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396 DM Class Flashcards

Chap. 396 Diabetes Mellitus Diagnosis Classification and Pathophysiology

1
Q

Refers to a group of common metabolic disorder that share the phenotype of hyperglycaemi

A

Diabetes mellitus

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2
Q

Factors Contributingvl to hyperglycaemia

A

Reduced insulin secretion
Decreased glucose utilisation
Increased glucose production

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3
Q

Develops as a result of autoimmunity against insulin producing beta cells, resulting in complete or near total insulin deficiency

A

Diabetes Mellitus type 1

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4
Q

Heterogenous group of disorders characterized by variable of insulin resistance, impaired insulin secretion, and increased hepatic glucose production

A

Type 2 diabetes mellitus

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5
Q

Subtypes of DM characterized by autosomal dominant inheritance, early onset of hyperglycemia usually less than 25 years of age and impaired insulin secretion

A

Maturity onset diabetes of the young (MODY)

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6
Q

Most reliable and convenient test for identifying DM in asymptomatic individuals

A

FPG and HbA1c

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7
Q

Incretin hormones that bind specific receptors on the beta cell to stimulate insulin secretion through cyclic AMP production

A

Glucagon like peptide 1 (GLP-1)

Glucose dependent insulintropic peptide (GIP)

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8
Q

Mechanism of action of incretins

A

Suppress glucagon production and secretion

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9
Q

Site of release of GLP-1

A

Neuroendocrine L cells of the GI tract following food intake and in the alpha cells of the pancreas

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10
Q

gestational diabetes mellitus

A

gestational diabetes mellitus

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11
Q

what is diagnosis if glucose tolerance is diagnosed during the first trimester of pregnancy

A

preexisting pregestation diabetes

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12
Q

what is the risk of GDM developing o DM in the next 10-20 yrs

A

35-60%

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13
Q

what is the recommended screening for the development of DM in patients with GDM

A

lifelong, every 3 years

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14
Q

has the highest incidence of type 1 DM

A

Scandinavia

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15
Q

what is the harbinger of type 2 DM

A

impaired glucose tolerance

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16
Q

what are the three broad categories of glucose tolerance

A

normal glucose homeostasis, impaired glucose homeostasis, DM

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17
Q

what is impaired fasting glucose

A

FPG 5.6-6.9 )100-125 mg/dl

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18
Q

what is impaired glucose tolerance

A

plasma glucose level 7.8-11 mmol or 140-199 mg/dL

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19
Q

values diagnostic of DM

A

FPG of more than 7 mmol or more than 136 mg/dl, 2hrs after glucose challenge plasma glucose more than 11 or more than 200 mg/dL, HbA1c more than 6.5%

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20
Q

random plasma glucose sufficient for diagnosis of DM

A

random plasma glucose more than 11.1 mmol or more than 200 mg/dL with classic symptoms

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21
Q

ADA recommendation for screening DM

A

age more than 45 yrs old every 3 yrs or earlier if BMI more than 25 or with additional risk factor for DM

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22
Q

most important regulator of metabolic equilibrium

A

insulin

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23
Q

useful marker of insulin secretion and allows discrimination of endogenous and exogenous sources of insulin in the evaluation of hypoglycemia

A

C peptide

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24
Q

indicative of beta cell dysfunction

A

proinsulin

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25
Q

key regulator of insulin secretion by the pancreatic beta cell

A

glucose

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26
Q

glucose level that stimulate insulin synthesis

A

glucose more than 3.9 mmol or 70 mg/dL

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27
Q

rate limiting step that controls glucose regulated insulin secretion

A

glucose phosphorylation by glucokinase

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28
Q

what is the secretory profile of insuline

A

pulsatile hormone release every 10 mins and greater oscillations about 80-150 min

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29
Q

Asymptomatic patient with FBS 130 mg/dl. What to do next?

A

in asymptomatic patients with FBS more than 126 mg/dl (more than 7 mmol); 2HPPG more than 200 mg/dl (11.1 mmol) 75 g OGTT or RBS more than 200 mg/dl with 3Ps is diagnostic of DM; repeat any of the test within 2 weeks for confirmation

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30
Q

when to use 75g OGTT

A

prior FBS 0f 100-125 mg/dl 5.6-6.9 mmol; previous diagnosis of cardiovascular disease; diagnosis of metabolic syndrome

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31
Q

prior stroke patient came in for screening for diabetes, what is the best screening test for this patient

A

75 g OGTT

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32
Q

what is the risk for T2DM in patient with GDM

A

substantial risk in next 10-20 years

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33
Q

when does insulin resistance during pregnancy occur

A

late pregnancy

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34
Q

True or false. In patients with GDM, there is development of impaired glucose tolerance during postpartum

A

False. Reverts to normal

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35
Q

True or false. There is increased insulin requirement in pregnancy

36
Q

True or false. All pregnant women should be evaluated at the first prenatal visit for risk for diabetes

37
Q

screening for patient with no risk factors

A

Weeks 24-28 weeks AOG

38
Q

screening for patients with high risk factors

A

first prenatal visit (soonest time possible)

39
Q

risk factor for GDM

A

prior history of GDM, glucosuria, family history of diabetes, first degree relative with T2DM, prior macrosomic baby, age more than 25 yrs old, diagnosis of PCOS, overweight or obese before pregnancy, polyhydramnios in current pregnancy, intake of drugs affecting carbohydrate metabolism

40
Q

preferred screening tests for GDM

41
Q

Threshold values by IADPSG. FBS, 1 hour, 2 hour,

A

FBS more than 92; 1 hr more than 180, 2 hr more than 153

42
Q

tests to detect overt DM in patients with GDM

43
Q

tests to assess glucose metabolism

A

75 g OGTT one year postpartum; FBS annually

44
Q

where is insulin secreted

A

About 50% secreted into the portal vein and degraded by the liver

45
Q

Type of insulin that enters systemic circulation

A

unextracted insulin

46
Q

what pathways are activated by activation of the insulin receptor signaling pathways

A

glycogen and protein synthesis, lipogenesis, and gene regulation

47
Q

refers to the time of initial clinical presentation of type 1 DM during which glycemic control is achieved with modest dose of insulin

A

honeymoon phase

48
Q

halotypes strongly associated with type 1 DM

A

DQA10301, DQB10302, DQB1*0201

49
Q

halotypes that seem to provide protection from type 1 DM

A

DQB1102, DBQ1602

50
Q

islet cell types spared from autoimmune destruction

A

alpha, delta, PP cells

51
Q

what is produced by alpha cells

52
Q

what is produced by delta cells

A

somatostatin

53
Q

what are PP cells

A

pancreatic polypeptide producing

54
Q

what mediates islet destruction

A

T lymphocytes

55
Q

True or false. Islet cell destruction is mediated by islet autoantibodies

A

false. Mediated by T lymphocytes

56
Q

True or false. Islet cell antibodies are present in the majority of individuals diagnosed with new onset type 1 DM

57
Q

Central to the development of type 2 DM

A

abnormal insulin secretion and insulin resistance

58
Q

most prominent variant of genes associated with type 2 DM

A

transcription factor 7-like 2 gene

59
Q

prominent feature of type 2 DM

A

insulin resistance

60
Q

dominant role in insulin resistance

A

postreceptor defects in insulin regulated phosphorylation/dephosphorylation

61
Q

insulin dose response curve

A

rightward shift

62
Q

result of decreased peripheral glucose utilization

A

postprandial hyperglycemia

63
Q

what is the impairment in skeletal muscle metabolism

A

nonoxidative glucose usage

64
Q

increased hepatic glucose output leads to

A

fasting hyperglycemia

65
Q

what does righward shift in insulin dose mean

A

decrease insulin sensitivity

66
Q

what is gluocotoxity

A

chronic hyperglycemia paradoxically impairs islet function

67
Q

what is lipotoxicity

A

increased fatty acids also worsen islet function

68
Q

True or false. In the pathogenesis of Type 1 DM, there is pre inflammatory islet atrophy

A

False. After beta cell destruction, inflammation subsides leading to islet atrophy

69
Q

The dyslipidemia found in Type 2 DM

A

elevated triglycerides, reduced HDL, increased LDL

70
Q

described a constellation of metabolic derangements that include insulin resistance, hypertension, dyslipidemia, central or visceral obesity, type 2 DM or IGT

A

metabolic syndrome

71
Q

type of insulin resistance. Undefined defect in the insulin signaling pathway; affects young women characterized by servere hyperinsulinemia, obesity and features of hyperandrogenism

A

Type A insulin resistance syndrome

72
Q

type of insulin resistance. Characterized by autoantibodies directed at at the insulin receptors. Affects middle aged women; presents with hyperinsulinemia, hyperandrogenism and autoimmune disorders

A

Type B insulin resistance syndrome

73
Q

advocated physical activity in the prevention of Type 2 DM

A

30 mins/ day five times a week

74
Q

Heterogenous group of disorders caused by genetic mutations that impact the beta cell function and or pancreatic development with onset less than 6 months of age

A

permanent neonatal diabetes

75
Q

most common cause of pancreatic agenesis

A

mutations in GATA6

76
Q

mutation in hepatocyte nuclear transcription factor HNF 4a

77
Q

mutation in hepatocyte nuclear transcription factor HNF1a

78
Q

mutation in hepatocyte nuclear transcription factor HNF 1b

79
Q

progressive decline in glycemic control but may respond to sulfonylureas

80
Q

results from mutationn in glucokinase where patient have mild to moderate but stable hyperglycemia that does not respond to oral hypoglycemia agents

81
Q

variant caused by mutations in pancreatic and duodenal homeobox1

82
Q

percent MODY associated genes as cause of type 2 DM

A

less than 5%

83
Q

when does the complications of chronic hyperglycemia appear

A

during the second decade of the hyperglycemia

84
Q

Blood pressure considered hypertension in individuals with diabetes

A

BP more than 130/80 mmHg

85
Q

when to assess autonomic neuropathy in Type 1 DM? In type 2 DM?

A

Annually 5 yrs after the initial diagnosis of Type DM, annually starting at the time of diagnosis for Type 2 DM

86
Q

Type 2 DM present with ketoacidosis but lack autoimmune markers

A

ketosis prone type 2 DM

87
Q

Type 2 DM phenotype but have autoimmune markers

A

latent autoimmune diabetes of the adult

Endocrine (15 decks)

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