DM and DMT2 and DMT1 Flashcards Preview

Endocrine > DM and DMT2 and DMT1 > Flashcards

Flashcards in DM and DMT2 and DMT1 Deck (23):
1

overt DMT1 presentation

increase thrist, urination

weight loss

bed wetting 

hunge

1

treatment for emergent severe hypoglycemia

glucagon injections

2

long term microvascular complications of DM

retinopathy

nephropathy

neuropathy

3

pathogenesis of DM complications (pathways impacted)

accumulation of advanced glycosylation end products

accumulation of sorbitol

disrupt of hexosamine pathway

disrupt of protein kinase C pathway

activation of poly ADP-Ribose polymerase pathway

increased oxidative stress

3

2 defects of DM2

 

2 outcomes

Insulin resistance (imp glucose production and uptake)

inadequate insulin secretion

 

outcomes:
inability to suppress glucose from liver and kidney during fast
inability to appropriately take up glucose

4

dehydration in ketoacidosis due to 

vomiting (due to ketoacids)

anion gap metabolic acidosis > compensatory tachypnea

severe hyperglycemia > glycosuria > water follows

5

most common insulin regimen

MDI - multiple daily injections

long acting (glargine or detemir) + short acting with meals (lispro or aspart)

6

electrolyte changes in untreated T1DM

hyponatremia

hypokalemia

low CO2 (bicarb) ketoacidosis

decreased phosphate intake and phosphaturia

7

Dx of DM

HbA1c >6.5%

OR

fasting plasma glucose >126mg/dL

OR

2 hour plasma glucose >200 ueing 75g oral glucose tolerance test

OR

Random glucose >200

7

fluid and electrolyte abnormalities in DM due to

osmotic diuresis that results from hyperglycemia

7

Adipose tissue inflammation pathogenesis in DMT2

changes in stromovascular cells to phenotypic activation of pro-inflammatory state.

adaptive immune cells interact+activate adipose macrophages>

> macrophages and Tcells shift from anti- to pro-inflammatory state

> CD8, Th1, Th17 cells stimulate M1 macrophage poalrization 

>chemokines and cytokines promote inflammation and insulin resistance

7

moderate hypoglycemia in insulin overdose symptoms

 

treatment

neurogenic symptoms: 

confusion, combativeness

poor coordination

slurred speech

 

treat with fast acting carbs

8

Dx of pre-diabetes

Fasting plasma glucose = 100-125

OR

2 hour plasma glucose 140-199 during 75g oral glucose tolerance test

OR

A1C 5.7-6.4%

10

patients present DMT1 when

80-90% of beta cells are lost

12

Dx of T1DM

random blood glucose >200

or

two fasting blood >126

or

positive oral glucose tolerance test

13

T1DM in adults pathogenesis

5-15% with DM express anti-islet autoantibodies

rapid 3 year progression to T1

HLA alleles associated

15

eitologic classification of DM

Type1

Type 2

gestational

1 - autoimmune B cell destruction with lack of insulin

2 - insulin resistance with relative insulin deficiency

Gestational - insulin resistance with B-cell dysfunction

16

long term macrovascular complications of DM

coronary artery disease

peripheral vascular disease

18

impaired consciousness in ketoacidosis due to

intracellular dehydration due to severe hyperglycemia

19

2 ketone bodies typically elevated in DKA

Acetoacetate

B-hydroxybuturate

21

Pathophys DMT1

molecular mimicry > APCs > CD4 differentiation to CD4Th1 cells

>CD4 Th1 INFg and IL 2 > CD8 CTls >

>CD8 attack beta cells > release more contents = more antigen

22

insulin overdose causes hypoglycemia, which causes mil adrenergic sympoms...

shakiness, 

headaches

dizziness

sweating

tachycardia

hunger + fatigue

(due to increased sympathetic tone)

23

locations and actions of glucagon like peptide 1 GLP-1

liver: reduces hepatic glucose output by inhibiting glucagon release

Stomach - slows gastric emptying

alpha cell - inhibits glucagon secretion

Beta cell - stimulates glucose-dependent insulin secretion and B-cell differentition and proliferation