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Clin Med II FINAL (Annie & Lauren) (the answer is always lifestyle modifications) > Diabetes I (Lauren) > Flashcards

Diabetes I (Lauren) Flashcards

1
Q

Is all diabetes Type 1, Type 2, or gestational?

A

No there is also “Secondary Diabetes” that can be caused by pancreas problems (cystic fibrosis) or drug-induced (steroids)

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2
Q

Type 1 diabetes is almost always __________

A

Autoimmune

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3
Q

What kinds of antibodies will someone with type 1 diabetes have?

A

GAD 65

Islet cell antibodies

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4
Q

Does everyone with type 1 diabetes have a constant rate of B-cell destruction?

A

No it is quite variable, and it is possible for some peopel to make it til they’re like 40 before they become type 1 diabetic

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5
Q

What is Latent Autoimmune DIabetes of Adults ?

A

Slow onset type 1 diabetes. (40 yr olds getting newly diagnosed with type 1)

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6
Q

What causes the body of someone with type 1 diabetes to just start attacking its B cells?

A

An immunologic trigger

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7
Q

What are the CLASSIC symptoms of Type 1 diabetes

A

Polyuria

Polydipsia

Polyphagia

Nocturia

Weight loss

Blurry vision (hyperosmotic state affects lens)

DKA

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8
Q

Type 2 diabetes is a (gradual/acute) onset

A

Gradual

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9
Q

_______obesity correlates with insulin resistance

A

Visceral

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10
Q

Why do peopel with type 2 diabetes end up with impaired insulin secretion?

A

the B cells burn out and die off

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11
Q

What happens to the liver in type 2 diabetes?

A

Increased hepatic glucose output

Fatty liver

Dyslipidemia

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12
Q

What is the progression of type 2 diabetes?

A
  1. Peripheral insulin resistance causing hyperinsulinemia
  2. Impaired glucose tolerance (Prediabetes)- elevated postprandial glucose, decreased insulin secretion, increased hepatic glucose production
  3. Overt diabetes- fasting hyperglycemia
  4. Beta cell failure- “Burn out”
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13
Q

How will most patients with type 2 DM present?

A

Asymptomatic

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14
Q

What are some of the symptoms on Type 2 DM if they’re going to have symptoms?

A

3 P’s

Nocturia

Blurry vision

Paresthesias

Fatigue

Chronic skin infections

Poor wound healing

Vaginal yeast infections ALL the time

Balanitis- yeast infection of penis

Hyperglycemic hyperosmolar state (no ketones)

DKA- very rare, but can happen

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15
Q

Acanthosis nigricans is indicative of_____________

A

Insulin resistance

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16
Q

Family history of diabetes is more common in type (1/2)

A

2 ***

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17
Q

Most common age at diagnosis

Type 1:

Type 2:

A

Type 1: <25, but can occur at any age

Type 2: >25, but increasing in younger people

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18
Q

Body type

Type 1:

Type 2:

A

Type 1: thin

Type 2: overweight

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19
Q

Autoantibodies present?
Type 1:

Type 2:

A

Type 1: yes

Type 2: no

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20
Q

Insulin dependent?

Type 1:

Type 2:

A

Type 1: yes

Type 2: no

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21
Q

Insulin sensitivity

Type 1:

Type 2:

A

Type 1: normal when controlled

Type 2: decreased

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22
Q

Risk of DKA

Type 1:

Type 2:

A

Type 1: high

Type 2: low

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23
Q

Who needs to be tested for type 2 diabetes?

A

Everyone over 45

People who are overweight/obese who have one or more additional risk factors****

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24
Q

What are the risk factors for type 2 diabetes?

A

1st degree relative with DM

High risk race- black, hispanic, Native American, Asian, Pacific Islander

CVD

HTN

HDL <35

Triglyceride >250

Women with PCOS/GDM

Sedentary lifestyle

Severe obesity

Acanthosis nigricans

(If they are overweught and have ONE of these, they need to be screened for type 2 DM!)

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25
Q

What are the 3 test that can be done to screen for diabetes?

A

Fasting plasma glucose

2-hr oral glucose tolerance test

HbA1C

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26
Q

Which diabetes measurement has a strong predictive value for diabetes complications?

A

HbA1C

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27
Q

Fasting plasma glucose levels

Normal:

Prediabetes:

Diabetes:

A

Normal: <100

Prediabetes: 100-125 (IFG)

Diabetes: 126+

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28
Q

2 hr oral glucose tolerance test levels:

Normal:

Prediabetes:

Diabetes:

A

Normal: <140

Prediabetes: 140-199

Diabetes: 200+

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29
Q

HbA1C levels

Normal:

Prediabetes:

Diabetes:

A

Normal: <5.7

Prediabetes: 5.7-6.4

Diabetes: 6.5+

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30
Q

When can a single random plasma glucose be diagnostic for diabetes?

A

If it is over 200 and they have classic symptoms of hyperglycemia

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31
Q

If you do a fasting plasma glucose, an OGTT, and an HbA1C, and one of them comes back at diabetes levels, can you diagnose diabetes in someone who is asymptomatic?

A

No, you would need a second test for confirmation

32
Q

If you have an asymptomatic patient and you do Fasting glucose, OGTT, and HbA1C, and 2 of them come back at diabetes levels, can you diagnose them?

A

Yes, because you had 2 positive tests

33
Q

If you have an asymptomatic patient and you do Fasting glucose, OGTT, and HbA1C, and only the HbA1C comes back at diabetes levels, when do you need to repeat the HbA1C to confirm the diagnosis?

A

Repeat it right away

You don’t need to wait 3 months. You’re just trying to rule out lab error

34
Q

If you have do Fasting glucose, OGTT, and HbA1C and only one of them comes back at diabetes levels, which one do you need to repeat to confirm the diagnosis?

A

Whichever one came back above the threshold

Ex: if only HbA1C came back high, you only need to repeat HbA1C (immediately)

35
Q

What HbA1C levels are considered “prediabetic”?

A

5.7-6.4%

36
Q

Prediabetes puts you at increased risk for:

A

Type 2 diabetes lol

Heart disease

Stroke

37
Q

You diagnosed your patient with Prediabetes. Now what?

A

WEIGHT LOSS NOW. Restores insulin sensitivity **

EDUCATION AND PREVENTION **

Metformin***

Counseling/maintenance programs

Screen for and treat risk factors for ASCVD

Test them YEARLY for diabetes ***

38
Q

How often do prediabetics need to be screened for diabetes?

A

yearly ****

39
Q

As HbA1C goes up, risk goes up (linearly/curvilinear)

A

Curvilinear continuum of risk for HbA1C

As A1C rises, the risk for diabetes rises disproportionately ****

40
Q

If you decide to screen a patient for diabetes and they’re not prediabetic or diabetic, how often do you need to repeat testing?

A

Every 3 years at a minimum

41
Q

Is someone with gestational diabetes always at a higher risk of regular diabetes

A

Yes

42
Q

What do you need to ask when you’re taking a history from a patient with DM?
(Long list sorry)

A

Age

Characteristics of onset of DM (ex age at dx)

Nutrition/weight

Physical activity/sleep behaviors

Dental disease

Last dilated eye exam?

Psychosocial health

SHx- smoking EtOH

Review meds and response to tx

Review patients glucose log

DKA- frequency, severity

Hypoglycemic episodes- aware of it?

Microvascular complications

Macrovascular complications

43
Q

What vaccinations do diabetics need

A

Hep B

Flu

Pneumococcal

44
Q

What are some comorbidities commonly seen in diabetics?

A

Autoimmune disease (Type 1)

Fatty liver

Obstructive sleep apnea**

Cancer**

Fractures*

Low testosterone in men

Dental disease

Hearing impairment

Depression/anxiety

45
Q

What do you need to do during your physical exam on someone who is diabetic?

A

Height, weight, BMI

BP

Fundoscopic exam

Thyroid palpation

Skin exam

FOOT EXAM

46
Q

What labs do you need to order when your diabetic patient comes in for a checkup

A

HbA1C***

Fasting lipid panel

LFTs

Urinary albumin to creatinine ratio

BMP

B12 (if on metformin)

TSH (Type 1 DM prone to other autoimmune)

47
Q

What vitamin deficiency may someone on metformin devleop ?

A

B12– which would cause ~paresthesias~ just like dieabteic neuropathy would whaoaaaaoaaa

48
Q

What is the leading cause of morbidity and mortality for diabetics

A

ASCVD

49
Q

What 3 conditions fall under the classification of ASCVD?

A

Coronary heart disease (which may progress to HF and kill them that way)

Stroke/TIA

PAD (of atherosclerotic origin)

50
Q

Diabetes itself confers independent _______ for ASCVD

A

Risk

51
Q

What causes diabetic nephropathy

A

Chronic hyperglycemia

Uncontrolled for a looong time- at least 10 years for type 1 DM, but may be present at diagnosis of Type 2

52
Q

What is the difference between diabetic Kidney disease and Diabetic nephropathy

A

Diabetic Kidney Disease: CKD related to diabetes. Albuminuria and reduced GFR

Diabetic Nephropathy: ~progressive~ albuminuria, HTN, declining GFR in a patient with diabetes for over 10 years

(I have no idea what this means)

53
Q

When do you need to start annual screening of diabetic patients for diabetic nephropathy?

A

Type 1- after they’ve had DM for 5 years

Type 2- at time of diagnosis

54
Q

How do you screen for diabetic nephropathy?

A

Urinary albumin

GFR

(2-3 specimens of urine collected within a 3-6 month period should be abnormal before considering a pt to have albuminuria)

55
Q

How do you prevent diabetic nephropathy

A

ACE/ARB

Control blood sugar

Control BP

56
Q

What is the leading cause of blindness for people 20-74 yrs old?

A

Diabetic retinopathy wow bet you didn’t see that coming

Lololololol

57
Q

Prevalence of diabetic retinopathy is strongly related to _________ and _________

A

Duration of diabetes

Level of glycemic control

58
Q

What are the 2 types of diabetic retinopathy?

A

Nonproliferative- hemorrhages, lipid exudates, cotton wool spots

Proliferative- all of the above plus NEOVASCULARIZATION due to ischemia
********

59
Q

What kind of vision loss will diabetic retinopathy cause?

A

Central vision loss

60
Q

Vast majority of patients who develop diabetic retinopathy have (many symptoms/no symptoms)

A

No symptoms***

Very important to do dilated eye exams yearly

61
Q

When do diabetics need to start doing annual dilated eye exams?

A

Type 1- within 5 years of DM diagnosis

Type 2- at the time of diagnosis

62
Q

If you discover diabetic retinopathy, should you try to handle it all on your own

A

Refer to ophthalmologist!

63
Q

What are the two types of diabetic neuropathy?

A

Peripheral neuropathy

Autonomic neuropathy

64
Q

Prevalence of diabetic neuropathy varies with both severity and duration of _____________

A

Hyperglycemia (need high sugar for a looong time)

65
Q

What pattern of sensory loss will someone with diabetic peripheral neuropathy have?

A

SYMMETRIC STOCKING GLOVE***

66
Q

What are the the signs/sx of diabetic peripheral neuropathy?

A

Burning/tingling

Numbness and loss of protective sensation*

Loss of vibratory sensation and altered proprioception**

Decreased ankle reflexes

67
Q

Why are diabetics at increased risk of foot ulcers?

A

Loss of protective sensation= hurt themselves and don’t know it

Poor wound healing

68
Q

What are risk factors for developing foot ulcers/amputation of your foot?

A

Poor glycemic control

Peripheral neuropathy with loss of protective sensation

Smoking- poor circulation

Foot deformity- i.e., Charcot foot**

Preulcerative callus or corn

Hx of ulcer/amputation

Visual impairment- can’t even see the ulcers on their feet

Diabetic nephropathy

PAD

69
Q

What is Charcot Arthropathy?

A

A “rocker bottom” foot due to their weird weight distribution

70
Q

How often do you need to do a comprehensive foot evaluation in diabetics?

A

At least once a year

Type 1- starting at 5 years after diagnosis

Type 2- starting at time of diagnosis

71
Q

Should you look at DM patients feet at every visit?

A

Yes

72
Q

How do you do a comprehensive foot evaluation?

A

Inspection

Check pulses

Perform an ABI- sx of claudication or decreased/absent pedal pulses ** ON TEST

Vibration sensation

Pressure sensation- 10-g monofilament testing*****

Pinprick or temperature sensation

73
Q

How do you do a monofilament test?

A

Poke bottom of foot in different places with enough pressure til the monofilament bends

(Their eyes should be closed)

74
Q

What is the most useful test to diagnose loss of protective sensation?

A

Monofilament test

75
Q

What is autonomic neuropathy?

A

They have dysfunction with their autonomic nervous system

76
Q

What are clinical manifestations of autonomic neuropathy?

A

Metabolic- hypoglycemia unawareness**

CV- orthostatic hypotension, resting tachycardia

GI- gastroparesis, GERD, poop problems

GU- Erectile dysfunction **

Sudomotor/vasomotor- can’t regulate sweating

Pupillary- pupil doesn’t dilate in the dark

77
Q

In the spirit of 1 health, who do you need to refer diabetic patients to?

A

Endocrinologist

Ophthalmologist

Family planning if they wanna b a mom

Dietician

Diabetes self-management education

Dentist

Podiatrist 👣

Mental health professional

Clin Med II FINAL (Annie & Lauren) (the answer is always lifestyle modifications) (3 decks)

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