Endocrine DM

Question 1

DM diagnosis criteria

Answer 1

FPG =/>126mg/dL (8 hr)

2hr PG =/> 200mg/dL

A1C =/> 6.5%

RPG =/> 200mg/dL PLUS symptoms of hyperglycemia

Question 2

Prediabetes

Answer 2

FPG: 100-125 mg/dL

2hr PG: 140-199 mg/dL

A1C: 5.7-6.4%

Question 3

Normal Blood Glucose

Answer 3

FBG: <100 mg/dL

2hr PG: <140 mg/dL

A1C: 5.7%

Question 4

T1DM

Answer 4

Beta cell destruction, immune mediated or idiopathic

Question 5

T2DM

Answer 5

Progressive insulin secretary defect plus insulin resistance

Question 6

Specific/secondary DM

Answer 6

T

Question 7

GDM

Answer 7

Glucose intolerance developing during the second or third trimester (>24 weeks)

Question 8

T2DM risk factors

Answer 8

• family history
• obesity (BMI>25)
• physical inactivity
• race/ethnicity
• prediabetes
• history of GDM or delivery of baby >4kg
• hypertension
• HDL <35, triglyceride >250mg/dL
• polycystic ovarian syndrome, acanthodians nigricans
• history of CVD

Question 9

Immunologic markers of T1DM

Answer 9

Anti-GAD
IAA (insulin)
IA-2 (tyrosine phosphatase)

Question 10

T1DM autoimmune response triggers

Answer 10

Infections: viruses, coxackie, rubella, enteroviruses
Bovine milk protein 
Nitrosurea compounds
Microbiome
 Viramin D deficiency

Question 11

Pathogenesis of T2DM

Answer 11

Impaired insulin secretion
Increased insulin resistance
Increased hepatic glucose production
Abnormal fat metabolism

Question 12

C peptide

Answer 12

C-peptide is a substance made in the pancreas, along with insulin.

C-peptide test can show how much insulin your body is making.

Good way to measure the level of insulin bc it tends to stay in the body longer.

Question 13

Amylin

Answer 13

Peptide hormone that is consecrated with insulin.

Inhibits glucagon secretion, slows gastric emptying and promoted satiety (satiety hormone) -> prevents post prandial spikes in blood glucose level

Forms amyloid fibrillation deposit in islet cells

Question 14

Metabolic syndrome/syndrome X/insulin resistance syndrome

Answer 14

Insulin resistance 
Hypertension
Dyslipidemia 
Central/visceral obesity 
T2DM or IGT/IPG
Accelerated CVD

Question 15

Incretin

Answer 15

R

Question 16

The Ominous Octet for T2DM

Answer 16

Decreased insulin secretion
Increased hepatic glucose production
Decreased glucose uptake
Increased lipolysis
Decreased incretin effect
Increased glucagon secretion
Increased glucose reabsorption (kidney)
Neurotransmitter dysfunction

Question 17

T1DM is associated with other endocrine disease such as

Answer 17

Addison’s disease
Autoimmune hypothyroidism
Pernicious anemia
Vitiligo

Question 18

T1DM

Answer 18

Beta cell destruction, immune mediated or idiopathic

Question 19

T2DM

Answer 19

Progressive insulin secretary defect plus insulin resistance

Question 20

Specific/secondary DM

Answer 20

T

Question 21

GDM

Answer 21

Glucose intolerance developing during the second or third trimester (>24 weeks)

Question 22

T2DM risk factors

Answer 22

• family history
• obesity (BMI>25)
• physical inactivity
• race/ethnicity
• prediabetes
• history of GDM or delivery of baby >4kg
• hypertension
• HDL <35mg/dL, triglyceride >250mg/dL
• polycystic ovarian syndrome, acanthosis nigricans
• history of CVD

Question 23

Immunologic markers of T1DM

Answer 23

Anti-GAD
IAA (insulin)
IA-2 (tyrosine phosphatase)

Question 24

T1DM autoimmune response triggers

Answer 24

Infections: viruses, coxackie, rubella, enteroviruses
Bovine milk protein 
Nitrosurea compounds
Microbiome
 Viramin D deficiency

Question 25

Symptoms of DM

Answer 25

``` Polyuria Polydypsia (excessive thirst) Constant hunger Weight loss Fatigue Blurred vision ``` *50% of T2DM patients are asymptomatic

Question 26

Physical examination of DM patients MUST

Answer 26

``` BP Eyes Peripheral nerves Cardiovascular system Peripheral arterial disease Foot examination ```

Question 27

Lab investigation of DM patients

Answer 27

``` FBS RBS HbA1C LFT RFT Lipids ECG Islet cell antibodies ```

Question 28

Sx of hypoglycemia

Answer 28

Y

Question 29

Ddx of DM (polysymptoms)

Answer 29

``` Diabetes insipidus Resolving acute kidney necrosis Diuretics Psychogenic polydipsia Hypothalamic disease ```

Question 30

Acute complications of DM

Answer 30

Hypoglycemia DKA HHS

Question 31

Chronic vascular complications of DM

Answer 31

Micro-vascular: Retinopathy Neuropathy Nephropathy Macro-vascular: Coronary arterial disease Cerebrovascular accident Peripheral arterial disease

Question 32

Ddx of DM (polysymptoms)

Answer 32

``` Diabetes insipidus Resolving acute kidney necrosis Diuretics Psychogenic polydipsia Hypothalamic disease ```

Question 33

Acute complications of DM

Answer 33

Hypoglycemia DKA HHS

Question 34

Chronic vascular complications of DM

Answer 34

Micro-vascular: Retinopathy Neuropathy Nephropathy Macro-vascular: Coronary arterial disease Cerebrovascular accident Peripheral arterial disease

Question 35

Chronic non-vascular complications of DM

Answer 35

GI: gastroparesis, diarrhea GU: Uropathy, sexual dysfunction Dermatological: Skin ulcers, hypopigmentation Infections: Respiratory, UTI, ear, GI, bone Cataract Glaucoma Periodontal disease: Tooth decay, tooth loss

Question 36

Wagner staging of foot ulcer

Answer 36

Grade 1-5: 1. Superficial diabetic ulcer 2. Ulcer extension to ligament, tendons and joint capsule. No abscess or osteomyelitis 3. Deep ulcer with abscess and osteomyelitis 4. Localized gangrene 5. Extensive localized gangrene

Question 37

Symptoms of DKA

Answer 37

Nausea/vomiting Thirst/polyuria Abdominal pain Shortness of breath

Question 37

Precipitating factors of DKA

Answer 37

Inadequate insulin administration Infection (pneumonia, UTI, gastroenteritis, sepsis) Infarction (cerebral, coronary, mesenteric, peripheral) Drugs (cocaine) Pregnancy

Question 37

Physical findings of DKA

Answer 37

``` Tachycardia Dehydration/hypotension Tachypnea/Kussmaul breathing Abdominal tenderness Lethargy, coma ```