DM Flashcards by Kim Grace

Most common endocrine disorder

Diabetes mellitus

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A group of metabolic disease characterized by inappropriate chronic hyperglycemia with disturbances of carbohydrates, fats and protein metabolism resulting from defect in insulin secretion, insulin action or both

Diabetes mellitus

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T/F: DM is a chronic condition

True

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Identify the year (DM Classification):
* Infantile or Childhood
* Young
* Adult
* Elderly

1965

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Identify the year (DM Classification):
* Insulin dependent DM
* Non-Insulin Dependent DM
* Other Types

1985

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Identify the year (DM Classification):
* Type 1 * Type 2

1999

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Identify the year (DM Classification):
* Type 1
* Type 2
* Specific Type
due to other
causes
* Gestational
diabetes

2023

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(DM Type) Destruction of pancreatic beta cell responsible of insulin production

Type 1 DM

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(DM Type) Associated with autoimmune disease

Type 1 DM

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(DM Type) Usually develops in children and young adult

Type 1 DM

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(DM Type) Associated with a faster onset of symptoms, leading to dependency on extrinsic insulin for survival

Type 1 DM

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(DM Type) More common type of diabetes

Type 2 DM

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(DM Type) Occurs in adults older than 40 years

Type 2 DM

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(DM Type) Peaks onset between 60 and 70
years

Type 2 DM

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(DM Type) Caused by a relative insulin deficiency and the body’s inability to effectively use insulin

Type 2 DM

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(DM Type) Symptoms are slower in onset and less marked than those of Type 1 DM

Type 2 DM

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Hyperglycemia that is first detected during pregnancy, usually diagnosed during the 2nd or 3rd trimester

Gestational diabetes

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Gestational diabetes is usually diagnosed during ______ or ______ trimester

2nd or 3rd

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Gestational diabetes is associated with adverse outcomes, including hypertension or _________, ___________ or fetal death

pre-eclampsia, fetal macrosomia

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(DM Type) onset is acute-symptomatic

Type 1 DM

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(DM Type) onset is slow-often-asymptomatic

Type 2 DM

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(DM Type) clinical picture: weight loss, polyuria, polydipsia

Type 1 DM

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(DM Type) clinical picture: obese, strong family history, pcos

Type 2 DM

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T/F: Type 1 and Type 2 DM has the same clinical picture but Type 2 DM has additional

True

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Ketosis: Almost always present

Type 1

No ketosis

Type 2

Antibodies: ICA+, Anti-Gad+, ICA512+

Type 1

Antibodies: ICA-, Anti-GAD-, ICA 512-

Type 2

Therapy: Insulin

Type 1

Therapy: Lifestyle, oral anti-diabetic agents, insulin

Type 2

Associated auto-immune diseases

Type 1

Not associated with auto-immune diseases

Type 2

C-peptide is ________ in Type 1

Low or absent

C-peptide is ________ in Type 2

Normal or elevated

Hormones affecting sugar levels in the body

* Insulin * Counterregulatory hormones * Incretin hormones * Amylin

Regulates CHO, CHON and lipid metabolism by promoting glucose uptake into the cell

Insulin

Promotes conversion of glucose to glycogen

Insulin

Facilitates cellular uptake of amino acids

Insulin

Decreases the breakdown of fatty acids into ketone bodies

Insulin

Produced during low glucose levels to increase the amount of glucose in the body

Counterregulatory hormones

Antagonizes insulin effects

Counterregulatory hormones

Promotes conversion of glycogen to glucose

Counterregulatory hormones

glucagon, growth hormones, catecholamines, cortisol

Counterregulatory hormones

Released or secreted after meal or nutrient intake to stimulate release of insulin

Incretin hormones

Inhibits inappropriate glucone secretion and increases beta cell growth and reproduction

Incretin hormones

Suppresses appetite

Incretin hormones, Amylin

Gastric inhibitory peptide (GIP) and Glucagon-like peptides (GLP)

Incretin hormones

Co-secreted with insulin

Amylin

Lowers post-prandial blood glucose level by prolonging the gastric emptying time

Amylin

Reduces post-prandial glucagon secretion

Amylin

___________ and __________ appear to code for either disease susceptibility or resistance of T1DM

Human Leukocyte Antigen (HLA) DQA and DQB

Environment factors in the pathophysioogy of T1DM

Viral, chemical or dietary

Autoimmunity in T1DM

* Anti-insulin ,anti-beta cell antibodies * Antibodies to glutamic acid decarboxylase

T/F: there is a > 90% concordance rate in identical twins if one has T2 DM

True

T2DM: __________dysfunction -> improper insulin secretion

Beta cell

Post-receptor binding, a decreased number of insulin receptor or defects in insulin receptors can lead to hyperglycemia (T2DM)

Peripheral site defect

For T2DM: Screening should be considered in ___________ who have overweight or obesity and who have one or more additional risk factors

youth

Risk factors of T2DM

* Maternal history of DM or GDM during the child’s gestation * Family history of T2 DM in first- or second-degree relative * Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander) * Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, or small-for-gestational-age birth weight)

(Most Common) Symptoms of Diabetes

* Glucosuria * Polyuria * Polydipsia * Polyphagia * Weight loss

Symptoms of Diabetes

Systemic weight loss Sexual problems Always Tired Frequent Urination Always Hungry Wounds won't heal Blurry vision Vaginal Infections Always thirsty Numbness or tingling in hands or feet

Fasting Blood Glucose Level

≥ 126 mg/dL

Random Blood Glucose Level

≥ 200mg/dL

Oral Glucose Tolerance Test

≥ 200 mg/dL

Hemoglobin A1c

≥ 6.5%

Criteria for dx of diabetes: FPG = ______________ 2h PG = ________________ using _____ anhydrous glucose dissolved in water A1C ___________ random plasma glucose _______

FPG = >/= 126 mg/dL (7.0 mmol/L) 2-h PG = >/= 200 mg/dL (11.1 mmol/L) A1C = >/= 6.5% (48 mmol/mol) random plasma glucose = >/= 200 mg/dL (11.1 mmol/L)

Testing for Asymptomatic Individuals:

* Physical activity * 1st degree relative with diabetes * High-risk ethnicity (African Americans, Latino, Native Americans, Asian Americans, Pacific Islander) * Women who delivered a baby weighing ≥ 9 lbs. or diagnosed with GDM * Hypertension (≥ 140/90 mmHg or on therapy for HTN) * HDL level < 35 mg/dL and/or triglyceride level > 250mg/dL * Women with polycystic ovaries syndrome * Previous testing indicative of pre-diabetes * Clinical condition with insulin resistance * History of CVD

Diabetes complications

Atherosclerosis (Stroke, Heart Attack, Artery Disease) Retinopathy (Cataract, Glaucoma) Neuropathy (Diabetic Foot) Nephropathy

Treatment Goals

* Prevent Complications * Optimize Quality of Life

Decision Cycle for Person-Centered Glycemic Management (T2DM)

* Assess Key Person Characteristics * Consider Specific Factors that Impact Choice of Treatment * Utilize Shared Decision-Making to Create a Management Plan * Agree on Management Plan * Implement Management Plan * Provide Ongoing Support and Monitoring * Review and Agree on Management Plan

Required for glycemic management in individuals with T1DM

Insulin

May be used in combination with oral agent or amylin agonist

Insulin

May also be initial or adjunctive agent for individual with T2DM

Insulin

Stimulates hepatic glycogen synthesis

Insulin

Increase protein synthesis

Insulin

Facilitates triglyceride synthesis and storage by adipocytes

Insulin

Inhibits lipolysis

Insulin

Stimulates peripheral uptake of glucose

Insulin

Pramlintide

Amylin Receptor Agonists

Enhance post-prandial control in individual with T1DM and T2DM

Amylin Receptor Agonists

CI: Gastric motility disorder

Amylin Receptor Agonists

* Slow gastric emptying time * Decrease post-prandial glucagon secretion * Suppresses appetite

Amylin Receptor Agonists

GLP-1 agonist

Incretin mimetics

Exenatide, Liraglutide, -glutides

Incretin mimetics

Management of T2DM

Incretin mimetics

CI: Severe GI motility, pancreatitis, renal or hepatic impairment

Incretin mimetics

MOA * Increase glucose-dependent insulin secretion, * Decrease hepatic glucose output * Increase beta cell growth and replication * Slow gastric emptying time * Enhance satiety or feeling of fullness to suppress appetite

Incretin mimetics

Sitagliptin, Saxagliptin, Linagliptin

Dipeptidyl peptidase IV (DPP IV) inhibitors

Indication: Patients with T2DM with normal or impaired hepatic and renal function

Dipeptidyl peptidase IV (DPP IV) inhibitors

CI: Pancreatitis

Dipeptidyl peptidase IV (DPP IV) inhibitors

MOA: * Prevents the inactivation of incretin hormones by the enzyme DPP IV during hyperglycemia * Inhibits the breakdown of GLP-1 allowing increased insulin secretion and decrease hepatic glucose production

Dipeptidyl peptidase IV (DPP IV) inhibitors

Targets fasting blood glucose level

Sulfonyureas

Binds to and inhibits the ATP-sensitive potassium channels to increase the beta cell sensitivity to glucose and stimulate the secretion of insulin

Sulfonyureas

Protein-bound

Sulfonyureas

Prone to drug-drug interactions

Sulfonyureas

1st Generation Sulfonyureas

Tolbutamide, Tolazamide, Chlorpropamide

Typically not prescribed since 2nd gen has fewer ADR

1st Generation Sulfonyureas

Associated with thrombocytopenia, agranulocytosis, hemolytic anemia, hyponatremia, SIADH, disulfiram-like reactions

1st Generation Sulfonyureas

2nd Generation Sulfonyureas

Glyburide, Glipizide, Glimepiride

DM Flashcards

(99 cards)