Diabetes I Flashcards
When is insulin released and what are its two roles?
High glucose levels in the blood triggers insulin release from the pancreas. Insulin has two actions that help the body control the blood glucose levels:
- Helps insulin travel from bloodstream to inside cells. Can be used for energy.
- Stops the liver from releasing more glucose into the blood from its stores of glycogen.
Define Diabetes Mellitus
What two things cause it?
Hyperglycemia. Elevated blood glucose levels due to:
- Failure of the pancreas to produce sufficient amounts of insulin.
AND/OR - Resistance of the body’s cells to the action of insulin.
What is the defining feature of diabetes
Hyperglycemia causes tissue injury= vascular damage is the primary pathology that happens all over the body
What two things can cause hyperglycemia?
Excessive glucose production by the liver (insulin usually tells liver to stop releasing glucose)
Impaired glucose clearance (cells can’t absorb blood glucose)
Normal blood glucose ranges
- Fasting
- Random
- A1C
- Oral glucose (OGTT)
- 70-99
- less than 140
- Less than 5.7%
- less than 140
What two blood glucose tests do we do in clinic?
Random and A1C
Diagnostic criteria for diabetes by single reading
- Fasting
- Random
- A1C
- Oral glucose (OGTT)
- 126+
- 200+
- 6.5% +
- 200+
Pre diabetes criteria
- Fasting
- Random
- 100-125
2. 140-199
What is hemoglobin A1C
Minor component of hemoglobin that binds glucose.
Tells average blood glucose conc over 2-3 months (lifespan of RBC)
More blood sugar= higher A1C
Normal, average pt with diabetes and goal for A1C levels
Normal- less than 5.7
Average for pt with diabetes- 8.5
Goal is less than 6.5 for newly diagnosed
What blood glucose reading predicts the likelihood of disability and death
A1C. Leads to more complications in the body.
Only __% of people know their last A1C reading
24%
How to estimate average glucose (eAG) based on A1C
A1C of 6%= 125 mg/dl glucose level in blood
Add 30 mg/dl for every 1% over 6%
Oral glucose tolerance test (OGTT)
Measurement after fasting
Ingest 75-100mg of glucose
Measure blood glucose at 1, 2, and 3 hours later.
Body should be able to clear it. If not, could indicate gestational diabetes.
Most common endocrine disorder in the US:
Diabetes Mellitus
9-11% of the pop
Rates are increasing
Race, gender, location, age that are more likely to get diabetes
Race: Native americans, AA, hispanic
Gender: Females
Location: South
Age: 65+
Overweight and sedentary lifestyle are main risk factors
Diabetes is the #__ cause of death in the US
7
3 major diabetic complications that we care about
- Retinopathy
- Cerebrovascular disease- stroke
- Neuropathy. CN palsy
Diabetes is the leading cause of which 3 complications?
Major contributor to which 2 things?
Kidney failure (will need dialysis to filter blood) Non traumatic lower limb amputation New cases of blindness in adults due to retinopathy
Major contributor to:
Heart disease
Stroke
Diabetes symptoms
Polyuria
Polydipsia
Polyphagia- cells not uptaking glucose. Will signal that body is still hungry.
Blurred vision
Weight loss - Body may break down muscle/fat to get energy since not getting energy from blood glucose
Extreme fatigue
Slow healing sores- blood vessels not working
Frequent infections
Tingling of numbness in hands/feet- neuropathy
Glucosuria
Glucose in the urine. Occurs if levels are above 200mg/dl. Kidney cannot keep up and will cause frequent urination–> Dehydration –> polydipsia.
Absolute or significant deficit of insulin
Type 1
Most common form of diabetes
Type II (95%)
Peripheral insulin resistance and insufficient insulin production
Type II
3 types of “other” diabetes
- Surgery induced. Ex: remove pancreas
- Medications (cortisol, corticosteroids)
- LADA, MODY
Pre-diabetes
- Symptoms
- Underlying problem
- Increased risk of ___
- 50% risk over 10 years of developing __
- Asymptomatic
- Insulin resistant in periphery.
- Cardiovascular pathology
- Type II
Prediabetes risk factor
*overweight
*sedentary life style
Older than 45
Family Hx of type II
Race
BMI over 25
Gestational diabetes
Having baby over 9lbs
Polycistic ovary syndrome- attack insulin
HTN
Hyperlipidemia (TG over 150 or HDL under 40)
How many people have Type I
5-10%
Cause of Type I
Pancreatic atrophy and loss of beta cells (80-90-100% beta cell loss)
When does Type I develop
Childhood or early adulthood
Two types/causes of Type I diabetes
- *Immune mediated. Can be due to body attacking normal beta cells (molecular mimicry due to viral infection) or body attacking abnormal cells due to damage.
- idiopathic.
Tx of Type I
Injectable insulin or pump
*Insulin cannot be given orally- it is a protein that would be broken down in GI
Type I risk factors
M=F Illness in early infancy Family History Older mom at birth Mom had pre-eclampsia Have other autoimmune diseases: Graves, addisons, MS, hashimotos. Body already primed to attack itself.
% of diabetes type II
90-95%
What causes diabetes type II
Polygenic disorder
*Insulin resistance
Decreased insulin production occurs too.
Type II clinical manifestations
Cardiovascular damage Vision probs Neuropathy Recurrent infections Renal failure
Type II risk factors
Sedentary lifestyle Obesity Family hx of diabetes History of gestational diabetes Impaired glucose metabolism Age Race
Type 2 tx
Diet
Excercise
Tx obesity
Meds- oral or injectable
What is gestational diabetes. How many pregnancies does it complicate?
Glucose intolerance that develops during pregnancy due to increased estrogen and progesterone that antagonizes insulin. Therefore, insulin does not work as well and causes a higher blood sugar level.
Complicates 2-10% of pregnancies, usually temporary
Gestational diabetes increases the risk of type II diabetes by how much
50% over next 10-20 years
Gestational diabetes risk factors
Race: AA, hispanic, native americans
Obesity
Family Hx of diabetes
Gestational diabetes dx and tx
Dx: By OGTT
Tx:
-insulin is DOC
-Oral meds are second choice: metformin, glyburide (category B-safe)
LADA (latent autoimmune diabetes of adults)
- Due to what
- Age onset
- Tx?
Type 1.5 diabetes
- Slowly progressive B cell failure of the pancreas
- Onset around 30 years, slim and fit
- Oral meds initially, insulin eventually needed once all B cells fail
MODY (maturity onset diabetes of the young)
- What type of genetic transfer
- Due to what
- Age onset
- How many % have it
- Tx
- Often misdiagnosed as
Early onset of type II
- Autosomal dominant. Do genetic testing
- Due to ineffective insulin production/release.
- Late teens or early 20s
- Rare (1-5%)
- Oral meds effective for most, insulin maybe later
- Misdiagnosed as type 2. lots of similarities.
diabetes plays a role in what syndrome
Metabolic
What is metabolic syndrome
A cluster of conditions that occur together.
How to diagnose metabolic syndrome
Requires 3 or more fo the following:
Fasting over 100 TG over 150 (or on meds for TG) HDL under 40 (or on meds for HDL) Blood pressure over 135/85 (or on meds for HTN) Large waistline -Women (35+) -Men (40+) -Apple shape
Metabolic syndrome affects how much of the population
23-25%
3 facts that metabolic syndrome SIGNIFICANTLY increases the risk of
CHD (2x)
Diabetes (5x)
Stroke
Metabolic disease is associated with
Obesity
Sedentary lifestyle
Insulin resistance
Metabolic disease is preventable with
Diet, exercise, meds.
Can take oral meds for which types
Type II
MODY
Can take insulin for which types
Type I
Type II
MODY
LADA
What 3 activities can increase insulin sensitivity?
- Cardio + strength training
- Cardio alone (40-60 mins)
- Strength training alone.
Questions to ask all diabetic pts
When did you last PCP, when are you going back?
BG reading- when, what is it, what’s normal range?
Last A1C?
Any vision changes