Diabetes Flashcards
Why is the HbA1c test preferred for diagnosing diabetes?
Reflects average blood glucose over 2–3 months. does not require fasting.
How does obesity contribute to T2DM development?
adipose tissue releases inflammatory cytokines that exacerbate insulin resistance
Diagnostic criteria for diabetes using FPG?
FPG ≥ 126 mg/dL (7.0 mmol/L)
Primary defect in gestational diabetes
insulin resistance induced by placental hormones
mechanism of sulfonylureas in type 2 DM
stimulate pancreatic beta cells to secrete insulin
mechanism of metformin in improving glycemic control type 2 DM
decreases hepatic glucose production
metformin reduces gluconeogenesis improving insulin sensitivity
A patient has hyperglycemia, ketosis and metabolic acidosis. What’s the possible diagnosis?
Diabetic ketoacidosis
lack of insulin leads to unrestrained lipolysis and ketogenesis
How does diabetic ketoacidosis (DKA) differ from hyperosmolar hyperglycemic state (HHS)?
DKA involves significant ketonemia and acidosis, while HHS is marked by extreme hyperglycemia and dehydration without ketoacidosis
What is the first-line antihypertensive in diabetic patients with albuminuria?
ACE inhibitors or ARBs.
These agents reduces intraglomerular pressure providing protection against diabetic nephropathy
Pathophysiological basis of diabetic neuropathy
microvascular damage and oxidative stress
pathophysiology of diabetic retinopathy
chronic hyperglycemia
damages the retinal microvasulature by:
1. vascular permiability
2. neovascularization due to high glucose levels
mechanism of GLP-1 in DM
enhances insulin secretion and supress glucagon
Agent mimics incretin hormones leading to:
1. glycemic control
2. weight loss
Why is hypoglycemia more common in Type 1 diabetes?
Absolute insulin dependence and impaired counterregulatory responses.
Why is the dawn phenomenon observed in diabetes?
early morning glucose elevation due to GH and cortisol
counterregulatory hormones increase glucose production overnight
significance of post-prandial glucose monitoring
reflects short-term glycemic control and predicts cardiovascular risk
mechanism of thiazolidinediones (TZDs) in insulin sensitivity
activates PPAR-gamma to enhance glucose uptake in adipose tissue targeting insulin resistance in type 2 DM
Differentiating marker of type 1 from type 2 DM
LOW/absent c-pep suggests type 1 DM insulin deficiency
c-peptide distinguishes between endogenous and exogenous insulin presence
Why is screening for microalbuminuria essential in diabetes management?
It is an early marker of diabetic nephropathy
threshold of Hba1c diagnostic for diabetes
HbA1c ≥6.5%
diagnostic criteria for gestational diabetes mellitus
elevated blood glucose levels on oral glucose tolerance test (OGTT) during pregnancy
What are the primary counter-regulatory hormones involved in hypoglycemia?
glucagon
epinephrine
recommended blood pressure target for most patients with diabetes
<140/90 mmHg (or <130/80 mmHg in high-risk patients).
A 45-year-old man presents with obesity and a fasting plasma glucose of 132 mg/dL. HbA1c is 6.9%. What is the next best step?
start metformin
R: first-line treatment for T2DM with lifestyle modifications
glucose level diagnostic for diabetes
126 mg/dL (7mmol/L) and higher
A 20-year-old woman with newly diagnosed T1DM develops abdominal pain, nausea, and rapid breathing. Lab results show pH 7.1, glucose 400 mg/dL, and serum ketones. What is the most appropriate initial treatment?
start IV fluids and insulin
R: patient has DKA
A 65-year-old man with T2DM has an HbA1c of 8.2% despite metformin. He has a history of heart failure. Which medication should be added?
SGLT2 inhibitor
A 58-year-old woman presents with severe hyperglycemia (glucose 850 mg/dL), dehydration, and no ketones in her urine. Which diagnosis is most likely?
hyperosmolar hyperglycemic state
R: without significant ketonemia or acidosis
A 35-year-old woman with a BMI of 31 is diagnosed with gestational diabetes at 28 weeks gestation. Which of the following is the most appropriate initial management?
Lifestyle modifications, including dietary changes and exercise, are the first-line treatment for gestational diabetes
A 50-year-old man with T2DM and chronic kidney disease has an HbA1c of 7.8% on metformin. Which medication is contraindicated?
Thiazolidinedione (TZDs)
R: it can exacerbate fluid retention worsening his condition
