pH less then 7.30, HCO3- less then 15 mEq/L 6. Serum and urine ketones (acetone) 7. Elevated BUN and creatinine 8. Leukocytosis with left shift 9. Increased amylase (of salivary origin)
What is the time frame for NKS?
- slowly over days to weeks - most common in elderly with type 2 DM
What are the 4 sx of NKS?
- Polydipsia - Polyuria - Lethargy - weakness ** NO GI or ketoacidosis**
What are the lab features of NKS? (5)
1. Severe hyperglycemia 2. greater then 600-1200 mg/dL 3. Glycosuria 4+ 4. Serum osmolality 320-380 mOsm/kg 5. Elevated BUN and creatinine **No metabolic acidosis, No ketones (ketoacids), pH greater then 7.30, HCO3- normal, Normal anion gap
Symptoms due to excessive secretion of epinephrine (autonomic response)?
1. sweating (cool, moist skin) 2. tremor, shakiness 3. tachycardia 4. anxiety 5. hunger 6. seen with milder OR more rapid onset hypoglycemia 7. ABSENT with hypoglycemia unawareness, due to autonomic neutopathy
Sx of Somogyi Phenomenon
- May be asymptomatic or manifested by: night sweats nightmares early morning headaches excessive hunger
How to dx Somogyi phenomenon?
Test blood glucose at 3 A.M. and 7 A.M.
Tx of somogyi phenomenon?
Treat by lowering bedtime insulin dosage
Sx with dawn phenomenon?
None (there is NO nocturnal hypoglycemia )
Diagnosis with dawn phenomenon?
Check blood glucose at 3 A.M. to rule out Somogyi phenomenon
Tx of dawn phenomenon?
Treat by increasing bedtime insulin dosage
Tx of hypoglycemia: 1. awake 2. Lethargic 3. comatose or stuporous 4.
1. oral glucose or sugar 2. oral sugar viz synringe 3. IV 50 perc. dextrose
correlation of microvascular complications?
Duration and severity of hyperglycemia
correlation of macrovascular complications
Hyperglycemia Hypertension Dyslipidemia
What is the leading cause of blindness in ages 20-74?
diabetic retinopathy Early sign-- non proliferative late sign-- proliferative Tx-- prevention!
What is the leading cause of end-stage renal dz in the US?
What are the earliest findings of diabetic nephropathy?
Increase in GFR (glomerular hyperfiltration) Microalbuminuria (30-299 mg/d)
Hyporeninemic hypoaldosteronism is common and causes _____
what is the tx of diabetic nephropathy?
ACE inhibitors or angiotensin receptor blockers Goal: less then 140/90 and nephrology consult
what are the sx of DM polyneuropathy?
- Paresthesias - Numbness - Pain (lancinating, nocturnal)
signs of DM polyneuropathy?
- Impaired sensation - Loss of ankle jerks - Silent trauma (plantar ulcers, fractures, deformities (Charcot joints)
What are the cardiovascular complications of diabetic autonomic neuropathy?
1. Postural hypotension 2. Failure to increase heart rate with exercise, stress, standing 3. Silent myocardial ischemia
GI complications of diabetic autonomic neuropathy?
Gastroparesis Abnormal intestinal motility
GU complications of diabetic autonomic neuropathy?
Cystopathy (infrequent voiding, incomplete emptying, urinary hesitancy, dribbling, overflow incontinence, increased residual volumes, increase UTI’s) Sexual dysfunction
Sudomotor complications of diabetic autnomic neuropthay?
Anhydrosis of distal lower extremities Hyperhydrosis of face, trunk and upper extremities
metabolic complication of diabetic autonomic neuropathy?
DM is a ______ risk?
Black eschar is hallmark for what?
Rhino cerebral mucomycosis (invasive fungal infection of the sinus)