Flashcards in Endocrine Deck (85)
what is the pathophysiology of T2DM?
begins when peripheral tissues develop resistance to insulin
In T2DM, beta cells initially compensate by increasing what? What happens decades later?
- insulin production
- beta cells function is lost - results in clinically manifest diabetes
T2DM: too much glucose – increase insulin production =
high blood glucose
is T1DM or T2DM more common?
what are 10 risk factors for increasing the chance of developing T2DM?
1. Genetic: first degree relative
2. ethnicity: HANAP
7. sedentary life style
8. over 45 y/o
9. h/o gestational diabetes
10. polycystic ovarian syndrome
11. h/o vascular disease
what does prediabetes indicate?
failing beta cells
what are the 3 characteristics of prediabetes? Do all of these have to be met?
- fasting plasma glucose between 100 + 125 mg/dL
- oral glucose tolerance test values between 140 + 199 mg/dL
- A1C > 5.7% + less than/equal to 6.4%
*any one of the 3 – does NOT have to be all
t/f: T2DM patients are usually asymptomatic
what symptom may T1 and T2 DM patients present with?
blurred vision due to transient refractive error shifts (myopic shift)
t/f: T2DM patients, usually have no physical exam findings
define acute hyperglycemia.
when blood glucose levels are higher than the threshold for glucose reabsorption in the kidney – glucose is excreted into urine
what three conditions are pathognomonic for hyperglycemia?
polyphagia: glucose excretion results in loss of calories
polydipsia: increased water excretion leads to increased thirst
polyuria: increased glucose in the urine results in increased water excretion
how is a hyperosmolar coma treated?
intravenous insulin to reduce plasma glucose levels
what are 5 tests to diagnose a patient with DM?
Do all 5 tests need to be met?
- fasting plasma glucose (FPG or FBG) of >= 126 mg/dL consecutively on two tests
- symptoms of hyperglycemia plus random plasma glucose >=200 mg/dL
- oral glucose tolerance test plasma glucose level >= 200 mg/dL
- glycosylated hemoglobin (HbA1C) >=6.5% consecutively on two tests
- A1C + FBG are above the diagnostic thresholds
* meeting one requirment is needed
Name 2 broad sequela types patients with hyperglycemia can present with.
Name 3 Microvascular complications 2/2 hyperglycemia.
what is the most common microvascular complication of diabetes?
t/f: retinopathy is more likely to arise with a longer duration of diabetes, + with poor glycemic control
what cells are MOST susceptible to damage from hyperglycemia?
cells that cannot regulate glucose entry
what eventually causes microvascular damage?
high levels of ROS
Name 2 macrovascular complications.
1. coronary artery disease 2. peripheral vascular disease
what are 2 subtypes of neuropathy associated with DM?
1. distal polyneuropathy
2. cranial mononeuropathy
define distal polyneuropathy. what are the symptoms?
- classic peripheral neuropathy
o ROS cause demyelination of peripheral nerves - results in neuronal apoptosis
o symptoms: paresthesia + hypoesthesia
** usually begins in the feet +legs
define cranial mononeuropathy. What DM type is it more common in?
– targets the EOM more than any other cranial nerve (CN3,4,6)
o patient reports pain + diplopia
- due to vascular occlusion + tissue ischemia
** MORE COMMON in T2DM
how does a DM patient develop hypoglycemia?
treated with oral hypoglycemics or insulin, but medications result in high levels of insulin even when blood glucose is low
what is the therapy goal for patients with DM?
A1C of = 7.0%
t/f: higher A1C is associated with reduced risk of microvascular complications
f: lower A1C is associated with reduced risk of microvascular complications
what is the treatment order for T2DM patients?
1. lifestyle modifications
3. pharmaceutical interventions