Diabetes 1

Question 1

When is insulin secretion stimulated?

Answer 1

basal secretion all the time + post prandial excretion

Question 2

When is insulin secretion stimulated?

Answer 2

basal secretion all the time + post prandial excretion

Question 3

When is insulin secretion stimulated?

Answer 3

basal secretion all the time + post prandial excretion

Question 4

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.

Answer 4

characterized by hyperglycemia

alterations in carbohydrates, fat and protein metabolism

Question 5

What of the population in the US has some degree of glycemic abnormality (DM and preDM)?

Answer 5

8.3% of US population

Question 6

What is the number one cause of death in type 1 and type 2 patients?

Answer 6

cardiovascular disease, accounting for 65% of mortality

Question 7

Name the 4 main types of diabetes.

Answer 7

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)

Question 8

Name the 4 main types of diabetes.

Answer 8

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)

Question 9

Name 4 different ways diabetes can be clinical diagnosed.

Answer 9

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

Question 10

What finding on the typical screening tests might suggest increased risk for DM?

Answer 10

FPG 100-125

2hr glucose >140 and

Question 11

Describe the mechanism of B-cell destruction in DM 1.

Answer 11

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

Question 12

Describe the mechanism of B-cell destruction in DM 1.

Answer 12

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

Question 13

What antibodies are helpful in diagnosis of DM1?

Answer 13

islet cell antibodies, GAD antibodies, insulin autoantibodies

Question 14

Does Type 1 typically run in families?

Answer 14

no, but there may be a family history of other autoimmune diseases

Question 15

Name other common symptoms of DM1 besides polydipsia, polyphagia and polyuria.

Answer 15

other common symptoms of hyperglycemia are blurry vision, fatigue, poor wound healing and recurrent infection

Question 16

What are the key features of type 2 diabetes pathogenesis?

Answer 16

impaired insulin secretions and insulin resistance

Question 17

What are the key features of type 2 diabetes pathogenesis?

Answer 17

impaired insulin secretions and insulin resistance (resistance is increased if patient is obese)

Question 18

Insulin has many systemic effects, particularly related to circulatory health, list some of them.

Answer 18

complex dyslipidemia (high TG and low HDL)
endothelial dysfunction
systemic inflammation
atherosclerosis
DM2/ IGT/IFG
HTN
disordered fibrolysis

Question 19

What is unique about the insulin receptor dysfunction in diabetes?

Answer 19

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

Question 20

What pathologic processes lead to hyperglycemia in DM2?

Answer 20

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

Question 21

List risk factors of type 2 DM.

Answer 21

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

Question 22

List risk factors of type 2 DM.

Answer 22

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

Question 23

When should screen for DM?

Answer 23

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

Question 24

When should screen for DM?

Answer 24

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

Question 25

What is the most important intervention in addressing DM2 prevention?

Answer 25

in those who are pre-diabetes, an intense exercise and diet plan is very important, even more impactful than Metformin (note it does not completely stop progression)

Question 26

Give examples of “other” specific types of DM.

Answer 26

genetic defects in beta cells (MODY)
genetic defects in insulin action
disease of exocrine pancreas
drug induced diabetes: steroids, niacin, newer anti-psychotics, HAART, pentamidine
endocrinopathies: Cushing's, acromegaly
infections : congenital rubella and CMV

Question 27

What are the risks of gestational diabetes, both to the mother and to the developing fetus?

Answer 27

women with GDM are at higher risk for developing DM later in life
untreated GDM is associated with macrosomia, neontal hypoglycemia and stillbirth

Question 28

What are the risks of gestational diabetes, both to the mother and to the developing fetus?

Answer 28

women with GDM are at higher risk for developing DM later in life
untreated GDM is associated with macrosomia, neontal hypoglycemia and stillbirth

Question 29

When and how is screening for GDM accomplished?

Answer 29

screen at 1st prenatal visit with those at risk
screen at 24-28 weeks in w/out risk factors
screen women with GDM for DM a min of every 3 years

one step screening is 75g OGTT with measures at 1 and 2 hrs: fasting >92 mg/dL, 1hr >180mg/dL 2 hrs >153mg/dL

two step: 50g 1h105 fasting, >190 at 1h, >165 at 2hrs, >145 mg/dL at 3hr