Diabetes Flashcards
TYPE 1 DIABETES
-Pancreatic islet β-cell destruction, usually leading to absolute insulin deficiency
Labs: HUKIAH
-Elevated glucose >= 126
-Glycosuria, ketonuria
-Ketonemia, insulinopenia
-Elevated A1C >= 6.5
-Islet cell antibodies
-Increased HLA antigens DR3/4
Ketosis, young age onset, lifelong dependency on insulin, associated with hypothyroidism or hypoadrenalism
TYPE 2 DIABETES
-Progressive loss of β-cell insulin secretion frequently with a background of insulin resistance
Labs
-Elevated glucose >= 126
-Abnormal glucose test >= 200
-Elevated A1C >= 6.5
Ketosis-resistant, resistance to insulin, obesity, adult onset, family hx
IMPAIRED FASTING GLUCOSE
-IFG = fasting glucose levels >= 100 and < 126
-At increased risk for developing diabetes
-Glucose tolerance test between normal and diabetic (140-200 mg/dL, 2 hours following a 75 g oral glucose load)
-A1C between 5.7 and 6.4
*Increased prevalence of atherosclerosis, electrocardiographic abnormalities, hypertension, hyperlipidemia, obesity
*Higher age group
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GESTATION DIABETES / IMPAIRED GLUCOSE TOLERANCE (IGT)
-This class of patients is defined as women in whom during pregnancy diabetes or IGT become manifest
-After pregnancy, the condition usually reverses to normal, but in some patient’s diabetes or IGT persists
MATURITY ONSET DIABETES OF THE YOUNG (MODY)
-rare autosomal dominant disorders
-ranging from asymptomatic hyperglycemia to acute presentation
-non insulin dependent
-under 25 years of age onset
-non obese
-genetic defects of B cell function
HYPERGLYCEMIA ASSOCIATED WITH CERTAIN CONDITIONS OR SYNDROMES
-Acromegaly
-Cushing’s syndrome
-Pheochromocytoma
-Glucagonoma
-Primary aldosteronism
-Hyperthyroidism
-Hemochromatosis
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Measurements of plasma glucose, in order to be easily interpretable, should be obtained under selected circumstances:
(1) in the fasting state, or (2) during an oral glucose tolerance test
Fasting plasma glucose (FPG)
pt is kept on an average usual diet and, after an overnight fast (no food or sweetened drinks after midnight), blood is drawn in the morning
Oral glucose tolerance test (OGTT)
-Following an 8 hour fast, the patient is asked to drink 75 g of an aqueous solution of glucose
-Drink within 5 minutes
-Vomit = invalid, repeat test
-Blood drawn at 0 and 120 min
-Pregnant women = 75 or 100 g
-Children = 1.75 g/kg up to max of 75 g
-Carb malabs = IV glucose test
OGTT Ranges
The 100 g OGTT indicates gestational diabetes when two or more of the following values in mg/dL are reached or exceeded: fasting 95, 1 hour 180, 2 hours 155, 3 hours 140.
The 75 g OGGT indicates gestational diabetes when two or more of the following values in mg/dL are reached or exceeded: fasting 95, 1 hour 180, 2 hour 155.
Most convenient method for estimating the degree of ketonemia and ketonuria utilizes _________
nitroprusside tablets (Acetest) or reagent strips (Ketostix)
*which reacts with acetoacetate and with acetone (only 1/20 of the reactivity of acetoacetate), and fails to react with B-hydroxybutyrate
GLYCOSURIA
-Appears when the blood glucose level exceeds the renal threshold for reabsorption of glucose
-This normally lies at about 170 mg/dL, but it may be lower in renal tubular disease or elevated in diabetics to above 300 mg/dL
-The glucose concentrations in the urine of diabetics are commonly in the range of 0.5 to 2.0 g/dL, but values over 5 g/dL are occasionally encountered
GLYCATED-HEMOGLOBIN (A1C)
Reference Range: 4.8 – 5.9%; General target goal is < 7%
AG Equation
AG = 28.7 (A1c) - 46.7
ALBUMINURIA
-Monitor renal involvement of diabetes
-ACEi
Reference Ranges
-Normal < 30
-Increased 30 - 300
-Clinical > 300
