Diabetes Flashcards

1
Q

Diabetes Mellitus def

A

Group of metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action or both

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2
Q

Symptoms of diabetes

A
Polyuria
Polydipsia
Polyphagia
Weight loss
Blurred vision
Fatigue
Headache
Poor wound healing
Chronic hyperglycemia can lead to organ damage
Kidney
Eyes
Heart
Nerves
Blood vessels
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3
Q

Classification of Diabetes

A

T1DM
T2DM
Gestational DM
Other ( monogenic DM, LADA)

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4
Q

T1DM

A

Age below 30
Absolute Insulin deficiency

Autoimmune destruction of B cells of islets of langerhans

Antibodies to Glutamic Acid Decarboxylase, pancreatic B cells and/or insulin

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5
Q

T2DM

A
Age over 30
Overweight
Positive family history
Signs of insulin resistance
High triglycerides & LDLs
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6
Q

Gestational DM

A

Elevated plasma glucose level during pregnancy

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7
Q

Monogenic DM

A

Formerly known as Maturity onset diabetes of the young

In children with atypical presentation or response to therapy

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8
Q

LADA

A

Latent autoimmune Diabetes of Adult

Slow destruction of B cells as in T2DM but antibodies are present as in T1DM

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9
Q

Secondary diabetes

A
Cushing Syndrome
Acromegaly
Cystic fibrosis
Down syndrome
Pancreatic disorder
Glucocorticoids
Antipsychotics
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10
Q

Prediabetes

A

Individual with high plasma glucose level. But not high enough for DM

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11
Q

Hormones involved in normal glucose regulation

A

Insulin

Glucagon
Growth hormone
Catecholamines
Cortisol

Incretin

Amylin

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12
Q

Insulin function

A

Regulates metabolism of carbs protein fats
Promotes cellular uptake of plasma glucose
Stimulates conversion of glucose into energy storing molecules (glucagon, fat)
Facilitate cell uptake of amino acid and their incorporation in protein
Inhibits production of glucose from liver, muscle glycogen, amino acids
Decrease breakdown of fatty acids to ketone bodies.

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13
Q

Counter regulatory hormones

A

Work against insulin
Increase blood glucose

Glucagon
Growth Hormone
Catecholamines
Cortisol

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14
Q

Incretin hormones

A

Released by intestine in response to glucose ingestion

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15
Q

Amylin

A

Cosecreted with insulin from B cells

Lowers postparendial glucose

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16
Q

Causes of T1DM

A

Genetics
Environment (infection, chemical, diet)
Autoimmune (Anti insulin, Anti B cell, Anti glutamic Acid Decarboxylase GAD found in blood in 70% )

17
Q

T2DM reasons

A

Genetics
B cell dysfunction
Peripheral site defect (defect in post receptor binding and decreased insulin rec)
Secondary diabetes

18
Q

Diagnostic test for Diabetics

A

Blood glucose monitoring
A1c
Glucose tolerance test

19
Q

Diabetes values in normal adults

A
Fasting >126 mg/dL
Random >200 mg/dL
Oral Glucose tolerance test (OGGT)
75g anhydrous glycerin in water > 200mg/dL
A1c >6.5%
20
Q

GDM values

A

Fasting >92 ng/dL
1 hr OGTT 180mg /dL
2hr >153 mg/dL

Postpartum testing gor 6 to 12 weeks.
If -ve then every 3 yr

21
Q

Prediabetes

A

Fasting 100 - 125mg/dL
GTolerance 140 - 199 mg/dL
A1c 5.7 - 6.4%

22
Q

Glycemic control goals

A

ADA :
A1c < 7%
FPG 70 to 130mg/dL
1 2 hr PPG< 140 mg/dL

AACE:
A1c < 6.5%
FPG< 110 mg/dL
2hr PPG <140 mg/dL

23
Q

Insulin types

A

Rapid acting
Short acting
Intermediate acting
Long acting

24
Q

Rapid acting Insulin

A

Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)

25
Short acting
Regular insulin | Humulin regular, Novolin Regular
26
Intermediate acting insulin
Isophane insulin suspension (neutral protamine Hagedron, NPH)
27
Long acting insulin
Glargine (Lantus) | Detemir (Levemir)
28
Premixed insulin
50/50 insulin 50% protamine lispro insulin + 50% lispro insulin 70/30 70% aspart protamine + 30% aspart insulin or 70% NPH + 30% regular 75/25 75% protamine lispro insulin with 25% lispro insulin
29
Extemporaneous Mixture insulin
Glargine should never be mixed with Detemir When rapid acting is mixed with another insulin it should be used immediately Stable for 14 days in fridge 7 days in room temp
30
Mechanism of insulin
Stimulates hepatic glycogen synthesis Increased protein synthesis Facilitate triglycerides synthesis and storage by adipocytes, inhibits liploysis Stimulates peripheral glucose uptake
31
Dosage for T1DM
0.6 units /kg/ day 50/50 rule: 50% of TDD given as basal dose ( glargine Detemir NPH) Remaining given as bolus divided b/w meals (regular aspart lispro glulisine)
32
Dosage for T2DM
0.1 - 0.2 units/ kg/ day Premixed on 0.2unit/kg/day, 2/3 dose given in morning, 1/3 in evening before last meal
33
Insulin dose adjustment | Based on Blood glucose levels
Rules of 1500 to 2200 Higher the rule lower the risk of hypoglycemia 1800/TDD = correction factor (CF) Dose adjustment = (Current blood glucose - target blood glucose) ÷ CF
34
Insulin dose adjustment | Carbohydrates
Rule of 500 | 500/TDD = x grams of carbohydrates
35
Dawn phenomenon somogyi phenomenon
Dawn phenomenon: Fasting hyperglycemia due to counter regulatory hormones Evening dose should be increased or moved closer to bedtime Somogyi Effect: Rebound hyperglycemia Decrese evening insulin dose
36
Rout of insulin administration
SC | IV