Diabetes Flashcards
What is threshold for random glucose plasma level that yields a diagnosis of diabetes?
Greater then 200 mg/dl (w/ classic symptoms: peeing, thrust, weight loss)
What is the threshold for fasting plasma glucose to diagnose a diebetic?
greater then or equal to 126 mg/dl
What is the normal range for FASTING blood glucose?
70-100 mg/dl
What is the threshold for the oral glucose tolerance test (glucose level 2 hours after a standard glucose load)? Whats the normal level?
> or equal to 200mg/dl (normal <140)
What is the threshold for Heme A1C? T/F measure twice..
greater then 6.5%..T measure twice
What condition is associated with polyuria, polydipsia, polyphagia, weight loss, high blood glucose, and loss of glucose to urine?
hyperglycemia (not necessarily DM)
What are the three main factors leading to type I DM?
environmental triggers, genetics, and immune destruction of beta cells
What is the hallmark test to determine type I?
ANTIBODIES test! They are unique to type I, they can even be used to indicate it in others.
Concerning the cause of insulin, what is the most common problem? Pre, during, or post receptor?
the most common issue is post receptor defect. There is something ary with the signal transduction
I vs II: autoimmune?
I
I vs II: more often in adults?
II
I vs II: often lean/underweight?
I
I vs II: would die without insulin?
I
I vs II: 95-100% concordance rate in twins
II
I vs II: Ketone bodies present
I
Does calorie restriction increase insulin sensitivity? Does exercise?
YES and YES
How long do you give a type II pt to lose weight before trying another treatment?
3 months
What is the first drug used for type II? (the workhorse) What does it do?
MET-FORM-IN (big-u-anide), it decreases liver GNG
What are the type II drugs that stimulate beta cell insulin secretion, inhibit alpha cell glucagon secretion, and decrease appetite?
GLP-1 (glucagon like protein-1)
What is the NEW type II drug that blocks reabsorption of filtered glucose in the kidney?
Kidney Sodium-Glucose Co-Transporter 2 (SGLT2T2) Inhibitors
Does a diabetic take boluses of insulin before or after a meal to adjust?
After the meal!
What condition can be the result of too much insulin therapy? What is the main metabolic process that is inhibited?
hypoglycemia!…GNG is a major factor here
What other hormone typically kicks in during hypoglycemia?
epinephrine
Name that condition: lethargy, impaired thinking, sweating, rapid heart rate, anxiety, hunger…
hypoglycemia!
What is the BEST immediate treatment for hypoglycemia?
Glucagon injection…stimulates glycogenolysis (also ingest glucose)
What is a good long term treatment for hypoglycemia?
altering the pt’s insulin treatment levels and behaviors
What are two short term complications of diabetes?
ketoacidosis, hyperosmolar coma
Which short term complication do you see massive lipolysis? Which type is this associated with?
KetoAcidosis…type I
What does insulin do to hormone sensitive lipase?
Insulin SUPRESSES hormone sensative lipase
What is epinephrine do to hormone sensative lipase?
epi stimulates hormone sensative lipase=lots of fat in blood
Which short term diabetic complication do we not see massive lipolysis and therefore no ketoacidosis? Which type is this associated with?
hyperosmolar coma…type II
How do you treat ketoacidosis? Hyperosmotic coma?
both treated with fluids and insulin
What is the best blood test to measure blood glucose over a number of weeks?
Heme A1C!
Whats an AGE? What do they do with other proteins?
Advanced Glycation Endproducts..Cross link w other proteins
HERE IT IS: What is the CASCADE of hyperglycemia to long term tissue damage?!
Hyperglycemia–>Altered Protiens/free radicals–>blood vessel inflammation–>endothelial cell dysfunction–>altered blood flow–>inchemia–>tissue damage
What do these symptoms indicate? Microaneurysms, dot and blot hemerages in the eye?
Diabetic retinopathy
Which condition can you treat with laser, VGEF antibodies, and glucocorticoid injections?
Diabetic retinopathy
What is the major structure affected in diabetic nephrophathy? What is the result?
The glomerulus! Proteins get pushed thru and lost in the urine.
Which chronic diabetes disease is associated with a 20x to 40x increase in death?
diabetic nephropathy
In diabetic neuropathy which usually goes first: sensory or motor loss?
Sensory
In diabetic neuropathy which usually goes first: distal or proximal nerves?
distal
What is the nickname for the movement of neuropathy from the feet up?
“stocking-glove” neuropathy
Which nervous system do all of these symptoms point to in neropathy?:dry mouth, hypotension, constipation, bladder won’t empty, impotence, abnormal sweating, no epi response to hypoglycemia
autonomic neuropathy (both sympathetic and parasympathetic)
What do these symptoms point to?large blood vessel damage, earlier, more diffuse, more severe, more heart attacks, more stroke, more amputations.
Diabetic macroangiopathy
Which disease risk is higher in people with insulin resistance even if blood glucose is not yet in diabetes range?
MacroVascular Disease
What is another name for insulin resistance syndrome, with these symptoms: hyperinsulinemia, hyperglycemia, hyper triglyceridemia, low HDL cholesterol, hypertension, apple obesity? (Dr. T would be proud)
Metabolic Syndrome
What are two indicators of COMBINED microvascular (nerve) and macro vascular conditions?
Impotence and foot ulcers
Why does diabetes cause an increased risk for PERIODONTITIS?
Bacteria like the high sugar in the blood. They produce enzymes, prostaglandins, and cytokines that cause inflammation and tissue damage.
What two cytokines are released that damage endothelium in the capillaries supporting the teeth (ultimately leading to periodontitis)?
Cytokines released are AGEs and Free Radicals
What are the drawbacks of intensive insulin therapy for type I’s?
severe hypoglycemia and weight gain
Does intensive glucose control therapy have a similar effect on type II’s as it did type I’s?
Nope, it had less of an effect for type IIs
How often should a neuropathic diabetic examine their feet?
Daily!
