Diabetes Flashcards
What does the first step of energy production require
insulin
What type of cells excrete insulin
beta cells from pancreas
What is the role of the pancreas when the blood sugar level starts to drop too low
excretes glucagon
What population is most affected by Diabetes type 1
children and adolescents
What population is more effected by type 2 diabetes and why
middle age - older adults from prolonged hyperglycemia from poor lifestyle and diet
What are some early symptoms of diabetes
polydipsia
polyphagia
polyuria
blurred vision
How do you diagnose diabetes
plasma glucose
what is the leading cause of mortality in diabetics
heart disease
Where is the islets of langerhans found and what do they contain
pancreas
Alpha and beta cells
What is the job of beta cells
insulin producing
What is the job of alpha cells
glucagon secreting
What is type 1 diabetes
destruction of pancreatic beta cells- generally from an autoimmune process
*leave insulin levels extremely low
What is type 2 diabetes
Insidious onset of imbalance between insulin levels and insulin sensitivity causing a functional deficit
What is a common cause of insulin resistance
obesity and aging
Which type of diabetes is associated with HLA antigens
Type 1
What influences a persons risk for developing type 1 DM
Polymorphins (MHC and HLA)
Which type of diabetes is more effected by genetics
type 2
What is MODY
Non-insulin dependent diabetes diagnosed at a young ago (<25y/o)
-autosomal dominant (no autoantibodies)
What is gestational diabetes
diabetes during pregnancy
What is the etiology of diabetes
people who have endocrinopathies
-cushings, acromegaly, hyperthyroidism etc
Which ethnicity is at an increased risk of DM type 1
Hispanic youth
Which socioeconomic area is most effected by type 2 diabetes
low to middle income and a higher prevalence in other ethnicities besides whites
At what serum glucose level are you likely to experience symptoms of polyuria and polydipsia
> 250mg/dL
What is insulin resistance
excess fatty acids and pro inflammatory cytokines leads to impaired glucose transport and increased fat breakdown
What is the biggest problem with type 2 DM
They have inadequate production of insulin to compensate for their insulin resistance
What does glycated hemoglobin (HbA1c) measure
Non-enzymatic glycation of proteins and lipids
What does glycation lead to
microvascular damage in retina, kidney, and peripheral nerves ultimately leading to diabetic retinopathy and nephropathy
What will be seen on physical exam with hyperglycemia
fatigue
poor skin turgor
distinctive fruity odor on their breath
+/- DKA
Macular hemorrhages
If a patient is in DKA, what symptoms should you expect
Kussmal’s breathing
N/V
What other things on PE help differentiate between Type 1&2
Type 2 is usually overwheight
-blurry vision
-frequent yeast/fungal infections
-numbness/neuropathic pain
-acanthosis nigricans
What is the most sensitive and best test for DM
OGTT (oral glucose tolerance testing)
What are the types of tests can you do for diabetes
Fasting plasma glucose (FPG)
Glycosylated HB (HbA1C)
OGTT
What is the diagnostic criteria for diabetes type 1&2
FPG >126
Random glucose >200 w/ symptoms
2hr plasma glucose >200 during 75g OGTT
What HbA1C indicated type 2 DM
> 6.5%
What is the pre diabetic criteria
FPG >100-125
2hr OGTT plasma glucose 140-199
HbA1C 5.7-6.4%
What are some factors that can effects the HbA1C
Hemoglobinopathies
iron deficiency
hemolytic anemia
thalassemia
spherocytosis
severe hepatic/renal disease
When is screening for diabetes recommended by the USPSTF
starting at 35 regardless of risk factors
What is home glucose testing useful for
trends of hyper/hypo glycemia
What is HbA1C useful for
extent of glycation due to hyperglycemia over previous 100 days
What is urine albumin useful for
Identification of diabetic neuropathy
What is serum lipid monitoring useful for
at time of diagnosis and continued ASCVD surveillance
What is critical for effective diabetes management
Diabetic education and patient engagement
What does diabetes management always start with
Diet and exercise (>150min weekly)
What are the glucose maintenance levels
HbA1C <7%
or
Time in range >70% and time below range <4% in adults
What is a major treatment complication for diabetes
Hypoglycemia
What are some signs of hypoglycemia
Hangry
confused
dizzy
sweaty
shaky
What is a BG of someone who is hypoglycemic
BG<50
How do you treat hypoglycemia
Glucose
Conscious: candy and complex carb meal
Coma: Glucagon 1mg IM or
IV D50
How long does it take glucagon to take effect
10min
What are the 3 most common and most devastating microvascular disease
retinopathy
nephropathy
neuropathy
What does treatment of diabetic retinopathy start with
intensive glycemic and blood pressure control
What is diabetic retinopathy
Retinal micro aneurysms then neovascularization and macular edema
What are some symptoms of diabetic retinopathy
focal blurring
vitreous/retinal detachment
partial/total vision loss
What are intensive treatments for diabetic retinopathy
Photocoagulation
vitrectomy
VEGF inhibitor
What is the leading cause of CKD in the US
Diabetic nephropathy
How is diabetic nephropathy diagnosed
detection of urinary albumin
What is diabetic nephropathy
thickening of glomerular basement membrane
mesangial expansion
glomerular sclerosis
all leading to glomerular hypertension and progressive decline in GFR
What is advanced diabetic nephropathy
albumin secretion >300mg/day
When is a urine dipstick positive
protein excretion >300-500mg/day
How do you treat diabetic nephropathy
ACE/ARB
intensive glycemic & BP control
What is diabetic neuropathy
nerve ischemia which is a direct effect of hyperglycemia and intracellular metabolic changes impairing nerve function
What are some examples of diabetic neuropathy
Symmetric polyneuropathy
Autonomic neuropathy
Radiculopathy
Cranial neuropathy
Mononeuropathy
What is the most common diabetic neuropathy
Symmetric polyneuropathy which affects the distal feet and hands (stocking-glove distribution)
What small-fiber symptoms will occur with symmetric polyneuropathy
pain
numbness
loss of temp sensation
*preserved vibration & position sense
What large-fiber symptoms will occur with symmetric polyneuropathys
Muscle weakness
loss of vibration & position sense
lack of DTRs
Atrophy of intrinsic foot muscles
*foot drop common
Where is the most common area for diabetic neuropathy in the ANS occur
L2-L4 nerve roots (diabetic amyotrophy)
What symptoms will occur with cranial neuropathies
diplopia
ptosis
anisocoria
What are some common causes of atherosclerosis of large vessels
hyperinsulinemia
dyslipidemia
hyperglycemia
Which type of diabetes is at higher risk of nonalcoholic fatty liver disease
type 2
*tx with diet/exercise/weight loss
What are rheum complications of DM
Dupuytrens
CTS
Adhesive capsulitis
sclerodactyl
How often should a foot exam be preformed with diabetes
at least 1x/year (more is preferred)
How often should retinal exams be preformed with DM
Annually w/ retinopathy
min every 2yr w/o retinopathy
When should Spot or 24hr urine be completed with DM
annual with serum creatinine
What is DKA
Diabetic ketoacidosis
*random BG >200mg/dL
symptoms will progress rapidly
What is the advantage of basal insulin
it controls glucose production between meals and overnight
What is the advantage of bolus insulin
Limits hyperglycemia after meals
What is the dosing for insulin
.4 - 1.0 units/kg/day
In what instances does the total daily insulin need to be increased
Puberty
pregnancy
medical illness
How does insulin concentration in an injection effect the absorption rate
The higher the concentration number, the longer it will take the insulin to absorb
What are some adverse reactions to insulin
lipoatrophy (loss of fat at injection site - may cause intramuscular injection)
hypertrophy (increase fat mass at injection site leading to variable absorption)
resistance (needing larger amount of insulin)
How much glucose is the preferred treatment for hypoglycemia
15-20g
What is the diagnostic criteria of DKA
Diabetic (Glucose >200)
Keto (Ketonuria)
Acidosis (PH <7.3)
What things can induce DKA
Infection
infarction
iatrogenic
incision
intoxication
initial
insulin
If a patient in DKA is also in shock, what type of fluid management do you give
Bolus 2-3 liters of normal saline STAT
What is the IV fluid management in someone with DKA NOT in shock
1 liter Normal saline over 1 hour
What are the steps of treating DKA
Fluid replacement
Electrolyte replacement (Na+, K+)
Insulin drip
*Once glucose is <200, switch to D5 to prevent hypoglycemia
What is the leading cause of death in children presenting with DKA
Cerebral edema
Which diets are effective strategies at trying to manage glucose intolerance
mediteranean and DASH
When does insulin resistance generally start before a clinical diagnosis of DM is given
4-7 years
What are some common risk factors for DM2
obesity
+ FH
hx HTN
Dyslipidemia
Who should be screened for T2DM and when
People >35 and at risk
Q3 years and labs are normal
What tests are ordered to screen for T2DM
FPG
HbA1C
plasma glucose
How do those with T2Dm present
Usually asymptomatic
*may present with hyperglycemia or other diabetic complications that have been present for a while
What are the signs and symptoms of T2DM
Polyuria, Polydipsia, orthostatic hypotension, dehydration
What is the criteria for diagnosing someone with T2DM
*ONE of the following
FPG >126
Random glucose >200
2hr plasma glucose >200
HbA1C >6.5%
Is HbA1C something that can be used to diagnose gestational diabetes or T1DM
no
