Classification, Screening and Diagonsis Flashcards
5 types of diabetes
Type 1 Type 2 Gestational Diabetes Monogenic Diabetes Secondary diabetes (medication/drug related, exocrine pancreas related, endocrinopathy related, infection related, etc)
Type 1 DM
Autoimmune or non-autoimmune mediated destruction of beta cells
Risk factors: genetic predisposition and environmental factors
3 proteins/antibodies you can look for in the lab to test for T1D
C-peptide
Anti-GAD Ab
Anti-ICA Ab
Type 2 DM
Insulin resistance due to obesity, abnormal insulin receptors, adipokines, inflammation, beta cell defects, and metabolic syndrome
Risk factors: genetic**, family history, ethnicity, obesity, poor diet, sedentary, smoking
Special Lab investigations for T2D
Creatinine/eGFR
UACR
Lipid panel
Diabetic eye exam
Gestational DM
Glucose intolerance that develops or is first recognized during pregnancy
From insulin resistance due to placental secretion of diabetogenic hormones (GH, CRH, hPL)
Pancreas predisposed to diabetes is unable to keep up with insulin demand
Risk factors for gestational diabetes
Maternal age > 37 Ethnicity Pre-pregnancy weight >80kg/ BMI over 28 Family Hx in 1st degree relative History of macrosomia/polyhydramnios/unexplained stillbirth PCOS
3 Investigations for gestational DM
Oral glucose tolerance test
Urine protein dipstick
Urine ketones
Monogenic diabetes
Single gene variants causing defects in glucose-induced insulin release
Risk factors: family history
Use genetic testing
How do cyclosporine, phenytoin and thiazides cause diabetes?
Interfere with insulin release from beta cells
How do glucocorticoids, niacin, and anti-viral protease inhibitors cause diabetes?
Induce insulin resistance
How do anti-psychotics cause diabetes?
Weight gain +/- beta cell dysfunction
2 genetic causes and 5 acquired causes of exocrine pancreas-related diabetes
Genetic: CF, hemochromatosis
Acquired: pancreatitis, trauma, infection, pancreatic cancer, pancreatectomy
5 causes of endocrinopathy-related diabetes
Acromegaly (excess growth hormone) Cushing's syndrome (excess cortisol) Cushing's disease (excess ACTH) Ectopic Cushing's syndrome (excess ACTH) Pheochromocytoma
Cushing’s syndrome vs disease
Syndrome: excess cortisol from any cause
Disease: excess ACTH from pituitary gland
5 viruses that can cause infection-related diabetes
Congenital rubella Coxsackievirus B Cytomegalovirus Adenovirus Mumps
Should you screen for T1D?
No
Because there are no interventions to prevent or delay T1DM
Should you screen for T2D?
You can screen for T2D using a FPG and/or A1C every 3 years in people 40+ or in individuals at high risk on a risk calculator (33% chance of developing diabetes over 10 years)
Risk factors for T2DM
Age 40+ 1st degree relative with T2DM High risk population (African, Asain, Arab, Hispanic, Indigenous, South Asian, low SES) History of pre-diabetes/gestational diabetes End organ damage Vascular risk factors Associated diseases Some meds
3 main microvascular end organ damages
Retinopathy
Neuropathy
Nephropathy
3 main macrovascular end organ damages
Coronary
Cerebrovascular
Peripheral
Numbers to diagnose diabetes
Fasting plasma glucose: 7.0+
A1C: 6.5+
2 hour plasma glucose in a OGTT: 11.1+
Random PG: 11.1+
These values are greater than or equal to
No symptoms you need 2 of them, with symptoms only need one
What is the prediabetes FPG and A1C
FPG: 6.1 to 6.9
A1C: 6.0 to 6.4%
What is the normal values for FPG and A1C
FPG: under 5.6
A1C: under 5.5%
When should you screen a pregnant woman for gestational diabetes?
Between 24 to 28 weeks
3 complications in gestational DM
High birth weight
Increased risk for c section
Neonatal hypoglycemia
