04b: Diabetes Flashcards
Diabetes can be defined using Fasting plasma glucose (FPG) greater than (X) mg/dL on at least (Y) number of occasions.
X = 126 Y = 2
(fasting = no caloric intake for at least 8h)
Diabetes can be defined using 2h plasma glucose, during OGTT (oral glucose tolerance test), of (X) mg/dL or greater.
X = 200
Diabetes can be defined using HbA1C greater than or equal to (X)%.
X = 6.5
HbA1c can be used to screen for/diagnose diabetes, but should not be used in which patients?
- Pregnant F
- Recent severe bleeding/transfusion
- Chronic kidney/liver disease
- Blood disorders (Fe-def anemia, megaloblastic anemia, SSD/thalassemia)
40 y.o. F patient presents with fatigue, pale skin, and mild dyspnea. Which test would you use to screen for diabetes?
Fasting plasma glucose or oral glucose tolerance test
NOT HbA1c since showing symptoms of anemia
Type I diabetes: what do you expect to see on biopsy of pancreas?
Insulitis (CD8 T cells infiltrate islets)
Pancreas biopsy showing amyloid deposits in islets is suggestive of (X) disease. Why does this amyloid deposit?
X = DM II
Insulin resistance causes excess insulin secretion from islets; with insulin, amylin (an amyloid protein) is also secreted and accumulates
Most common cause of death patients with DM is:
MI (Vfib)
Pts with DM have (X)x risk of amputations
X = 100
What’s the primary pathophysiology behind all the DM complications?
Accelerated atherosclerosis
Papillary Tip Necrosis/Necrotizing papillitis is a relatively specific renal complication of (X) disease.
X = DM
Which glomerular lesions would you expect to see in DM?
- BM thickening
- Mesangial sclerosis
- KW (Kimmelstiel-Wilson) nodules
KW (Kimmelstiel-Wilson) nodules are composed of (X) material and form in regions of (Y).
X = pink hyaline Y = glomerular capillary loops
DM: which lesions in eye develop?
- Cataract
- Glaucoma
- Retinopathy (proliferative)
Diabetic retinopathy can occur via which mechanisms?
- Retinal hemorrhage (sudden blindness)
- Retinal microaneurysms
- Neovascularization
A large (X) value along identifies 46% of subjects who will develop Metabolic Syndrome in 5y.
X = waist circumference (assess central fat distribution)
Waist circumference measured at which landmark? Taken at the end of (normal/max) (inspiration/expiration).
Top of Iliac crest
Normal expiration
T/F: BMI increase is linearly associated with decreased insulin sensitivity.
False - % central abdominal fat is!
Weight loss by 7% reduces metabolic syndrome by (X)%.
X = 41
Key relevance of metabolic syndrome is to ID patients who:
Need aggressive lifestyle modification focused on weight loss and increased exercise
Major diseases associated with metabolic syndrome:
- DM II
2. Risk of CVD
T/F: In metabolic syndrome, lifestyle modification has been shown to have greater risk reduction in development of diabetes than metformin.
True - 58% v 31% risk reduction
In obese patients with metabolic syndrome, NIH recommends (X)% weight reduction at rate of (Y) lb/week
X = 5-10 Y = 1-2
Qualifications for bariatric surg:
- BMI over 40 OR
2. BMI over 35 with comorbidity
Metabolic syndrome is an entity characterized by:
- Insulin resistance and hyperinsulinemia
- HT
- Dyslipidemia
In general, metabolic syndrome prevalence (increases/decreases) with age.
Increases
Metabolic syndrome diagnosed clinically by presence of 3 of the following:
- Fasting glucose over 100
- BP over 130/80
- Dyslipidemia (TG over 150, HDL under 40 (M)/50 (F))
- Increased waist circumference (based on ethnicity/sex)
Decrease in synthesis/release of (X) hormone from adipose has been shown to predict development of DM II and CVD.
X = adiponectin
Exercise has been shown to (increase/decrease) AMPK in muscle and other tissues. Which endogenous hormone (activates/inhibits) AMPK?
Increase
Adiponectin; activates
Experimentally, AMPK activators were found to decrease:
Inflammation, oxidative/ER stress, mito dysfunction, insulin resistance
T/F: 90-95% of diabetes patients in US are Type II.
True
T/F: Majority, but not all, pre-diabetic patients eventually develop diabetes.
False - majority never develop diabetes!
Pre-diabetes: most important intervention to prevent progression to diabetes is…
Regular exercise
Insulin resistance has a key effect on (X) process in adipose tissue, which (increases/decreases) circulating (Y).
X = lipolysis (increased in insulin resistance)
Increases
Y = FFA and TGs
How does the (increase/decrease) in FFAs cause insulin resistance?
Increase
Increases hepatic gluconeogenesis
T/F: Dyslipidemia in DM II involves low HDL and high LDL.
False - LDL usually not affected
List some inflammatory markers that are elevated in DM II
- CRP (also higher in obesity)
2. Cytokines (TNF-alpha, IL6)
TNF-alpha role in DM II: (increases/decreases) (X) via activation of (Y).
Increases
X = FFAs and insulin resistance
Y = NF-kB transcription factor
IL-6 role in DM II: (increases/decreases) (X) via stimulation of (Y).
Increases
X = FFAs
Y = lipolysis
(X) is type II diabetes that occurs in young patients (under 25 yo). What’s the issue?
X = MODY (maturity onset diabetes of young)
Impaired insulin production (but no antibodies like in DM I) - AD transmission
MODY (maturity onset diabetes of young) patients respond well to:
Sulfonylureas
Requirements for DKA diagnosis.
DKAA: D: glucose over 250 K: ketonemia A: acidosis (pH under 7.3) A: alkalosis (bicarb under 18)
Mild v severe DKA is dependent on level of:
Alkalosis (lower bicarb, worse prognosis)
Requirements for HHS (hyperglycemic hyperosmolar state) diagnosis.
- glucose over 600 mg/dL
2. Effective serum osmolarity over 320
Effective osmolarity differs from total osm in that (X) (is/isn’t) taken into account in the latter
X = BUN
is
Which values do you need to know to calculate effective osm?
Serum Na and glucose
T/F: HHS (hyperglycemic hyperosmolar state) is primarily a disorder of hyperglycemia.
False - disorder of dehydration
Ketone bodies form when enzymes of (X) process become saturated
X = TCA cycle
Most common medical cause of DKA is:
infection (esp UTI and pneumonia)
What are two causes of euglycemic DKA (blood glucose under 250 mg/dL)?
Pregnancy or SGLT2 inhibitors
T/F: Urine and plasma ketone assays measure acetoacetate.
True (not the predominant ketone body, so could be falsely low initially)
T/F: Acetoacetate is the predominant ketone body.
False - BHB (beta-hydroxy butyrate) is
Correcting hyperosmolarity: avoid decreasing effective osm by more than (X) in an hour
X = 3 mOsm/kg H2O
Hyperglycemia: first, most important step in Rx is…
IV rehydration (use serum Na as guide to % saline)
HHS/DKA Rx: when glucose reaches 300 in HHS and 200 in DKA, how does IV fluid Rx change?
Change to fluid containing dextrose
T/F: Pts being treated for HHS/DKA are normokalemic.
True - but K still given!! (total body K low)
T/F: In pts being treated for HHS/DKA, it’s crucial to give insulin along with or immediately after IV fluids.
False - no rush.. make sure K is over 3.3; check serum glucose hourly
(X) values are the best ways to decide when DKA is resolved.
X = anion gap and serum bicarb
DKA resolution criteria:
2/3 of:
- Serum HCO3 over 15
- Venous pH over 7.3
- Anion gap over 12
