B2.039 Big Case Mrs. Dolan

Question 1

what are the diagnostic criteria for diabetes mellitus?

Answer 1

fasting plasma glucose <126 mg/dl
two hour plasma glucose of >200 mg/dl during oral glucose tolerance test
A1C value >6.5%

Question 2

characterize type 1 diabetes

Answer 2

10% of cases
autoimmune destruction of pancreatic beta cells
absolute insulin deficiency
DKA initial presentation in 25% of adults

Question 3

what are the classic symptoms of DM1?

Answer 3

polyuria, polydipsia, nocturia, blurred vision

Question 4

characterize type 2 diabetes

Answer 4

most common, greater than 90% of cases
majority are asymptomatic
may present w classic symptoms
hyperglycemia and insulin deficiency and resistance

Question 5

how does insulin act on adipose?

Answer 5

increase glucose uptake
increase lipogenesis
decrease lipolysis

Question 6

how does insulin act on muscle?

Answer 6

increase glucose uptake
increase glycogen synthesis
increase protein synthesis

Question 7

how does insulin act on the liver?

Answer 7

decrease gluconeogenesis
increase glycogen synthesis
increase lipogenesis

Question 8

what are 3 symptoms of obesity that contribute to insulin resistance?

Answer 8

increased adipokines
increased FFAs (free fatty acids)
inflammation

Question 9

what are 2 causes for autoimmune mediated islet cell destruction in DM1 patients?

Answer 9

failure of self tolerance in T cells

anti insulin antibodies

Question 10

what are some effects of insulin resistance in DM2 patients?

Answer 10

initially B cell hyperplasia to compensate
eventually B cell failure
role of excess FFAs
role of inflammation

Question 11

what is macrovascular disease?

Answer 11

accelerated atherosclerosis affecting large arteries
myocardial infarction
peripheral vascular disease

Question 12

what is microvascular disease?

Answer 12

diffuse thickening of vascular membranes

Question 13

what organs experience major complications of microvascular disease?

Answer 13

eyes: vessel damage causing retinopathy, cataracts, and glaucoma
kidney: HBP and excess glucose damages small vessels and overworks kidneys, nephropathy
NS: hyperglycemia damages nerves in PNS

Question 14

what organs experience major complications of macrovascular disease?

Answer 14

brain: increased risk of stroke and cerebrovascular disease
heart: HBP and insulin resistance increase risk of CHD
extremities: narrowing of blood vessels increases risk of reduced blood flow

Question 15

what is the second leading cause of death in diabetes?

Answer 15

diabetic nephropathy

Question 16

for management of DM, what needs to be done frequently?

Answer 16

eye exam
foot exam
BP
dental exam
smoking cessation
CVD prevention
screening from increased urinary albumin

Question 17

what are important lab studies in diabetes?

Answer 17

hemoglobin A1C
serum creatinine
urinary albumin-to-creatinine ratio
TSH
fasting lipid profile