Approach to Endocrine Topics 1 Flashcards
Diabetes Type 2 Pathophysiology
insulin resistance leading to ineffective transport of glucose out of blood vessels
What is a major outcome of hyperglycemia?
organ damage
What value for HbA1c determines diabetes type 2?
HbA1 > 5.7
What are some risk factors for diabetes type 2?
age > 45
BMI > 25
sedentary lifestyle
HbA1c and high fasting glucose
What are some clinical presentations of diabetes type 2?
polyuria
polydipsia
polyphagia (excessive eating)
recurrent UTIs, tingling & pain
What are some physical exam findings for diabetes type 2?
acanthosis nigricans
retinopathy
foot ulcer
What are the criteria for type 2 diabetes diagnosis from the ADA?
HbA1c > 6.5%
fasting glucose > 126
2 hour glucose > 200 on oral glucose tolerance test
random glucose > 200 with symptoms of hyperglycemia
What do you look for on a diabetic foot exam?
callus/corn formation, dryness, breaks in skin,
check pulses
check sensation
Management for diabetes type 2
lifestyle changes
oral metformin
insulin
check HbA1c every 3 months
BP & lipid control
Ominous Octect for Diabetes type 2
NT dysfxn increased lipolysis & reduced glucose uptake impaired insulin secretion increased glucagon secretion increased glucose reabsorption increased hepatic glucose production decreased incretin effect decreased glucose uptake
What are some complications assoc w/ diabetes type 2?
microvascular diseases
macrovascular disease (stroke, PVD)
increase in infections (unusual infections)
What is diabetic ketoacidosis?
mental changes nausea, vomiting, abdominal pain signs of dehydration Kassmual respirations fruity smelling breath
What are some precipitating factors for diabetic ketoacidosis?
Inadequate insulin treatment (out of meds)
new onset diabetes
acute illness
Signs of DKA
hyperglycemia (blood glucose > 200)
metabolic acidosis
ketosis
Signs of HHS
marked hyperglycemia (>600)
minimal acidosis
absent or mild ketosis
marked serum osmolality
Management for DKA/HHS
Admit to hospital (electrolyte correction)
Need IV fluids, IV insulin, potassium replacement
Do NOT manage as outpatient
Diabetes Type 1 Pathophysiology
immune-mediated beta cell destruction
What are risk factors for diabetes type 1?
genetic susceptibility
environmental trigger
Clinical presentation of diabetes type 1
polydipsia (excessive thirst)
polyuria
weight loss w/ hyperglycemia or ketonemia
DKA (first presenting sign)
What are some associated conditions w/ type 1 diabetes?
autoimmune thyroiditis
celiac disease
addison’s disease
Management of type 1 diabetes
education
insulin
Metabolic syndrome pathophysiology
metabolic abnormalities that confer increased risk of CVD & diabetes (increased risk w/ increased age)
What are some risk factors assoc w/ metabolic syndrome?
overweight sedentary lifestyle genetics/aging DM type 2 CVD lipodystrophy
Diagnosis guidelines for metabolic syndrome
Need 3 of:
Abdominal obesity Triglycerides >150 HDL <40 in men & <50 in women BP > 130/85 fasting glucose >100
Assoc Conditions for Metabolic Syndrome
Polycystic ovary syndrome
Obstructive sleep apnea
Nonalcoholic fatty liver disease
Hyperuricemia
Management for metabolic syndrome
LIFESTYLE (diet & exercise) weight loss medication weight loss surgery BP meds Metformin
Presenting signs of metabolic syndrome
weight gain/loss urinary frequency excessive thirst numbness/tingling in feet or hands vision changes diet & exercise family history
