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Foundational Sciences I-II > Diabetes > Flashcards

Diabetes Flashcards

1
Q 
Definition
▪ Diabetes mellitus is a disease complex with metabolic and vascular components
▪ Chronic disease characterized by \_\_\_\_\_
▪ Complications may include
 Vascular disease (macr0- and micro-)
 Nephropathy
 Retinopathy
 Neuropathy
 Poor wound healing
A

hyperglycemia

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2
Q

Historical Persepctives
▪ Symptoms first recognized in _____ (1500 BCE)
 Excessive urination, weight loss
▪ Diabetes mellitus
 Greek physician Aretaeus (80 – 130 CE)
 Reflected sweet taste of urine in these individuals
▪ First measurement of increased glucose in urine  _____

A

ancient egypt

1776

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3
Q

Epidemiology
▪ Globally >360 million people have DM

 Expected to reach >550 million by 2030
 >90% have Type _____

▪ >25 million people in the US have diabetes

▪ DM is a major risk factor for the development of _____
with vascular complications

A

2 DM

atherosclerosis

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4
Q 
Classification
▪ Type 1 DM
 \_\_\_\_\_-mediated 
 \_\_\_\_\_
▪ Type 2 DM 
 Obese
 Non - obese
A

immune

idiopathic

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5
Q

Type 1 DM
▪ Accounts for up to _____ of all DM cases
 Immune mediated
> _____ of cases
 Idiopathic
< _____ of cases
▪ Circulating insulin is virtually absent
▪ Pancreatic B cells fail to respond to all _____ stimuli

▪ _____ onset (days to weeks)
▪ Majority of cases develop before age _____

A 
10%
90%
10%
insulinogenic
acute
25
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6
Q

Immune-mediated Type 1 DM
▪ Infectious or toxic insult to persons whose _____ is genetically predisposed
 Viruses
 Toxic chemical agents

▪ Develop a vigorous _____ response against pancreatic B cells

A

imune sytem

autoimmune

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7
Q

Idiopathic Type 1 DM
▪ Fewer than _____ of subjects have no evidence of pancreatic Β cell autoimmunity

▪ Only a minority of patients with Type 1 diabetes fall into this group
 Majority are of _____ or African origin

A

10%

asian

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8
Q

Signs and Symptoms of Type 1 DM

▪ Increased _____
 Consequence of osmotic diuresis
2o to sustained hyperglycemia

▪ _____ despite increased appetite
 Depletion of water, glycogen, and triglycerides

▪ Reduced _____
 Amino acids are diverted to form glucose and ketone bodies

▪ Lowered _____
 Hypotension

▪ _____
 Temporary dysfunction of
peripheral sensory nerves

▪ _____ changes
 Degree of hyperosmolality

A 
urination
weight loss
muscle mass
plasma volume
paresthesias
mental status
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9
Q

Type 2 DM
▪ More than _____ of all diabetics in the USA are included under this classification

▪ Circulating insulin is sufficient to prevent _____ but is inadequate to prevent _____ in the face of increased needs secondary to tissue insensitivity

▪ Cause is unknown in most cases
 High genetic predilection (_____ >_____)
 Lifestyle risk factors

A 
90%
ketoacidosis
hyperglycemia
type 2
type 1
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10
Q

Type 2 DM
Pathophysiologic defects in Type 2 DM:

▪ _____ to insulin in target cells (esp. muscle)
▪ Increased production of _____ by the liver
▪ Insulin secretory _____ of pancreatic B cells

A

peripheral resistance
glucose
defect

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11
Q

Obese Type 2 DM

▪ Accounts for up to _____ of individuals with Type 2 DM
▪ _____ to extra-pancreatic factors that produce
insensitivity to endogenous insulin
 Defect of insulin production
 Resistance to insulin in target tissues of obese patients due to receptor defects in insulin action

A

70%

secondary

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12
Q

Non-obese Type 2 DM
▪ Individuals demonstrate an _____ or blunted _____ of insulin release in response to glucose
▪ Majority are _____

A

absent
early phase
idiopathic

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13
Q 
Childhood type 2 diabetes
▪ Historically, childhood DM was \_\_\_\_\_
▪ Type 2 DM accounts for nearly \_\_\_\_\_ of new cases in children /
adolescents
▪ Global \_\_\_\_\_ in childhood obesity 
 Calorie-dense foods
 Sedentary lifestyle
 Easy access to transportation
▪ Higher \_\_\_\_\_ among specific ethnic groups 
 Hispanic
 African – American 
 Asian – American
A

type 1
45%
increase
prevalence

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14
Q

Gestational Diabetes
▪ Occurs in _____ of pregnancies
▪ Increased risk with maternal obesity / advancing age
▪ Progressive maternal insensitivity to insulin
 Maternal hyperglycemia > fetal hyperinsulinemia

▪ Normoglycemic state returns s/p parturition
▪ Increased risk of developing: 
 Type 2 DM (\_\_\_\_\_)
 Metabolic Syndrome (\_\_\_\_\_)
 Cardiovascular disease (\_\_\_\_\_)
 Obesity (\_\_\_\_\_)
A 
5%
maternal/fetal
maternal/fetal
maternal
fetal
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15
Q

Signs and Symptoms of Type 2 DM
▪ Insidious onset
 Commonly _____

▪ May present with evidence of _____ or cardiovascular complications

▪ Should be considered in individuals with chronic _____
 Oral
 Genital

A

asymptomatic
neuropathic
candida infections

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16
Q

Complications of Type 2 DM: _____ is often times a complication; _____ are normally seen in clinics treating DM

A

diabetic foot

podiatrists

17
Q

Clinical features of diabetes at diagnosis:

Type 2: wins in _____ and _____

Type 1: wins in _____, weakness or _____, polyphagia with _____, and _____

A

peripheral neuropathy
often asymptomatic

polyuria & thirst
fatigue
weight loss
nocturnal enuresis

18
Q 
Laboratory Evaluation: Urinalysis
▪ \_\_\_\_\_
 Clinistix, Diastix
▪ \_\_\_\_\_
 Acetest, Ketostix
A

glucosuria

ketonuria

19
Q 
Blood testing procedures
▪ \_\_\_\_\_ glucose
▪ Oral glucose tolerance test (OGTT)
▪ Glycosylated hemoglobin (\_\_\_\_\_)(monitoring) 
▪ Self-monitoring
A

serum

HbA1C

20
Q

Criteria for Diagnosis of Prediabetes and Diabetes

Memorize the NUMBERS

A

YES

21
Q

Self Monitoring of Blood Glucose
▪ Capillary blood glucose measurements performed by the patient
▪ _____
▪ Glucose oxidase paper strips exposed to
capillary blood for _____

A

glucometer

seconds

22
Q 
Complications of DM
▪ Sustained \_\_\_\_\_ 
▪ Altered cellular function 
▪ Altered tissue structure
▪ AGEs
 \_\_\_\_\_ 
 Cell damage / apoptosis

▪ RAGEs
 Receptor for AGE
 Activates _____ pathways

A

hyperglycemia
advanced glycation end products
inflammatory

23
Q

Chronic Complications of Diabetes
▪ Ketoacidosis (_____)
▪ Hyperosmolar nonketotic coma (_____)

▪ Ocular
 cataracts
 retinopathy 
 glaucoma
▪ Nephropathy
▪ Accelerated \_\_\_\_\_ 
 CAD
CVA
 Gangrene of feet

▪ _____
 peripheral
 painful
 autonomic

▪ Early Death

A

Type 1
Type 2

atherosclerosis
neuropathy

24
Q

Chronic Complications of Diabetes
▪ Ketoacidosis (_____)
▪ Hyperosmolar nonketotic coma (_____)

▪ Ocular
 cataracts
 retinopathy 
 glaucoma
▪ Nephropathy
▪ Accelerated \_\_\_\_\_ 
 CAD
CVA
 Gangrene of feet

▪ _____
 peripheral
 painful
 autonomic

▪ Early Death

A

Type 1
Type 2

atherosclerosis
neuropathy

25
Q 
Diabetic Nephropathy
▪ Glomerular hyperfiltration
 ▪ Microalbuminemia
▪ Gross proteinuria
▪ Kimmelstiel – Wilson lesion
Management
▪ Glycemic \_\_\_\_\_
▪ \_\_\_\_\_
▪ Protein restriction
▪ Combination therapy

long term management: better _____; less risk in forming tissue damage

ACE inhibitors on _____ > taste, lesions > oral pathology

A

control
inhibitors

glycemic control
oral cavity

26
Q 
Vascular complications
▪ \_\_\_\_\_
▪ \_\_\_\_\_ oxidation of LDL’s
▪ \_\_\_\_\_ platelet aggregation
▪ \_\_\_\_\_ microvascular abnormalities
▪ \_\_\_\_\_ adaptive response of blood vessels
A 
atherosclerosis
increased
increased
increased
decreased
27
Q

Medical Management: Diet
▪ A well-balanced, nutritious diet
▪ _____ fiber
▪ Artificial _____*

artificial sweeteners > have similar effects as _____ in metabolic effects

A

dietary
sweeteners
glucose/sugar

28
Q

Old drugs

Increase insulin secretion:
\_\_\_\_\_
Meglitinides
\_\_\_\_\_
(acting on pancreas)
\_\_\_\_\_ (acting on liver)

Increase glucose uptake:
_____ (acting on muscle)

Delay Glucose Absorption:
_____ (acting on SI)

A

sulfonylureas
phenylalanice derivatives
biguanides

thiazolidinediones

alpha-glucosidase inhibitors

29
Q 
GLP-1 agonists
▪ Gut-derived hormone secreted in response to meals 
 Glucagon-like Peptide-1
▪ Augment release of \_\_\_\_\_
 Inactivated by \_\_\_\_\_
▪ \_\_\_\_\_ (albiglutide) ▪ Trulicity (dulaglutide) ▪ Byetta (exenatide)
▪ \_\_\_\_\_ (liraglutide)
▪ Adlyxin (lixisenatide)
A

insulin
DPP-4 enzyme
tanzeum
victoza

30
Q 
DPP-4 Inhibitors
▪ Prevents inactivation of GLP-1
 Prolong activity of \_\_\_\_\_ released insulin
▪ Long \_\_\_\_\_ of action 
▪ Nesina (alogliptin)
▪ Tradjenta (linagliptin)
▪ Onglyza (saxagliptin)
▪ \_\_\_\_\_ (sitagliptin) (MOST COMMON)
A

endogenously
duration
januvia

31
Q 
SGLT-2 Inhibitors
HIGHEST RISK OF \_\_\_\_\_
▪ Inhibits action of \_\_\_\_\_ in kidneys 
 Glucose reabsorption decreased
 Glucose excretion \_\_\_\_\_
▪ ADRs: hypotension, UTIs, RF, DKA, long \_\_\_\_\_ 
▪ Invokana (Canagliflozin)
▪ Farxiga (Dapagliflozin)
▪ \_\_\_\_\_ (Empagliflozin)
A 
adverse reactions
Na-glucose co-transporter
increased
bone fractures
jardiance
32
Q

Further Treatment Modalities . . .

▪ Insulin pumps
 Designed to deliver short, frequent pulses of insulin into _____
- Rapidly and more predictably absorbed compared to injections

▪ Whole pancreas transplantation
 Organ availability
 Graft failure
 Morbidity with long-term
immunosuppression
 Surgical complications
  • Islet cell transplants
     _____ DM
     >1,500 patients in 40 international centers
     _____ achieve insulin independence at 5 years
A

peritoneal cavity
Type 1
50-70%

33
Q 
Oral Complications of DM
▪ \_\_\_\_\_
▪ Increased incidence / severity of caries
▪ \_\_\_\_\_
▪ Oral burning / \_\_\_\_\_
▪ \_\_\_\_\_
 Oral mucosal lesions

▪ _____ / Sialadenosis ▪ Altered wound healing

A

xerostomia
candidiasis
glossodynia
lichen planus

parotitis

34
Q 
Periodontal Health and DM
▪ DM considered a risk factor for prevalence and severity of \_\_\_\_\_
▪ Degree of glycemic control 
 Increased levels of gingivitis
 Attachment loss
 Progressive destructive periodontitis
 Alteration in wound healing
 ↑ risk of periodontal abscess formation
A

periodontal disease

35
Q

Periodontal Health and DM
▪ Periodontal infection may adversely affect _____
▪ Periodontitis may be associated with increased risk of developing _____ and _____
▪ Aggressive periodontal treatment may positively affects glycemic control

A

glycemic control
nephropathy
macrovascular disease

36
Q 
Before Dental Treatment
▪ Determine \_\_\_\_\_
▪ Antibiotic prophylaxis?
 Lack of \_\_\_\_\_recommendations
▪ \_\_\_\_\_ appointments
 1.5 - 3 hours after breakfast / insulin
▪ Avoid elective dental treatment with
BG > \_\_\_\_\_
▪ Have glucose source available
A

glycemic control (HbA1C)
evidence-based
short AM
400 mg/dl

37
Q

Dental Treatment Recommendations vs HbA1

< 7%: _____
7 to 9%: _____ risk for infections like candidiasis; may not be a good candidate for dental impllant
> 9%: _____ only; systemic _____ before surgery; may need to adust _____ due to inabiliy to eat

A 
no modifications
increased
urgent care
antibiotics
hypoglemia medications
38
Q

During Dental Treatment
▪ Limit _____ in poorly controlled diabetics to minimize ↑ in blood glucose levels
▪ Keep glucose source available
▪ Recognize signs and symptoms of hyper- and hypoglycemia

A

epinephrine

39
Q

After Dental Treatment
▪ Adjust insulin dose according to ability to maintain caloric intake ▪ Avoid _____
▪ Post-operative antibiotics when appropriate

A

glucocorticosteroids

Foundational Sciences I-II (14 decks)

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