Week 5 DM Flashcards by Brooklyn Burley

What is diabetes mellitus (DM)?

A metabolic disease characterized by hyperglycemia and dysfunction of glucose metabolism by insulin

DM results from inadequate insulin production or resistance to insulin’s action.

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What are the two main types of diabetes mellitus?

Type 1 DM and Type 2 DM

Type 1 is often autoimmune, while Type 2 is associated with obesity.

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What characterizes Type 1 DM?

Autoimmune destruction of β cells in the pancreas leading to lack of insulin

Mostly diagnosed in children and young adults.

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What is the primary characteristic of Type 2 DM?

Insulin resistance and relative insulin deficiency

Strongly associated with obesity.

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What is the management objective for diabetes mellitus?

Prevention of complications

Complications may include coronary artery disease, CKD, retinopathy, and neuropathy.

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What is the significance of long-term monitoring in diabetes management?

Key to preventing complications

Maintenance of optimal blood glucose levels is crucial.

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What is the typical presentation age for Type 1 DM?

Typically diagnosed in children or adults < 25 years of age

Commonly diagnosed at ages 4–6 years.

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What percentage of all diabetics are Type 1?

5%–10%

Type 1 DM has a strong age, race, and geographic bias.

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What is the estimated worldwide prevalence of Type 2 DM as of 2017?

425 million people

Type 2 DM accounts for 90%–95% of all diabetics.

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What is gestational diabetes?

Occurs in 5%–7% of pregnancies in the United States

Associated with increased risk for nongestational diabetes later in life.

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What are some risk factors for gestational diabetes?

Hemoglobin A1c ≥ 5.7%
Gestational diabetes in previous pregnancy
≥ 110% of ideal body weight
Family history of DM
Glucose in urine at 1st prenatal visit
Previous children ≥ 4 kg at birth
PCOS

Additional factors include glucocorticoid use and multiple gestations.

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What is the autoimmune cause of Type 1 DM?

Destruction of pancreatic β cells by GAD antibodies

HLA-linked (HLA-DQ, HLA-DR3, and HLA-DR4) and associated with other autoimmune conditions.

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What is the role of insulin in Type 1 DM management?

Insulin replacement is essential

Patients require insulin at all times to manage hyperglycemia.

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What are the common symptoms of hyperglycemia in Type 1 DM?

Polydipsia
Polyphagia
Polyuria
Weight loss
Blurred vision

DKA can also occur as an urgent presentation.

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What distinguishes Type 2 DM from Type 1 DM in terms of onset?

Gradual onset and often asymptomatic for several years

High glucose levels may be detected before symptoms appear.

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What are the diagnostic criteria for diabetes mellitus?

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Random plasma glucose > 200 mg/dL with symptoms
Fasting plasma glucose ≥ 126 mg/dL
Plasma glucose ≥ 200 mg/dL after a 2-hour OGTT
Hemoglobin A1c ≥ 6.5%

Screening for diabetes is recommended for individuals with certain risk factors.

What is the recommended HbA1c target for diabetes management?

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< 7%

Less strict goals may be set for elderly patients and children.

What is the first-line drug of choice for Type 2 DM?

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Metformin

It is a biguanide that helps improve insulin sensitivity.

What is the role of lifestyle modifications in diabetes management?

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Balanced diet
Regular exercise
Weight loss
Smoking cessation
Stress management

These modifications are crucial alongside pharmacologic therapies.

What are the common chronic complications of diabetes?

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Coronary artery disease
Chronic kidney disease (CKD)
Retinopathy
Neuropathy

These complications are related to prolonged hyperglycemia.

What is the first-line drug of choice for treating insulin-resistant diabetes (usually type 2)?

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Biguanide (metformin)

Metformin is commonly used as it helps improve insulin sensitivity.

Which class of medications has demonstrated benefit for cardiorenal outcomes in type 2 diabetes?

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Sodium–glucose cotransporter-2 (SGLT-2) inhibitors

These medications are particularly beneficial for heart failure hospitalization, risk of kidney disease progression, and mortality.

Name two other classes of medications used to treat type 2 diabetes aside from metformin and SGLT-2 inhibitors.

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Dipeptidyl peptidase-4 (DPP-4) inhibitors
Sulfonylureas
Thiazolidinediones
Insulin therapy

Insulin therapy is also used in type 1 diabetes and sometimes in type 2 when oral medications are insufficient.

What is the onset time for rapid-acting insulins?

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10–15 minutes

Examples include Glulisine (Apidra), Lispro (Humalog), and Aspart (NovoLog).

What is the peak time for short-acting insulin?

2–3 hours ## Footnote Short-acting insulin starts working in 30 minutes.

What are the long-acting insulins that last 12–24 hours?

* NPH (neutral protamine Hagedorn) * Glargine (Lantus or Basaglar) * Detemir (Levemir) ## Footnote Long-acting insulins are often used for basal control.

Which noninsulin injectable therapy is preferred for patients with cardiac or renal comorbidities?

Glucagon-like peptide-1 (GLP-1) receptor agonists ## Footnote Examples include Exenatide (Byetta), Dulaglutide (Trulicity), Liraglutide (Victoza), and Semaglutide (Ozempic).

What is the dawn phenomenon?

Morning hyperglycemia caused by the disappearance of exogenous insulin and increased insulin-antagonistic hormones ## Footnote This phenomenon occurs early in the morning.

What is the Somogyi effect?

Rebound morning hyperglycemia after nighttime hypoglycemia due to excessive insulin administration ## Footnote It is a response to low blood sugar levels that occur during the night.

What is DKA and what are its primary symptoms?

Diabetic ketoacidosis (DKA) characterized by severe hyperglycemia, vomiting, shallow respirations, and confusion ## Footnote It can lead to coma and death if untreated.

What are the symptoms of severe insulin-induced hypoglycemia?

* Confusion * Irritability * Anxiety * Slurred speech * Diplopia ## Footnote These symptoms can lead to loss of consciousness, seizures, or death if untreated.

What is hyperosmolar hyperglycemic state (HHS)?

Severe hyperglycemia leading to high osmolarity without significant ketoacidosis, symptoms include dehydration and altered consciousness ## Footnote HHS requires hospitalization.

What complications can arise from gestational diabetes?

* Miscarriage * Fetal deformities * Large-for-gestational-age fetus * Macrosomia * Preeclampsia * Hypoglycemia in the infant ## Footnote The risk of complications is proportional to the level of hyperglycemia.

What is maturity onset diabetes of the young (MODY)?

Clinically heterogeneous disorder characterized by non-insulin-dependent diabetes diagnosed at a young age with autosomal dominant transmission ## Footnote It lacks autoantibodies.

What is latent autoimmune diabetes of adulthood (LADA)?

A form of type 1 DM that can be diagnosed with antibody testing in patients with newly manifested diabetes ## Footnote It is important to distinguish LADA from type 2 DM.

Fill in the blank: Steroid-induced hyperglycemia may occur due to medications like _______.

Prednisone ## Footnote This condition may resolve after the course of steroids or persist, revealing underlying type 2 DM.

What is secondary diabetes and what can cause it?

Diabetes resulting from conditions such as Cushing’s disease, acromegaly, or glucagon hypersecretion due to islet alpha cell tumors ## Footnote Other causes include Down syndrome, hemochromatosis, chronic pancreatitis, and pancreatic malignancy.

Week 5 DM Flashcards

(37 cards)