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Clin Med II Final > DM > Flashcards

DM Flashcards

(59 cards)

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1
Q

DM is the leading cause of

A

ESRD

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2
Q

Conditions associated w/ DM

A 
HTN
dyslipidemia
hypo/hyperglycemia
ASCVD
Kidney disease
Amputation
Stroke
Retinopathy
Neuropathy
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3
Q

Types of DM

A

type 1
type 2
gestational (GDM)
secondary diabetes: genetic defects (monogenic DM- maturity onset diabetes of the young (MODY), disease of exocrine pancreas, druge or chemical induces- steroids)

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4
Q

Insulin production from

A

pancreatic beta-cells

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5
Q

Glucan production from

A

pancreatic alpha cells

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6
Q

T1 DM

A

autoimmune destruction of the pancreatic beta cells –> ABSOLUTE INSULIN DEFICIENCY;
beta cell destruction rate is variable

absolute requirement for insulin therapy

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7
Q

Autoimmune portion of T1 DM

A

glutamic acid decarboxylase (GAD) 65, islet cell antibodies

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8
Q

Epidemiology of T1 DM

A

children and young adult

Latent autoimmune diabetes of adults (LADA) - slower onset

prone to other autoimmune disorders

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9
Q

Sx of T1 DM

A 
polyuria, polyphagia, polydipsia
DKA***
nocturia
weight loss
blurry vision
Fatigue
paraesthesia
infections
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10
Q

Most common type of diabetes in adults

A

T2

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11
Q

T2 DM

A

gradual onset
INSULIN RESISTANCE –> hyperglycemia (genetic or environmental influences i.e. obesity)

prevalence increases w/ obesity (visceral obesity = insulin resistance)

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12
Q

Pathophys of T2 DM

A

insulin resistance

  • impaires glucose utilization by insulin-sensitive tissues
  • increase hepatic glucose output

abnormal fat metabolism

  • fatty liver
  • dyslipidemia

impaired insulin secretion
- beta cell mass decreases over time (worn out)

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13
Q

IGT

A

impaired glucose tolerance – high glucose but not quite type 2 DM yet

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14
Q

Peripheral insulin resistance leads to

A

hyperinsulinemia

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15
Q

IGT leads to

A

elevations in POSTPRANDIAL glucose
decline in insulin secretion
increased hepatic glucose production

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16
Q

Over Diabetes

A

fasting hyperglycemia

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17
Q

Beta cell failure

A

beta cell burn out from trying to compensate and produce more insulin

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18
Q

Presentation of T2 DM

A 
often ASYMPTOMATIC*
3 P's
nocturia
blurry vision
paresthesia, fatigue
chronic skin infection
poor wound healing
vulvovaginitis
balanitis
hyperglycemic hyperosmolar state
DKA (higher liklihood in type I)
*ANCATHOSIS NIGRICANS
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19
Q

Usually associated w/ family history

A

T2 DM

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20
Q

Who should be tested for prediabetes or T2?

A

overweight or obeses (BMI >25, or >23 in asians) who have one or more additional risk factor for diabetes

all others, testing @ 45 YO

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21
Q

Risk factors for diabetes

A 
1st degree relative hx
high risk ethnicity
Hx of CVD
HTN
HDL <35 and/or a triglyceride level >250
women w/ PCOS/GDM
physical inactivity
Severe obesity
acanthosis nigricans
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22
Q

High risk ethnicities for diabetes

A 
african american
hispanic latino
american indian
asian american
pacific islander
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23
Q

Testings for diabetes

A

fasting plasma glucose (FBG)
2-hr oral glucose tolerance test (OGTT)
HbA1C

symptoms + random plasma glucose >200 = diagnostic; all other tests need repeated for confirmation

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24
Q

HbA1C

Study These Flashcards
A

average of 3 months
strong predictive value for diabetes complications
greater convenience - no fasting
take into account: race/ethnicity, pregnancy, anemia/hemoglobinopathies

25
Acute onset of T1 DM testing
Blood glucose (not HbA1C)
26
FBG values
Nml: <100 Prediabetes: 100-125 (IFG) Diabetes: >126
27
2-hr OGTT values
Nml: <140 Prediabetes: 140-199 (IGT) Diabetes: >200
28
HbA1C values
nml: <5.7 prediabetes: 5.7-6.4 Diabetes: >6.5
29
Prediabetes at increased risk for
T2 DM Heart disease stroke
30
Tx for prediabetes
Education & prevention Lifestyle management- activity, nutrition f/u counseling and maintenance Metformin** (esp. BMI >35, age <60, women w/ prior GDM) TEST YEARLY FOR DEVELOPMENT screen for and treat risk factors for ASCVD
31
When to screen again if patient does not test + for prediabetes or diabetes
repeat screen in 3-year intervals
32
Eval for diabetes
hx and PE Lab eval Referral
33
Hx for diabetes
``` age characeteristics of onset FHx nutrition/weight hx activity/sleep behaviors dental disease last dilated eye exam? Psychosocial health SHx Review meds and response to tx (A1C records) pt glucose log DKA- frequency, severity Hypoglycemic episodes? Microvascular/macrovascular complications assess comorbidities ```
34
Vaccinations for diabetes pts
hep B influenza pneumococcal
35
Common comorbidities w/ DM
``` autoimmune FLD OSA CA Fx HIV Low T in men periodontal disease hearing impairment cognitive impairment depression/anxiety ```
36
PE and labs for diabetes
``` height, weight, BMI BP fundoscopic thyroidc palpation skin exam comprehensive food exam HbA1C*** lipid panel LFTs urinary albumin-Cr ratio BMP Vitamin B12 (if on metformin) TSH - T1 DM ```
37
Macrovascular complications
ASCVD- CHD, cerebrovascular disease or PAD leading cause of morbidity and mortality!!! heart failure (From CVD)
38
Tx for ASCVD
lifestyle mod. BP control Lipid management Antiplatelet - ASA, Plavix
39
Microvascular complications
nephropathy retinopathy neuropathy
40
Diabetic nephropathy
related to CHRONIC hyperglycemia usually after 10 years in type 1- often have other signs like retinopathy/neuropathy may be present at diagnosis in type 2
41
Dx of CKD
albuminuria and/or reduced GFR urinary albumin (spot UACR) and GFR should be checked yearly - start in T1 at >5 years, start at time of diagnosis of T2
42
Presentation of CKD
>10 years of diabetes | progressive albuminuria, HTN, declined GFR
43
Tx of CKD due to diabetes
intensive glycemic and BP control | ACEI and ARBS!
44
When to consider albuminuria present
2-3 UACR collected w/i 3-6 month period should be abnormal
45
Leading cause of blindness between 20-74
diabetic retinopathy
46
Increased risk of retinopathy
Diabetic CKD HTN Dyslipidemia
47
Types of diabetic nephropathy
nonproliferative- hemorrhages, exudates, cotton wool proliferative - neovascularization
48
Tx for retinopathy
refer to optho
49
Screening for retinopathy
T1: dilated eye exam w/i 5 years after diagnosis T2: dilated eye exam at time of diagnosis
50
Types of diabetic neuropathy
peripheral neuropathy | autonomic neuropathy
51
Peripheral neuropathy
distal symmetric neuroapthy | "socking-glove" sensory loss - feet first
52
S/sx of peripheral neuropathy
pain and dysesthesias (burning/tingling) numness and loss of protective sensation (LOPS)- risk for foot ulcers!!!! Loss of vibratory senstion and altered proprioception decreased or absent ankle reflexes
53
Major cause of morbdity
foot ulcers/amputation
54
Risk factors for foot ulcers/amputations
``` poor glycemic control peripheral neuropathy w/ LOPS cigs foot deformity (charcot foot) preulcerative callus/corn Hx of foot ulcer amputation visual impairment nephropathy- esp. on dialysis PAD ```
55
Foot eval
done at LEAST annually - start 5 years after T1 dx - start at time of T2 diagnosis INSPECT palpate- DP and PT pulses ABI**** - sx of claudication or decreased/absent pedal pulses Neuro exam to identify LOPS: vibration, pressure (monofilament***), pinprick or temp sensation
56
Most useful test to diagnose LOPS
Monofilament test- 3 on metatarsal, 1 big toe, 1 3rd toe, 1 on front of foot b/w big/2nd toe
57
Systems affected by autonomic neuropathy
``` CV GI/GU pupillary sudomotor neuroendocrine ```
58
Manifestations of autonomic neuropathy
metabolic- hypoglycemia unawareness CV: orthostatic hypotension, resting tachy GI- gastroparesis, GERD, esophageal dysmotility, diarrhea/constipation GU: ED, female sexual dysfunction Sudomotor/vasomotor: anhidrosis/hyperhidrosis, altered thermoregulation Pupillary: decreased diameter of dark adapted pupil
59
Referrals
optho family planning for women of reproductive age registered dietician (RD) for medical nutrition therapy (MNT) DSME/DSMS Dentist podiatrist mental health

Clin Med II Final (6 decks)

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