Diabetes 1 Flashcards
When is insulin secretion stimulated?
basal secretion all the time + post prandial excretion
When is insulin secretion stimulated?
basal secretion all the time + post prandial excretion
When is insulin secretion stimulated?
basal secretion all the time + post prandial excretion
DM is a group of metabolic diseases characterized by ______ resulting from primarily defect in insulin secretion , insulin action or both. What other changes in metabolism are likely.
characterized by hyperglycemia
alterations in carbohydrates, fat and protein metabolism
What of the population in the US has some degree of glycemic abnormality (DM and preDM)?
8.3% of US population
What is the number one cause of death in type 1 and type 2 patients?
cardiovascular disease, accounting for 65% of mortality
Name the 4 main types of diabetes.
type 1 diabetes (B cell destruction); type 2 diabetes (insulin sensitivity and underproduction) other specific types (genetic, exocrine pancreas disorders, drug induced diabetes etc) gestational diabetes (newly dx in pregnancy)
Name the 4 main types of diabetes.
type 1 diabetes (B cell destruction); type 2 diabetes (insulin sensitivity and underproduction) other specific types (genetic, exocrine pancreas disorders, drug induced diabetes etc) gestational diabetes (newly dx in pregnancy)
Name 4 different ways diabetes can be clinical diagnosed.
A1c > 6.5%
FPG >126mg/dL (8hr. fast)
2 hr glucose > 200 after 75g OGTT
classic symptoms of hyperglycemia and a random glucose > 200mg/dL
What finding on the typical screening tests might suggest increased risk for DM?
FPG 100-125
2hr glucose >140 and
Describe the mechanism of B-cell destruction in DM 1.
type 1 diabetes is an autoimmune disease with T-cell mediated destruction of B-cells of the pancreatic islets and absolute islets; environmental trigger is thought o initiate the immune process in genetically susceptible people
Describe the mechanism of B-cell destruction in DM 1.
type 1 diabetes is an autoimmune disease with T-cell mediated destruction of B-cells of the pancreatic islets and absolute islets; environmental trigger is thought o initiate the immune process in genetically susceptible people
What antibodies are helpful in diagnosis of DM1?
islet cell antibodies, GAD antibodies, insulin autoantibodies
Does Type 1 typically run in families?
no, but there may be a family history of other autoimmune diseases
Name other common symptoms of DM1 besides polydipsia, polyphagia and polyuria.
other common symptoms of hyperglycemia are blurry vision, fatigue, poor wound healing and recurrent infection
What are the key features of type 2 diabetes pathogenesis?
impaired insulin secretions and insulin resistance
What are the key features of type 2 diabetes pathogenesis?
impaired insulin secretions and insulin resistance (resistance is increased if patient is obese)
Insulin has many systemic effects, particularly related to circulatory health, list some of them.
complex dyslipidemia (high TG and low HDL) endothelial dysfunction systemic inflammation atherosclerosis DM2/ IGT/IFG HTN disordered fibrolysis
What is unique about the insulin receptor dysfunction in diabetes?
response to glucose is blunted but other inciting substances produce a normal insulin response; meaning its a post receptor dysfunction whose etiology is largely unknown
What pathologic processes lead to hyperglycemia in DM2?
increased glucagon production and decreased insulin production in the pancreas
increased hepatic glucose output and decreased glucose uptake in muscle and fat (insulin resistance) leading to higher fasting glucose and post-prandial glucose
insulin resistance is fairly consistent and glucose production slowly decreases typically in DM2
List risk factors of type 2 DM.
family Hx of DM BMI > 25 ethnic background (people color) test results suggesting pre-diabetes >45 yo habitual physical inactivity history of gestational DM or delivering a baby >albs HTN dyslipidemia PCOS hx of CV disease
List risk factors of type 2 DM.
family Hx of DM BMI > 25 ethnic background (people color) test results suggesting pre-diabetes >45 yo habitual physical inactivity history of gestational DM or delivering a baby >albs HTN dyslipidemia PCOS hx of CV disease
When should screen for DM?
baseline FPG or A1c in adults >45yo, if normal repeat every 3 years
begin screening at an earlier age if patient has risk factors and screen those at risk yearly
When should screen for DM?
baseline FPG or A1c in adults >45yo, if normal repeat every 3 years
begin screening at an earlier age if patient has risk factors and screen those at risk yearly
