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Endocrinology - Chapters > Chap.102 Diabetes GreenB > Flashcards

Chap.102 Diabetes GreenB Flashcards

1
Q

What is the most prevalent endocrinologic problem encountered in primary care practice?

A

diabetes mellitus

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2
Q

What are the characteristics of diabetes mellitus?

A

hyperglycemia
relative or absolute deficiency of insulin
insulin resistance
risk of longterm microvascular and macrovascular complications

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3
Q

What is the ultimate goal of therapy of DM?

A

the prevention of future complications such as: microvasular and macrovascular complications, consequences of diabetes that make the condition a major risk for cardiovascular disease, stroke, visual impairment, renal failure, impotence, peripheral neuropathy, foot ulcers, limb loss and death

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4
Q

Effective management of DM requires care that is thoughtful and meticulous, incorporating intensive _______ involving the entire health care team.

A

patient education

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5
Q

Euglycemic control, with the level of hemoglobin A1c kept less than _____ has emerged as a major treatment objective because of its oassocaition with a marked reduction in the risk for the microvasular complications.

A

7%

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6
Q

What are 4 important things to consider in the treatment of a patient with DM?

A

lifestyle adjustments (exercise, weight reduction), determining when to initiate pharmacologic therapy, selection among available agents and setting an achievable goal for hyperglycemic control

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7
Q

What characteristic of DM has gained more attention for its pathological significance and importance of early diagnosis?

A

hyperglycemia

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8
Q

What is the threshold for diagnosis for the fasting plasma glucose level?

A

126 mg/dL

It has been revised downward from 140 to 126 to increase the sensitivity of determination

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9
Q

What is deemed the preferred test to diagnose diabetes in children and nonpregnant adults?

A

fasting glucose level

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10
Q

The diagnosis of DM can be made based on the presence of one of three glucose abnormalities found on two separate days. What are these abnormalities?

A
  1. Fasting plasma glucose 126 mg/dL or greater.
  2. Random plasma glucose 200 mg/dL or greater in a person with diabetes symptoms (polyuria, polydipsia, or weight loss)
  3. Two- hour postprandial plasma glucose level 200 mg/dL or greater after administration of the equivalent of a 75g oral glucose load (oral glucose tolerance test)
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11
Q

What are the diagnostic criteria for normal fasting glucose and impaired fasting glucose?

A

normal- less than 100 mg/dL

impaired- 100-125 mg/dL

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12
Q

Impaired glucose tolerance was refined as a fasting glucose less than ______ and a 2 hour PG of ____ to _____ mg/dL.

A

126 mg/dL

140-199 mg/dL

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13
Q

What are considered “pre-diabetes” and are risk factors for the development of future diabetes and cardiovascular disease.

A

IFG and IGT

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14
Q

Classification of Diabetes…. :)

A

DON’T YOU JUST LOVE IT!!!!!!

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15
Q

The preferred approach to classification, as issued by the American Diabetes Association, is according to underlying __________.

A

pathophysiology

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16
Q

Which type of diabetes is characterized by an autoimmune destruction of the pancreatic beta cells leading to an absolute deficiency of insulin - patients are ketosis prone and require insulin to live.

A

type 1 diabetes

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17
Q

In which type of diabetes does peripheral insulin resistance a more contributing factor?

A

type 2

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18
Q

Patients with type 1 diabetes may have detectable serum autoantibodies to such pancreatic antigens as ______ and _________.

A

islet cells

glutamic acid dehydrogenase

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19
Q

Which type of diabetes is characterized by variable degrees of insulin secretory deficiency and resistance? –> insulin is present but in amts insufficient to meet metabolic needs in a timely fashion

A

type 2

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20
Q

What is believed to be the major role in insulin resistance? (present in 60-80% of patients with type 2 diabetes)

A

obesity

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21
Q

type 2 diabetics exhibit impaired ______ secretion at any plasma glucose conc. and ________.

A

insulin

insulin resistance

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22
Q

What is the most common type of diabetes?

A

type 2

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23
Q

What is used to identify a patient with impaired glucose tolerance?

A

fasting glucose less than 126 mg/dL and a 2 hour glucose level of 140 to 199 mg/dL

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24
Q

Pts with experiencing impaired glucose tolerance are more at risk for what?

A

development of type 2 diabetes is increased as is the risk for cardiovascular disease

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25
Q

The principal pathology for type 1 diabetes is ___________, usually due to ________ destruction of the ________, which leads to a loss of insulin production.

A

pancreatic beta-cell destruction

autoimmune destruction of the beta cells

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26
Q

The pathogenesis of Type 2 diabetes is characterized by ________ and _______.

A

impaired insulin secretion

insulin resistance

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27
Q

What are the pathophysiologic hallmark signs of insulin resistance?

A

inappropriate hepatic glucose production and decreased muscle glucose uptake- these occur despite the secretion of insulin

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28
Q

What often precedes type 2 diabetes that is associated with caloric excess and inactivity.

A

metabolic syndrome

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29
Q

What are the features of metabolic syndrome?

A 
insulin resistance
obesity
dyslipidemia
hypertension
strongly increased risk for macrovascular artherosclerotic disease--> coronary risk increased two to four fold
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30
Q

What is an important contributor to type 2 diabetes, exacerbating insulin resistance?

A

weight gain

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31
Q

Glucose intolerance in diabetic patients may be worsened by?

A 
infection
stress
thiazides
glucocorticoids
pregnancy
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32
Q

Excess secretion of these things may contribute to glucose intolerance

A 
GH 
cortisol
catecholamines
glucagon
and diseases that destroy a substantial portion of the pancreas (chronic pancreatitis, hemochromatosis, cystic fibrosis)
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33
Q

Type 1 diabetes may present emergently as _______ or less dramatically with the classic triad of ______, ______ and _______.

A

ketoacidosis

polyuria, polydipsia and polyphagia

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34
Q

Typically, the onset of type 1 is when?

A

in the first two decades of life, but may occur later

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35
Q

In which decade of life does incidence of type 2 rise significantly?

A

starting in the fourth decade

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36
Q

How is type 2 often discovered?

A

incidentally on a screening urinalysis or blood sugar measurement

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37
Q

Sometimes, _____ is the predominant symptom of diabetes (type 2).

A

fatigue

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38
Q

Type 1 diabetes may be found through a complication such as myocardial ischemia, stroke, intermittent claudication, impotence, peripheral neuropathy, proteinuria or retinopathy.

A

Hang in there :)

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39
Q

What is a common initial complaint in men with type 1 diabetes?

A

erectile dysfunction

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40
Q

The overall course of untreated diabetes is one of progressive worsening of glycemic control due to the combination of?

A

pancreatic endocrine failure and peripheral insulin resistance

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41
Q

The rate of clinical failure is typically rapid and progessive in type 1, following years of silent immune-mediated ______ destruction; however, early on, there may be a transit “honeymoon” period before ______ sets in.

A

islet cell

beta cell exhaustion

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42
Q

Untreated type 2 diabetes is more heavily influenced by the state of _______.

A

insulin resistance

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43
Q

Early clinical type 2 disease is characterized by impaired timing of insulin producing postprandial hyperglycemia and the potential for episodes of _______-total insulin production may actually rise.

A

hypoglycemia

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44
Q

Complications of diabetes occur often and most correlate with the magnitude and duration of ________.

A

hyperglycemia- there does not seem to be a glycemic threshold for the development of complications

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45
Q

The major complications of diabetes can be classified as either _______ or ________.

A

microvascular

macrovascular

46
Q

Which type of diabetes complication causes things like retinopathy, neuropathy, and nephropathy? (microvascular or macro vascular)

A

microvascular

47
Q

Which type of diabetes complication causes large vessel arteriosclerosis?

A

macrovascular disease

48
Q

The effects of smoking, hypertension, and other risk factors for vascular disease appear to be synergistic with those of ________.

A

hyperglycemia

49
Q

What reduces the risk for large-vessel artherosclerosis?

A

tight control of glucose

Major reductions in the risk for coronary events and stroke can be achieved by correcting other major cardiovascular risk factors such as smoking, hypertension, and hyperlipidemia.

50
Q

Effective treatment of what risk factors appears more important than normalization of glucose per se in the prevention and limitation of cardiovascular complications?

A

smoking, hypertension and hyperlipidemia

51
Q

_______ disease accounts for much of the morbidity of diabetes, causing neuropathy, retinopathy and nephropathy.

A

microvascular disease

52
Q

________ ______ is one of the leading causes of end stage renal failure in adults, accounting for 25% of cases.

A

diabetic nephropathy

53
Q

What are characteristic renal changes in a person with diabetic nephropathy?

A

glomerular basement membrane thickening and mesangial proliferation

54
Q

Mesangial proliferation correlates strongly with the onset of ______ and _______.

A

proteinuria and hypertension

55
Q

Will diabetic nephropathy or the stage of clinical proteinuria be present first?

A

Subclinical and histological findings for diabetic nephropathy are present long before the stage of clinical proteinuria.

56
Q

What three things contribute to the progression of renal impairment?

A

elevated glomerular filtration rate (hyperfiltration)
genetic determinants
hypertension

57
Q

With persistent proteinuria, _______ becomes established and glomerular filtration begins to decline at the rate of 1 mL/min per month.

A

hypertension

58
Q

*The risk for the development of nephropathy correlates with the duration of disease and the degree of ______.

A

hyperglycemia

59
Q

___________- can reduce the risk for renal failure, particularly as primary prevention and if done early.

A

tight control of the blood glucose

It can reverse mild proteinuria in type 1 diabetics who do not yet have renal insufficiency.

60
Q

Bladder dysfunction and resultant ________ can also contribute to renal impairment in pts with diabetic nephropathy.

A

urinary tract infections

61
Q

*The risk for retinopathic changes is related to the duration and degree of _________.

A

hyperglycemia

62
Q

After 20 years of diabetes, ALL age groups show a ___% to ____% prevalence of retinopathy.

A

75-80%

63
Q

The cumulative incidence of retinopathy can be reduced by more than 50% with?

A

intensive insulin therapy- greatest effect is in primary prevention and in those with mild to moderate nonproliferative retinopathy

64
Q

What two things occur in increase frequency in patients with diabetic retinopathy?

A

cataracts and glaucoma

65
Q

______ may develop in 50% of diabetics and lead to a peripheral sensory deficit, autonomic dysfunction or a mononeuritis.

A

Neuropathy

66
Q

What are two mechanisms of neuropathy?

A

myo-inositol depletion in nerve cell membranes- prolongs the conduction time

hyperglycemia induced sorbitol accumulation in nerve tissues that have a polyol pathway for glucose metabolism (e.g.. Schwann cells)

67
Q

What is believed to be responsible for mononeuropathy?

A

microangiopathic changes that decrease the blood supply to the myelin sheaths

68
Q

Independent risk factors for neuropathy:

A 
duration of diabetes 
current level of glycosylated hemoglobin
BMI
Smoking
hypertension 
presence of cardiovascular disease
69
Q

Which type of neuropathy is predominately sensory, reducing sensation in the lower extremities?

A

peripheral neuropathy- may progress to cause pain and dysesthesias (abnormal sensation)

70
Q

Which type of neuropathy often presents as impotence?

A

Autonomic neuropathy

71
Q

Besides impotence, what are some other potential manifestations of autonomic neuropathy?

A

delayed gastric emptying
orthostatic hypotension
urinary retention

72
Q

Which type of neuropathy is almost always seen in association with distal polyneuropathy?

polyneuropathy- disorders are often symmetric and frequently affect the feet and hands, causing weakness, loss of sensation, pins-and-needle sensations or burning pain

A

autonomic

73
Q

Impaired leukocyte function, compromised vascular supply and neuropathy in patients with diabetes can cause?

A

It causes these patients to be more susceptible to infection.

74
Q

Cellulitis and candidiasis infections can occur in ischemic foot lesions in patients with diabetes. Why would this be a bigger deal for diabetics?

A

Because they are more susceptible to infection, osteomyelitis may occur and may require amputation.

75
Q

Screening to detect prediabetes (IFG or IGT) and diabetes should be considered in individuals ____ years or older- especially if their BMI is 25 or greater.

A

45 y/o

76
Q

When should screening of individuals less than 45 years of age be considered?

A

if they are overweight and have other risk factors for diabetes

77
Q

How often should screening be repeated?

A

every 3 years

78
Q

_____, ______ and ______ are important in the prevention and treatment of type 2 diabetes.

A

diet
exercise
weight

79
Q

A supervised program of modest weight reduction (sustained 7% weight loss), regular aerobic exercise ( ____ hrs/wk of moderately brisk walking), and a low-fat, low- calorie diet can prevent onset of diabetes when fully implemented and obtained.

A

2.5 hours/week

80
Q

The principal goal of diabetes therapy is __________ to prevent the multisystem complications that may result from hyperglycemia.

A

normalization of blood glucose

81
Q

The American Diabetes Association recommends a treatment goal of HbA1c less than _____% and as close to normal as possible without significant hypoglycemia.

A

less than 7%

82
Q

How often should HbA1c levels be checked?

A

two times a year or more frequently in pts whose therapy has changed or who are not meeting glycemic goals

83
Q

Normalization of _____ metabolism stands as a major treatment objective for all diabetics.

A

carbohydrate metabolism

84
Q

The risk for ______ with intensive insulin therapy is a serious concern; it can be especially dangerous in patients who have underlying coronary or cerebrovascular disease.

A

hypoglycemia

However, the goal of safe and convenient glucose normalization is becoming easier to achieve.

85
Q

Until implantable glucose sensors and insulin delivery systems automate the control process, the maintenance of normoglycemia will still require attention to the details of _____, _____, _______ and the many facets of medical therapy the achieve the best possible outcome.

A

diet
exercise
weight control

86
Q

The overall treatment strategy of a diabetic patient is pathophysiology based, with a focus on the importance of establishing euglycemia as quickly as possible because diabetic complications are mostly a function of the degree and duration of ________.

A

hyperglycemia

WE WILL NOT MISS THIS QUESTION :)

87
Q

What is the most important determinant of daily glycemia?

A

fasting glucose level

88
Q

In type 1 diabetes, the emphasis of treatment is on?

A

intensive insulin therapy to make up for the loss of insulin production

Diet and exercise also play key roles but insulin resistance is the priority of treatment for type 1 diabetics.

89
Q

In type 2 diabetes, insulin resistance is treated with?

A

diet, weight reduction and exercise

if necessary- drug therapy

90
Q

New recommendations for type 2 diabetics include drug therapy with the drug __________ in combination with lifestyle modification as the initial approach (followed by the early addition of other oral drugs or insulin if glycemic control is not readily achieved)

A

Metformin

91
Q

Early drug therapy is indicated in which types of patients?

A

pregnant women

if it is unlikely that the patient can lose weight

92
Q

______ remains the first choice agent in patients with sever hyperglycemia, whether from type 1 or 2 diabetes.

A

insulin

93
Q

What does a patients fasting glucose level need to be to be diagnosed as hyperglycemic?

A

> 240 mg/dL

94
Q

Can modest weight loss improve hyperglycemia?

A

Yes, a substantial reduction in blood glucose can be seen even within several days of instituting a low-calorie diet

95
Q

______ ____ has been shown to enhance the sensitivity of peripheral insulin receptors to endogenous insulin and reduce the requirements for administered insulin.

A

weight loss

Hepatic glycogen stores are depleted rapidly with caloric restriction.

96
Q

The glycemic response to weight loss is related to the initial ________.

A

fasting blood glucose level

Pts with lower fasting blood glucose levels will tend to normalize their blood glucose with less weight loss than those who start off with higher levels.

97
Q

The hyperglycemia of most type 2 diabetics can be controlled by achieving an ideal body weight- such weight reduction is hard to be maintained because permanent restriction in caloric intake is required. The goal is gradual sustained weight reduction of approximately ____ pounds each week.

A

1 to 2 lbs each week

98
Q

An effective exercise program is another cornerstone treatment of type 2 diabetes. Aerobic exercise facilitates ______ control independent of it effect on weight, reducing insulin resistance in _____ and _____.

A

facilitates glycemic control

liver and muscle

99
Q

_______ for type 2 diabetics is controversial and less critical than achieving and ideal body weight.

A

diet composition

100
Q

The ADA recommends diets ____ in calories, ____ in fat and ______ in complex carbohydrates, with as much as ___% of total calories allowed from carbs for type 2 diabetics.

A

low in cals
low in fat
liberal in complex carbs
60%

101
Q

Increasing ____ content in the diet is associated with a low prevalence of diabetes mellitus.

A

fiber

102
Q

Special dietary considerations for patients on insulin

A

You aren’t the only one, I’m bored out of my mind right now too!

103
Q

For type 1 diabetics who are at their ideal body weight, the essential aspect of dietary therapy is the regulation of ______ and the _____ of meals.

A

regulation of CALORIC INTAKE and the SPACING of meals

104
Q

________ are generally restricted from type 1 diabetics because they worsen postprandial (after eating) hyperglycemia.

A

simple sugars

105
Q

ADA diets recommend 2/9 of calories of the calories throughout the day should be consumed at breakfast, 2/9 at lunch and _____ for dinner and _____ as snacks

A

4/9 for dinner

1/9 for snacks

106
Q

Timing of meals must match peak insulin effects and activity schedules; increased activity requires what to prevent hypoglycemia?

A

increased food intake or decrease in insulin dose

107
Q

What is used in treatment of diabetes that both increases glucose consumption and reduces insulin resistance?

A

exercise

108
Q

Which forms of exercise improve insulin sensitivity?

A

all forms of aerobic exercise, even walking and other forms of nonvigorous activity

109
Q

Significant improvement in glycemic control has been demonstrated in pts who exercise ___ times per week for ___ to ___ minutes.

A

three times a week

30-60 minutes

110
Q

Precautions should be taken in patients planning to take part in more vigorous activity. The increased absorption of insulin in an exercising limb may precipitate _______ in patients on insulin; therefore, the _______ should be used as the site for insulin injection.

A

hypoglycemia

abdomen

111
Q

Because of the possibility of underlying ischemic heart disease, _______ should be considered before a rigorous exercise is undertaken by a sedentary person with longstanding diabetes or other atherosclerotic risk factors.

A

an exercise electrocardiogram

Endocrinology - Chapters (20 decks)

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