Diabetes

Question 1

epidemiology highlights of diabetes in México

age, covid, regions, mortality

Answer 1

the prevalence starts getting higher at the age of 50 - 59 years old, there are more women than men.

With the COVID, the prevalence grew.

The north of the country has a higher prevalence than the rest of it, mainly because they are closer to USA.

The mortality rate is higher in the east cost because there are less hospitals.

Question 2

how does hormones behave in diabetes?

(insulin, glucagon, epinephrine, cortisol, hGH)

Answer 2

low level of insulin = other hormones raise their leves in order to maintain “steady” glucose levels.

• Glucagon releases glucose already storage from the liver.
• Cortisol pulls from every place glucose so that it is available.
• epinephrine rise to realse more glucose from the liver
• GH rise causing muscle and fat to be less sensitive to insulin

Question 3

what is diabetes type 1?

Answer 3

Autoinmune disease
Selective destruction of b cells by lymphocytes, genetic and environmental factors.
Virus like coxsackie, pox virus, viruella

Question 4

what are the main two things that happens in the body that lead to DM2?

Answer 4

1. Insulin action is deficient
   - increase glucose production (liver)
   - decrease glucose utilization (muscle and adipose cells)
2. B cells destruction
   - dysfunction in insulin secretion

Question 5

what happens when there is no insulin in the body?

Answer 5

The glucose can’t enter to the tissues meaning it stays in the blood stream, causing hyperglucemia but the tissue send signals that they aren’t receiving any glucose so it activates catabolic pathways like proteolisis (muscle breakdown) and anabolic such as gluconeogenesis

Question 6

main three symptoms and their explanation

Answer 6

Cells are starving → polyphagia.

Dropping glucose in urine (change in osmolarity (osmotic gradient), more water is retained) → polyuria.

As the body sense you are urinating a lot → polydipsia.

Question 7

name the three acute complications

Answer 7

1. hypoglycemia (happens a lot in hospitals)
2. ketoacidosis
3. non keto hyperosmolar state

Question 8

how does chronic complications are classified?

Answer 8

1. vasculare
   - microangiopathy
   - macroangiopathy
2. non vascular

Question 9

what happens in a neuropathy?

Answer 9

Burning pain in both feet (socks) and hands (gloves)
* Paresthesias, disesthesias
* Fine stinging paresthesias, electrical paroxisms
* Allodynia to mechanical touch and thermal heat

Charcot foot: they stop feeling risky sensations on the foot. You have to teach the patient to pay attention and be extremely careful with their foot. They normally notice the problem when it is to advance because it smells bad.

Question 10

diagnostic criteria according to the ADA

(American Diabetes Association)

Answer 10

Glucose at fasting state: ≥ 126 mg/dl
Posprandial: ≥ 200 mg/dl
HbA1C: ≥ 6.5%

measure the glucose 2 times to make the diagnosis in different days

Question 11

non pharmacological treatment

Answer 11

1. diet
2. excercise
3. avoid precipitant factors

Question 12

main pharmacological treatment

Answer 12

Sulfonylureas “squeeze” the pancreas to stimulate insulin secretion
Biguanides (metformin) make the muscle more sensitive to insulin.
Thiazolidinediones increase the sensitivity to insulin in a lot of tissues, including muscle.
**Ia-glucosidase inh **are inhibitors of the glucose receptor in the small intestine.
When three medications aren’t enough to reach a good level of glycosylated hemoglobin, only then we use insulin.

Question 13

types of insulin

Answer 13

Patients here in mex are given intermediate-acting because it does not cause hypoglycemia. (durates aprox 4-12 hours)
When ambulatory insulin is given, the patient most check the blood glucose every day.

Question 14

follow up goals

Answer 14

fasting: 80-110 mg/dl
after meal: <140 mg/dl
HbA1C: < 7%