Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General Pathology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes Mellitus

A

A syndrome with disordered carbohydrate metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In the US, diabetes is the leading cause of….

A

end-stage renal disease, adult-onset blindness, and nontraumatic lower-extremity amputations resulting from atherosclerosis of arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Type 1 Diabetes Mellitus (T1DM)

A

Due to pancreatic islet beta cell destruction predominantly by an autoimmune process, and these patients are prone to ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Type 2 Diabetes
Mellitus (T2DM)

A

The most prevalent form of DM and results from insulin resistance, mainly caused by visceral obesity, with a defect in compensatory insulin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Type 1.5 Diabetes (latent autoimmune diabetes in adults (LADA))

A

Autoimmune diabetes that begins in adulthood and does not need insulin for glycemic control at least in the first 6 months after diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Maturity-onset diabetes of the youth (MODY)

A

Refers to disorders due to monogenic defects in beta-cell function, with little or no defect in insulin action that was observed in non-obese children, adolescents, and young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gestational diabetes mellitus (GDM)

A

Characterized by carbohydrate intolerance during pregnancy usually resolving after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Secondary diabetes

A

Diabetes that develop secondary to some other identifiable etiology or acquired disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the epidemiology of T1DM?

A

Incidence most commonly peaks in the middle of the first decade and again at the time of growth acceleration of adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The onset of T1DM is usually clinically abrupt with marked….

A

Polyuria
Polydipsia
Polyphagia
Weight loss
Fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which diabetes patients have Hyperglycemia with little or no endogenous insulin secretion?

A

T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T1DM patients are highly prone to ______ and frequently may present themselves for tx in an initial episode of ________

A

ketosis; diabetic ketoacidosis (DKA)

(A prodromal phase of polyuria, polydipsia, and weight loss may proceed development of DKA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the epidemiology of T2DM?

A

-Occurs most commonly in adults aged 40yrs or older
-However, the incidence is increasing more rapidly in adolescents and young adults than in other age groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe patients with T2DM

A

-Maintain some endogenous insulin secretory capability
-Relatively resistant to the development of ketosis
-Marked resistance or insensitivity to insulin, and have decreased insulin receptors
-Failure of postreceptor coupling and of intracellular insulin action
-Long presymptomatic phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Gestational Diabetes Mellitus (GDM) increases your risk for….

A

Increased risk (approximately 40-60%) for developing T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List the clinical presentations of T1DM

A

-Increased urination (polyuria) is a consequence of osmotic diuresis
-Thirst (polydipsia)
-Weight loss (muscle wasting and weakness and loss of subcutaneous fat)
-Postural hypotension
-Paresthesias (occurs due to a temporary dysfunction of peripheral sensory nerves)
-Blurred vision
-Altered level of consciousness (level of consciousness can very - stupor or even coma may occur)
-Fruity breath odor of acetone
-Diabetic ketoacidosis (DKA) (produces anorexia, nausea and vomitting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List the clinical presentations of T2DM

A

-Increased urination (polyuria)
-Increased thirst (polydipsia)
-Some are initially asymptomatic
-Neuropathic or cardiovascular complications
-Chronic skin infections (pruritus and chronic candidal vulvovaginitis)
-Frequent acute urinary tract infections
-Obesity
-Mild hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T2DM occurs more frequently in women who have _______

A

delivered large babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the tests that can diagnose DM

A
  1. Glycosylated hemoglobin A1C (HbA1c) value
  2. A fasting plasma glucose (FPG)
  3. An oral glucose tolerance test (OGTT)
  4. Symptoms of hyperglycemia and a casual (random) plasma glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the HbA1c test

A

-Value >6.5% is considered diagnostic for DM
-HbA1c is useful for diabetes screening and diagnosis in routine clinical practice and this test is preferred.
-Glycosylated hemoglobin is abnormally high in diabetics
-Hemoglobin A1c (glycogemoglobins) generally reflect the state of glycemia over the preceding 2-3 months, thereby providing an improved method of assessing diabetic control. Glycohemoglobins are extremely useful in monitoring the progress of diabetic patients and HbA1c testing should be performed routinely in all pts with diabetes first to document the degree of glycemic control at initial assessment and then are part of continuing care
-HbA1c test reflects mean glycemia over the preceding 2-3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the fasting plasma glucose (FPG) test

A

A fasting plasma glucose > (or equal to) 126 mg/dL should be confirmed with repeat testing on a different day (fasting is defined as no caloric intake for at least 8 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe oral glucose tolerance test (OGTT)

A

An OGTT with a plasma glucose > (or equal to) 200 mg/dL, 2 hours after a 75g (or 100g for pregnant women) glucose load

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What other test is indicative of DM?

A

Symptoms of hyperglycemia and a casual (random) plasma glucose > (or equal to) 200 mg/dL
-Classic symptoms of hyperglycemia include polyuria, polydipsia, and unexplained weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Individuals with glucose levels higher than normal but not high enough to meet the criteria for diagnosis of DM are considered to have…..

A

“Prediabetes” (also sometimes called impaired glucose tolerance (IGT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

List the acute complications of Diabetes Mellitus

A

-Hyperglycemia
-Diabetic ketoacidosis (DKA)
-Hyperosmolar hyperglycemic syndrome/state (HHS)
-Hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Hyperglycemia

A

If allowed to persist at high enough levels in the susceptible diabetic, hyperglycemia will progress to diabetic ketoacidosis (DKA). A less common complication, but with higher fatality rate is hyperosmolar hyperglycemic syndrome (HHS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Diabetic ketoacidosis (DKA)

A

-DKA is more commonly seen in pts with T1DM
-DKA results from the inability of the body to metabolize ketones as rapidly as they are produced and the failure of the body to compensate for the decrease in pH via renal and respiratory mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List the symptoms of DKA

A

-headache
-flushed face
-weakness,
-fatigue
-hunger
-confusion
-disorientation
-nausea
-vomiting
-abdominal cramps tenderness and pain
-diarrhea
-dyspnea
-deep rapid respirations (Kussmaul respirations)
-“fruity” (acetone) breath
-hypotension
-weak pulse
-polydipsia
-polyuria
-polyphagia
-loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Hyperosmolar hyperglycemic syndrome/state (HHS)

A

-HHS is a diabetic-related complication marked by severe hyperglycemia, resultant extreme hypertonic dehydration and absence of significant ketoacidosis
-Frequently, pts with HSS present in coma or with impaired consciousness. (Therefore sometimes is called: hyperosmolar, hyperglycemic, nonketotic coma (HHNC))
-HHS is more commonly seen in pts with T2DM
-Hyperglycemia also creates an increase in the osmotic gradient. Free water with electrolytes and glucose is lost via urinary excretion producing glycosuria causing (typically) severe dehydration.

30
Q

T/F: Dehydration is usually more severe in DKA compared to HHS, and there is more risk for cardiovascular collapse

A

FALSE

Dehydration is more severe in HHS compared to DKA

31
Q

Symptoms of HHS

A

-Weakness
-Polyuria
-Polydipsia
-Pts do NOT demonstrate rapid respirations/hyperventilation seen in DKA
-Pts do NOT have the fruity acetone breath
-Significant orthostatic hypotension
-Altered mental status and confusion, as well as other neurologic signs are often present (such as hemisensory defects, transient hemiparesis, aphasia or seizures)

32
Q

What is the most common complication that occurs in pts BEING TREATED for DM?

A

Hypoglycemia

33
Q

Hypoglycemia

A

Failure to ingest sufficient foods following insulin administration, exercise without sufficient intake of food, over-administration of insulin, sulfonylureas or meglitinides, or the presence of infection or other disease

34
Q

Signs and symptoms of hypoglycemia

A

-Nonspecific and vary among persons. Can change from time to time in the same person
-Neurogenic signs and symptoms include tremulousness, tachycardia, palpitations and anxiety as well as diaphoresis, hunger and presthesias
-Neuroglycopenic signs and symptoms include weakness, dizziness, tingling, difficulty concentrating, blurred vision, confusion, behavioral changes, seizure and coma

35
Q

In pts with T1DM, complications from _______ are a major cause of death, whereas pts with T2DM are more likely to have ________ as the main causes of death

A

end-stage renal disease; macrovascular diseases leading to myocardial infarction and stroke

36
Q

List the chronic complication of diabetes mellitus

A

-Diabetic Macrovascular Disease
-Diabetic Microangiopathy
-Diabetic Renal Disease
-Hypertension
-Diabetic Neuropathy
-Ocular complications
-Ulceration and Gangrene of the feet
-Skin and Mucous Membrane complications
-Oral complications
-Increased risk for infections

37
Q

Diabetic Macrovascular Disease

A

-Hypercholesterolemia and a markedly increased predisposition to accelerated atherosclerosis especially in the aorta and large- and medium-sized arteries
-Cardiovascular disease (causes 80% of deaths in T2DM; diabetics have a 3-7.5x greater incidence of death from cardiovascular causes compared to the non-diabetic population)(Incidence of myocardial infarction is twice as high in diabetics as in non-diabetics)
-Patients with diabetes have an increased stroke incidence
-Renal atherosclerosis and arteriolosclerosis

38
Q

Diabetic Microangiopathy

A

Microvascular disease caused by capillary changes
-Hyaline arteriosclerosis (wall thickening of small arterioles and capillaries which causes narrowing of the lumen)
-Hyaline arteriosclerosis is responsible for ischemic changes in the kidney, retina, brain, and peripheral nerves, and associated with hypertension
-Diabetic microangiopathy is characterized by diffuse thickening of basement membranes that is most evident in the capillaries of the skin, skeletal muscle, retina, renal glomeruli, and renal medulla and underlies the development of diabetic nephropathy, retinopathy, and some forms of neuropathy

39
Q

Diabetic Renal Lesions

A

1) Glomerular lesions: (changes in glomerulus leads to diabetic nephropathy)
-Capillary basement membrane thickening
-Diffuse mesangial sclerosis
-Nodular glomerulosclerosis (Kimmelstiel-Wilson lesion)
*Diabetic nephropathy is characterized by persistent albuminuria “microalbuminuria”
*W/o tx, may develop overt nephropathy with macroalbuminuria with a decline in glomerular filtration (GFR) and hypertension
*Diabetic nephropathy is the leading cause of chronic renal failure (CRF), (end-stage renal disease (ESRD), or stage 5 chronic kidney disease (CKD) in the US

2) Renal vascular lesions, principally arteriosclerosis (nephrosclerosis)
-Hyaline arteriosclerosis affects both afferent efferent renal arterioles in patients with DM

3) Pyelonephritis, including necrotizing papillitis:
-pyelonephritis is an acute or chronic inflammation of the kidneys
-necrotizing papillitis (or papillary necrosis)

40
Q

Hypertension

A

Develops with progressive renal involvement, and coronary and cerebral atherosclerosis seems to be accelerated. Approximately two-thirds of adult patients with DM have hypertension

41
Q

Diabetic Neuropathy
-Peripheral (sensory) Neuropathy

A

Peripheral (sensory) and autonomic neuropathy

1) Peripheral (sensory) Neuropathy
a) Distal symmetric polyneuropathy
-most common form of diabetic peripheral neuropathy
-sensory involvement usually occurs first and is generally bilateral, symmetric, and associated with dulled perception of vibration, pain and temp, particularly in lower extremities
-Occasionally severe “burning” pain and discomfort
-Insensitivity of the feet, leading to repeated “silent” trauma
-Axonal degeneration and segmental demyelination.
-Accumulation of sorbitol in peripheral sensory nerves

b) Isolated (peripheral) neuropathy
-Has been attributed to vascular disease/ischemia in blood vessels supplying nerves or traumatic nerve damage

42
Q

Diabetic Neuropathy
-Autonomic Neuropathy

A

Clinical manifestations include:
1. Cardiovascular disturbances: orthostatic and postural hypotension, tachycardia
2. Gastrointestinal disturbances: gastroparesis
3. Genitourinary disturbances

43
Q

Ocular Complications

A
  1. Diabetic retinopathy
    a. Background, or “simple”, retinopathy
    b. Pre-proliferative retinopathy
    c. Proliferative, or “malignant”
  2. Diabetic cataracts
  3. Glaucoma
44
Q

Ulceration and Gangrene of the feet

A

-Foot ulcers –> leading cause of hospitalization in pts with DM
-Foot ulcers become infected and are first step to gangrene and lower extremity amputation

45
Q

Skin and Mucous Membrane Complications

A
  1. Necrobiosis lipoidica diabeticorum (NLD)
  2. Scleroderma diabeticorum (digital sclerosis when affecting digits or toes)
  3. Dermatitis herpetiformis
  4. Vitiligo
  5. Acanthosis nigricans (with significant insulin resistance)
  6. Diabetic dermopathy
  7. Eruptive xanthomatosis (eruptive xanthomas) associated with uncontrolled blood sugars and extremely high triglycerides
  8. Candidal skin infections
46
Q

Oral complications

A

Oral complications may include xerostomia; bacterial, viral, and fungal infections (including candidiasis); poor wound healing; increased incidence and severity of caries; gingivitis and periodontal disease; periapical abscesses; and burning mouth/tongue symptoms

47
Q

Xerostomia

A

-Effects of hyperglycemia lead to increased amounts of urine, which deplete the extracellular fluids and reduce the secretion of saliva
-DM pts present with xerostomia and low levels of salivary calcium, phosphate, and fluoride
-Saliva glucose levels are elevated

48
Q

Periodontal Disease

A

-DM results in enhanced inflammatory responses contributing to increased risk for periodontitis
-Periodontal disease is clearly a complication of T1DM and T2DM
-Overall, periodontal disease is more severe and more frequent in pts with poorly controlled DM

49
Q

Caries

A

May be more significant in pts with diabetes and may be attributed to several causes including xerostomia and elevated saliva glucose levels

50
Q

Oral fungal infections

A

Candidiasis

51
Q

Oral lesions

A

Candidiasis, traumatic ulcers, lichen planus, and delayed healing

52
Q

Diabetic neuropathy

A

Oral burning symptoms

53
Q

Increased risk for Infections

A

-Abnormal elevation of blood and tissue glucose concentrations can decrease immune function via effects on neutrophil activity and phagocytosis, immunoglobin and complement function
-Enhanced susceptibility to infections, especially skin infections and tuburculosis, pneumonia, and pyelonephritis

54
Q

Describe T1DM pathogenesis

A

T1DM is an autoimmune disease in which destruction of pancreatic beta-cells in the islets of Langerhans in the pancreas are caused primarily by immune effector cells reacting against endogenous beta-cell antigens
-After 80-90% of the beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed
-Pts need exogenous insulin

55
Q

______ is considered the major factor in the pathophysiology of T1DM

A

Autoimmunity
-Certain viral infections may stimulate the production of antibodies against a viral protein that trigger an autoimmune response against antigenically similar beta-cell molecules

56
Q

A majority of T1DM patients have circulating _______ and also have detectable ______ before receiving insulin therapy

A

circulating islet cell antibodies; anti-insulin antibodies

57
Q

What is the most commonly found islet cell antibodies in T1DM?

A

Those directed against glutamic acid decarboxylase (GAD)

58
Q

The prevalence of T1DM is increased in pts with other autoimmune diseases such as…..

A

Graves disease, chronic autoimmune (Hashimoto) thyroiditis, and Addison disease

59
Q

What are the major genetic determinants of T1DM?

A

Polymorphisms of the class II human leukocyte antigen (HLA) genes that encode DR and DQ

60
Q

T2DM is a heterogenous and multifactorial complex disease that involves interactions of….

A

genetics, environmental risk factors, and inflammation

61
Q

The two defects that best characterize T2DM are:

A

1) A decreased ability of peripheral tissues to respond to insulin (insulin resistance)
2) Beta-cell dysfunction that is manifested as inadequate insulin secretion in the face of insulin resistance and hyperglycemia

62
Q

T/F: For T2DM to occur, both insulin resistance and inadequate insulin secretion must exist

A

TRUE

63
Q

Insulin resistnace

A

In the progression from normal to abnormal glucose tolerance, postprandial blood glucose levels increase first. Eventually, fasting hyperglycemia develops as suppression of hepatic gluconeogenesis fails

64
Q

Beta-cell dysfunction

A

While insulin resistance by itself can lead to impaired glucose tolerance, beta-cell dysfunction is an essential component in the development of overt T2DM

65
Q

Obesity

A

Obesity is present in approximately 80-90% of T2DM patients. Obesity is a major risk factor for the development of T2DM, and the most important environmental factor causing insulin resistance

66
Q

What is the most important environmental factor causing insulin resistance?

A

Obesity

67
Q

Excess glucagon (Hyperglucagonemia)

A

Plays an important role in the pathophysiology of T2DM, wherein there is a pancreatic islet cell dysfunction in which the reciprocal relationship between the glucagon-secreting alpha-cells and the insulin-secreting beta-cells is lost, leading the hyperglucagonemia and hence the consequent hyperglycemia

68
Q

Genetic factors relating to T2DM

A

-Genome-wide association studies of single-nucleotide polymorphisms (SNPs) have identified a number of genetic variants that are associated with beta-cell function and insulin resistance. Some of which appear to increase the risk for T2DM
-Susceptibility to T2DM may also be affected by genetic variants involving incretin hormones, which are released from endocrine cells in the gut and stimulate insulin secretion in response to digestion of food

69
Q

Metabolic syndrome:

A

-A syndrome of insulin resistance, termed “metabolic syndrome” or “syndrome X” has been proposed to explain the frequent association of hypertension, glucose intolerance (insulin resistance), abdominal obesity, hyperlipidemia and accelerated atherosclerosis
-Individuals with metabolic syndrome are at a high risk for the development of T2DM

70
Q

Pancreatic Histologic/Morphologic features

A

1) Reduction in the number and size of islets (most often seen in T1DM)
2) Leukocytic infiltrates in the islets (insulitis) (most often seen in T1DM)
3) Amyloid deposition within islets in T2DM. In advanced stages, the islets may be virtually obliterated; fibrosis also may be observed.
-The type of amyloid associated with T2DM is islet amyloid polypeptide (IAPP) or (amylin).
-IAPP and its precursor, pro-islet amyloid polypeptide (pro-IAPP), have been linked to T2DM and the loss of islet beta-cells

General Pathology (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions