diabetes Flashcards
if an asymptomatic patient is being screened for diabetes what is the mosyt appropriate test?
fasting blood glucose levels
what is the best test used for the monitoring of blood glucose ?
HBA1c
what test is used for the screnin for gestational diabetes ?
glucose tolerance test
what type of hypersensitivity reaction is associated with type 1 DM ?
type 4
t cell mediated
what is seen on biopsy of T1Dm ?
ilets leuckoytic infiltation
what is the treatment for T1Dm ?
insulin
what is the most common initial presentation of T1DM ?
diabetic ketoacidosis
precipitated by infection
associated with skipping insulin therapy
what is the presentation of DKA ?
dehydration
high glucose
hyperkalemia
fruity breath
abdominal pain and nausea
what type of metabolic disturbance associated with T1DM ?
anion gap metabolic acidosis
kussmaul breathing
what environmental triggers can be associated with T1DM ?
coxasckie virus B
what are the levels of phosphate associated with DKA ?
risk of hypophosphatemia
which will cause osmotic diuresis
what are the clinical consequences associated with hypophosphatemia ?
loss of ATP will lead to muscle weakness
eventually causing respiratory failure
and heart failure due to reduced cardiac contractility
what are the common causes of death associated with DKA ?
arrythmia due to hyperkalemia
cerebral edema (common in children)
what infections are associated with DKA ?
mucormycosis
fungal infection
caused by rhizopus and mucor
what is the classic presentation of mucormycois ?
starts in the nose and sinuses
fever headache and eye pain
what is the treatment for DKA ?
insulin and IV fluids
what must be monitored in DKA ?
potassium levels must be monitored
careful monitoring of glucose
what is the main pathology in T2Dm ?
insulin resistance
what is the major risk factor associated with T2DM ?
obesity
what are the different types of obesity are associated with T2DM ?
apple shape
pear shape
apple shape is worse
what is the classic histology finding associated with T2DM ?
amyloid in pancreatic islets made by beta cells
what is HHS ?
hyperglycemic hyperosmolar syndrome
life threatning complication of T2DM
what is the difference between DKA and HHS ?
no ketones in HHS , so no acidosis
but very high serum osmolarity in HHS
what are the symptoms of HHS ?
mental status changes
polyuria and polydydipsia
what is the treatment of HHS ?
IV fluids and insulin
what skin finding is associated with T2DM ?
acanthosis nigricans - present in skin folds
what malignancy is associated with acanthosis nigricans ?
gastric adenocarcinoma
what are they key mechanisms responsible for diabetic complications ?
sorbitol accumulation
non enzymatic glycation
what is no enzymatic glycation ?
when glucose sticks to important structures in the body
creates a schiff bond
turns into amadori products
and eventually turns into Advanced Glycation End Products (AGEs)
what do these AGE do ?
associated with atherosclerosis formation
hence the coronary artery disease
stroke TIA
peripheral vascular disease
leads to diabetic kidney disease
what is the effect of diabetes in renal arterioles ?
hyaline atherosclerosis
results from AGE
affecting efferent and afferent
what is the difference in effect if the afferent arteriole is affected vs the efferent arteriole ?
afferent arteriole : ischemia
efferent arteriole : hyperfiltration
when is efferent atherosclerosis seen ?
rare except in diabetes
what is the best treatment for when albumin is found in urine in diabetics ?
use ACE inhibitors
what effect does diabetes have on the glomerular basement membrane ?
causes thickening of the BM due to AGE
what are the different types of glomerulosclerosis in association with diabetes ?
1- diffuse - deposition of proteins, collagen, may cause nephrotic syndrome
2- nodular glomerulosclerosis (more specific to diabetes)
what is the hallmark of nodular sclerosis of the kidney in association with DM ?
kimmelstiel wilson nodule
what are the pathologies associated with sorbitol accumulation ?
cataract
neuropathy ( accumulation in schwann cells)
what is the presentation of diabetic neuropathy ?
stocking and glove sensory loss
loss of vibration sense, proprioception
delayed gastric emptying - gastroparesis
how does sorbitol cause diabetic retinopathy ?
pericyte degeneration
