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The Skinny On Diabetes Flashcards

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1
Q

What’s the top 5 things of the list

A
  1. HbA1C under 7%
  2. Control BP
  3. Control Cholesterol
  4. Rule out SA
  5. Rule out Anemia
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2
Q

Hypertensive patients with diabetes need their BP to be what?

A

125/80 or better

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3
Q

At what concentration of cholesterol will we see retinal deposits?

A

> 240mg/dl

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4
Q

What 4 things does a CPAP do?

A
  1. Reduce nocturnal HTN
  2. Increase Oxygen
  3. Decrease FBS
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5
Q

Hemaglobin should be above what to rule out anemia?

A

Hb must be above 11

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6
Q

At what level of Hb should Procrit be considered?

A

If below 9

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7
Q

At what concentration of proteinuria are we afraid of adverse effects?

A

300mg or more (albuminuria)

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8
Q

What category of drug should a patient be on if proteinuria is dx?

A

ACE inhibitor or ARB

- renoprotective

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9
Q

Smoking causes what 3 things?

A
  1. Increases proteinuria
  2. BV wall damage
  3. Vasoconstriction
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10
Q

Insufficient sleep causes what?

A
  1. Increase blood insulin + inflammation
  2. Decreased leptin + increased ghrelin
  3. Increased cortisol release
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11
Q

Hyperhomocystein can be found in diabetics taking metformin due to a loss of what vitamin?

A

Vitamin B12

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12
Q

What is the reward center of the brain?

A

Nucleus Accumbens

- dopamine is released

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13
Q

What is the emotional center of the brain?

A

Amygdala

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14
Q

What stage of DM gives you CSME?

A

Both proliferative and NP

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15
Q

What type of cholesterol is fluffy and doesn’t stick?

A

Pattern A

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16
Q

What type of cholesterol is sticky?

A

Pattern B

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17
Q

What drug allows erythropoietin be injected? What’s it for? At what Hb level do we use it?

A

Procrit - used to treat lower than normal RBCs

Use if Hb is below 9

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18
Q

What is the definition of Anemia?

A

Hb below 11

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19
Q

What is a CPAP used for?

A

Used for sleep apnea

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20
Q

What protein is released by liver to help keep blood in the vessels?

A

Albumin

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21
Q

What is the name of the hormone that blocks leptin? What does it do? Where is it secreted from?

A

PYY- acts as appetite suppressant

- secreted by small intestine

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22
Q

What type of fat comes from estrogen?

A

Subcutaneous fat - cardio protective

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23
Q

What type of fat comes from a sedative lifestyle?

A

Visceral fat - smooth fat, causes heart attacks

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24
Q

What is the BMI for obese and overweight ppl? What about anorexia?

A

Obese - 30
Overweight - 25
Anorexia - less than 17

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25
If patient has proteinuria, what medication should they be on? Why?
ACE inhibitors - protects capillaries
26
Ghrelin secreted by the stomach tells you what?
Hungry
27
Leptin secreted by fat tells you what?
Tells you that you're full
28
WIT: caused by abnormal autoimmune reaction, leads to destruction of pancreatic cells causing decreased insulin production
T1DM
29
Type 2 DM accounts for what percentage of patients w/ dm in the US?
90%
30
Type 2 diabetics are resistant to what?
resistant to insulin action
31
DM is the ___ leading cause of death in US
7th
32
When someone has DM, theres a __ to __ fold increase in risk of CV disease.
2 to 4 fold increase
33
How many people have diabetes?
> 29 million
34
How many ppl have type 1 DM?
1.5 million
35
How many people have T2DM? What % diagnosed and undiagnosed?
23 million 70% diagnosed 30% undiagnosed
36
How many people have pre-DM? What percentage is over 20 yo?
86 million | 37% over 20
37
What ethnicity has the highest prevalence of diabetic retinopathy over 50?
Hispanics
38
What ethnicity has the highest prevalence of DR from 40-49 yo?
Blacks
39
DM is the leading cause of blindness in Americans between what age?
20-74 years old
40
What 3 ethnicities are high risk for DM?
African Americans Hispanics Native Americans
41
DM is a small vessel disease that leads to the dysfunction of the capillary vessels, causing ?
Retinopathy Nephropathy Neuropathy
42
DM is a large vessel disease leading to atherosclerosis, increasing the risk for ?
- Strokes - Cerebral Artery Disease - Coronary Artery Disease - Peripheral Vascular Disease
43
Hyperglycemia causes the release of? What does this cause in the body?
Mitochondrial ROS Inflammation
44
What 4 pathways occur due to the release of mitochondrial ROS?
1. P. Kinase 2. Glycation 3. Polyol 4. Hexosamine
45
All 4 pathways lead to what?
Diabetic micro and macroangiopathy disease
46
What study(s) concluded that hyperglycemia is the initiating cause of diabetic tissue damage seen clinically?
DCCT - diabetic control and complication trial UKPDS - UK prospective diabetic study
47
What are the systemic biomarkers for inflammation?
CRP ICAM-1 VCAM-1
48
What’s upregulated for a cotton wool spot? What else causes a CWS?
1. ICAM-1 and VCAM-1 (signals that recruit WBCs) | 2. Accumulation of platelets
49
Hyperglycemia causes a decrease in what omega-3 ?
DHA
50
HTN exacerbates DM induced retinal inflammation by increasing the expression of what molecules?
1. VEG-F | 2. ICAM-1
51
What cell cycle does the inner retina rely on?
Glycolysis
52
What cell cycles does the outer retina rely on?
Oxidative phosphorylation
53
How many ganglion cells are lost before retinal thinning is noted?
~200K
54
What is the most common cause of central vision loss and decreased vision in working-aged Americans?
Diabetic Macular Edema | - loss of inner BRB
55
After 15 years of known DM, risk of CSME is what percent in T1DM?
20 %
56
After 15 years of known DM, risk of CSME is what percent in T2DM taking insulin?
25%
57
After 15 years of known DM, risk of CSME is what percent in T2DM not taking insulin?
14%
58
After 20+ years of DM, risk of CSME in mild NPDR = ?
3%
59
After 20+ years of DM, risk of CSME in mod to sev. NPDR = ?
38%
60
After 20+ years of DM, risk of CSME in severe NPDR = ?
71%
61
What was the first study to introduce the term CSME?
ETDRS - Early Treatment Diabetic Retinopathy Study
62
What are the 3 definitions of CSME?
1. Thickening of retina within 500 um of center of macula 2. Hard exudates w/in 500 um of center of macula w/ thickening 3. 1 zone of retinal thickening greater than 1 DD in size
63
What study said aspirin therapy is good for diabetic patients to reduce inflammation? How much? what age?
ETDRS - Early treatement diabetic retinopathy study 81-325mg/day 30 and over
64
Aquaporin-4 promotes increased leakage, edema and cell disorganization. What drug should be used to stop this?
Steroids = reduce aquaporin-4
65
If we have swelling the macula w/o meeting definitions of CSME, what is this called?
Diabetic maculopathy
66
DR = presence of a few microanuerysms, RTC 1 year
Mild NPDR
67
DR = MAs, hemes, venous beading, CWS, RTC 6-9 mths.
Moderate NPDR
68
Explain the 4-2-1 rule found in severe NPDR. (we only need 1 of these things to be classified as severe)
- 4 quads of 20 hemes - 2 quads of venous beading - 1 quad of IRMA (intraretinal microvasculature abnormalities)
69
What type of vision loss do we have in NPDR?
Moderate = doubling of the visual angle usually caused by CSME
70
Proliferative DR is characterized by what 3 things?
1. Neo 2. Tractional RD 3. Vitrous Hemorrhage
71
What are the 3 high risk findings related to severe vision loss?
1. NVD > 1/3 DD 2. Vitrous or preretinal heme 3. NVE > half disc area
72
What classifies an Advanced PDR?
1. extensive vitrous heme & can't grade DR 2. RD involving mac 3. Phthisis bulbi
73
What type of vision loss is found in PDR?
less than 5/200 or 20/800 vision

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