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Integrative Analysis > Diabetes > Flashcards

Diabetes Flashcards

1
Q

diabetes definition

A

a chronic disease consisting of a group of metabolic disorders characterized by hyperglycemia resulting from insufficiency/lack thereof insulin and/or peripheral sensitivity to insulin

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2
Q

insulin deficiency may be due to _____- Type 1,

or _____- typically Type 2

A

absolute absence of insulin (relatively speaking);

reduction in overall production of insulin

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3
Q

peripheral insulin sensitivity is reduced secondary to _____- typically associated with Type 2

A

obesity and associated factors mediated by free fatty acids, inflammation, and overall decrease in receptor availability

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4
Q

diabetes is the ____ leading cause of death in the US

A

7th

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5
Q

____% of Americans have diabetes; if this trend continues, the number is expected to result in _____ Americans being diabetic by 2050

A

~12-14;

1 in 3

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6
Q

_____ people worldwide have diabetes, expected to increase to _____ by 2040 secondary to obesity crisis

A 
415 million (8.8% of pop.);
642 million
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7
Q

blood glucose and insulin homeostasis:

  • food intake of sugars in the form of carbs absorbed via ____
  • increased blood glucose levels recognized results in _____
  • increased blood glucose levels trigger co-secretion of _____
  • increase levels of circulating _____ activate skeletal muscle receptors, resulting in _____
A

the small intestines;
release of insulin from B-cells within the pancreas;
amylin from B-cells, which acts in tandem with insulin by slowing gastric emptying and promoting the feeling of satiety;
insulin/amylin;
uptake and storage/utilization of glucose

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8
Q

hypoglycemia results in _____

A

glucagon release from a-cells within pancreas

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9
Q

increased serum levels of glucagon activate _____

A

gluconeogensis within the liver

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10
Q

glycogen storage within the liver _____

A

is broken down to increase blood glucose availability

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11
Q

glucagon inhibits ____

A

uptake of glucose and conversion into glycogen

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12
Q

elevated levels of blood glucose activate _____

A

insulin production

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13
Q

hyperglycemia in combination with reduced insulin sensitivity (or no insulin within the system) results in ____

A

breakdown of free fatty acids from fat stores (typically abdominal, but could be anywhere)

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14
Q

increased free fatty acids broken down for energy release _____

A

ketone bodies as by-product into bloodstream

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15
Q

increased ketone bodies within the bloodstream ____

A

shift pH to acidic levels resulting in ketoacidosis

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16
Q

pathyphysiology of vascular complications secondary to DM

A
  • not completely understood
  • chronic hyperglycemia results in disruption of endothelial cell wall homeostasis, leading to inhibition of vasoregulatory mechanisms and subsequent vascular wall collapse
  • eventual focal hypoxia secondary to failure of delivery of oxygen and nutrients resulting in cellular death and the release of inflammatory and cellular modulators perpetuating the decline of surrounding viable structures
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17
Q

Type 1 DM risk factors

A
  • family history
  • viral exposure: Epstein-Barr virus, coxsackie, mumps, cytomegalovirus
  • autoimmune conditions: Graves, Addison’s, celiac, Crohn’s, rheumatoid arthritis
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18
Q

Type 2 DM risk factors

A
  • family history
  • overweight: BMI 25 kg/m2 or higher
  • age: over 45
  • ethnicity: AA, Hispanic/Latino, American Indian, Alaska Native, Asian American, Pacific Islander
  • gestational diabetes or baby greater than 9 lbs
  • pre-diabetes
  • HTN: BP 140/90 or higher
  • abnormal cholesterol levels: HDL less than 35 mg/dL and/or triglyceride level greater than 250 mg/dL
  • physical inactivity: less than 10 min per week in areas of work, leisure, and transportation
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19
Q

pre-diabetes

A
  • at increased risk for development of T2DM, stroke, and heart disease
  • impaired fasting glucose or impaired glucose tolerance: hyperglycemia below the diagnostic criteria for DM and are known risk factors for the future development of DM
  • set based on testing with fasting plasma glucose or oral glucose tolerance test
  • IFG: 100-125 mg/dL
  • IGT: 2 hour plasma glucose value in the 75 OGTT is 140-199 mg/dL
  • HbA1C: 5.7-6.4%
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20
Q

Type 1 DM

A
  • lack of, typically complete, insulin secretion from the B-cells of the pancreas
  • etiology may be genetic, environmental, other factors, or idiopathic
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21
Q

T1DM: two types

A
  • immune mediated with autoimmune markers: 85-90% of those with fasting hyperglycemia have at least one marker, strong human leukocyte antigen (HLA) associations exist
  • idiopathic diabetes: no known cause, strongly inherited but lacks autoimmune markers and HLA associations
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22
Q

T1DM accounts for ____% of all DM cases in US

A

~6

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23
Q

peak age of diagnosis for T1DM is ____

A

typically between 14-17 (hospitalization for symptoms typical setting for diagnosis)

24
Q

which type of DM is more likely to express the symptoms of polyphagia, polydipsia, polyuria?

A

T1DM

25
Q

which type of DM is more susceptible to ketoacidosis?

A

T1DM

26
Q

T2DM

A
  • characterized by peripheral insulin resistance and/or reduced insulin production (2’ to chronic stress to pancreas due to hyperinsulinemia- body is not getting glucose into skeletal muscle, so keeps producing more insulin to compensate, essentially “burning out” the B-cells)
  • etiology primarily due to obesity, age, and lack of physical activity
27
Q

T2DM accounts for ____% of all DM cases in the US

A

~91

28
Q

onset of T2DM is _____

A

typically older, but with increasing obesity epidemic in children, the mean age is decreasing

29
Q

most cases of T2DM are _____ for years, until the patient _____

A

undiagnosed;

receives medical care that requires blood work or complains of specific symptoms that would require a work-up

30
Q

T2DM has strong ____ factors

A

genetic/hereditary, socio-economic and cultural

31
Q

vast majority of cases of T2DM are influenced significantly by ____

A

lifestyle of patient

32
Q

gestational diabetes

A

-diagnosis made between the 24-28 week (abnormal glucose regulation occurring in 5-10% of pregnancies with approximately 35-60% going on to develop T2DM post-partum depending on other risk factors)

33
Q

now recommended that high-risk women found to have diabetes during their initial prenatal visit in the first trimester receive a diagnosis of _____

A

overt, not gestational, diabetes

34
Q

gestational diabetes is influenced by race

A

American Indians, AA, Hispanics > Caucasian

35
Q

gestational diabetes etiology

A

secondary to hormonal changes influencing insulin efficacy

36
Q

testing process for gestational diabetes

A
  • 50g, 1-hr Glucose Challenge Test (GCT): less than 130 or 140 mg/dL (depending on doctor)
  • 100g, 3-hr OGTT: fasting less than 95, 1-hr less than 180, 2-hr less than 155, 3-hr less than 140
37
Q

once pregnancy is complete, gestational diabetes ____

A

typically resolves within 6 weeks, but patient now at higher risk for developing T2DM in next 10-20 years

38
Q

babies born to mothers who had gestational diabetes ____

A

have a higher risk of developing T2DM in their teen/early adult years

39
Q

diagnosing diabetes

A
  • Random Plasma Glucose (RPG): ≥ 200 mg/dL when accompanied by symptoms of polyuria, polydipsia, and weight loss
  • Fasting Plasma Glucose (FPG): ≥ 126 mg/dL following 8 hrs of no caloric intake
  • Oral Glucose Tolerance Test (OGTT): 2 hr plasma glucose ≥ 200 mg/dL using a 75g load of anhydrous glucose dissolved in water
  • HbA1C: ≥ 6.5%
  • all testing recommended to be repeatable other than RPG
40
Q

HbA1C is an average over ____

A

3 months

41
Q

HbA1C of 6% roughly equals ____ glucose reading; every 1% change in A1C roughly correlates to a _____ change in serum glucose

A

120 mg/dL;

30 mg/dL

42
Q

the American Diabetes Association recommends maintenance of HbA1C of less than _____; this has shown to _____

A

7%;

reduce microvascular complications

43
Q

individuals with short duration of diabetes, long life expectancy or no other significant cardiovascular disease should maintain HbA1C less than ____

A

6.5%

44
Q

medications for Tx of DM

A

Type 1:
-exogenous insulin

Type 2:

  • biguanide
  • 2nd generation sulfonylurea
  • DPP-4
  • SGLT-2
  • GLP-1
  • Amylin analog
  • insulin
  • Afrezza
  • combinations
45
Q

biguanide

A

Metformin; blocks hepatic glucose output and enhances insulin secretion and insulin sensitivity

46
Q

2nd generation sulfonylurea

A

glyburide, glipizide, glimepiride; stimulates pancreas to release more insulin, reduces hepatic glucose production and increases insulin receptors

47
Q

DPP-4

A

dipeptidyl-peptidase 4 inhibitors; Januvia, Onglyza, Nesina; slows the inactivation of hormones responsible for increasing insulin synthesis and secretion, suppresses glucagon release, delays gastric emptying, and increases satiety

48
Q

SGLT-2

A

sodium glucose transporter-2 inhibitors; Invokana, Steglatro, Farxiga, Jardiance; blocks kidney reputake of sugar from the bloodstream

49
Q

GLP-1

A

glucagon-like peptide; Byetta/Bydureon, Victoza, Ozempic, Tanzeum, Trulicity; injection; delays gastric emptying, stimulates insulin release, inhibits post-prandial glucagon release, suppresses appetite

50
Q

amylin analog

A

Symlin; injection; satiety, slows gastric emptying, and inhibits excessive glucagon secretion

51
Q

insulin (for tx)

A

Novolog, Humalog, Lantus, Levemir, Humilin, Tresiba; insulins have different onset and peak activity times, and may be taken for immediate pre-meal intake, or for long-lasting daily supply

52
Q

Afrezza

A

rapid acting inhaled insulin powder; when the insulin is inhaled through the device, the powder is aerosolized and delivered to the lung

53
Q

combination medications

A
  • Soliqua
  • Qtern
  • Xultophy
  • Synjardy
  • Xigduo
  • Jentadueto
54
Q

patients with DM should be educated about the potential benefits of _____

A

blood pressure control in reducing the risk for development or progression of diabetic retinopathy

55
Q

individuals with DM should be educated about the long term benefits of _____

A

optimizing lipid control in reducing the risk for progression of diabetic retinopathy

56
Q

recommendations to prevent ocular manifestations of DM

A
  • stop smoking!!!
  • daily BG monitoring
  • daily BP monitoring (for every 10 mmHg reduction in BP, risk of CVD and microvascular complications related to DM is reduced by 12%)
  • daily exercise
  • weight management
57
Q

systemic conditions associated with DM

A

macrovascular:

  • coronary artery disease and myocardial infarction
  • peripheral arterial disease
  • carotid occlusive disorders
  • cerebrovascular accident

microvascular:

  • retinopathy
  • nephropathy
  • neuropathy

Integrative Analysis (5 decks)

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