Diabetes I (Lauren) Flashcards
Is all diabetes Type 1, Type 2, or gestational?
No there is also “Secondary Diabetes” that can be caused by pancreas problems (cystic fibrosis) or drug-induced (steroids)
Type 1 diabetes is almost always __________
Autoimmune
What kinds of antibodies will someone with type 1 diabetes have?
GAD 65
Islet cell antibodies
Does everyone with type 1 diabetes have a constant rate of B-cell destruction?
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
What is Latent Autoimmune DIabetes of Adults ?
Slow onset type 1 diabetes. (40 yr olds getting newly diagnosed with type 1)
What causes the body of someone with type 1 diabetes to just start attacking its B cells?
An immunologic trigger
What are the CLASSIC symptoms of Type 1 diabetes
Polyuria
Polydipsia
Polyphagia
Nocturia
Weight loss
Blurry vision (hyperosmotic state affects lens)
DKA
Type 2 diabetes is a (gradual/acute) onset
Gradual
_______obesity correlates with insulin resistance
Visceral
Why do peopel with type 2 diabetes end up with impaired insulin secretion?
the B cells burn out and die off
What happens to the liver in type 2 diabetes?
Increased hepatic glucose output
Fatty liver
Dyslipidemia
What is the progression of type 2 diabetes?
- Peripheral insulin resistance causing hyperinsulinemia
- Impaired glucose tolerance (Prediabetes)- elevated postprandial glucose, decreased insulin secretion, increased hepatic glucose production
- Overt diabetes- fasting hyperglycemia
- Beta cell failure- “Burn out”
How will most patients with type 2 DM present?
Asymptomatic
What are some of the symptoms on Type 2 DM if they’re going to have symptoms?
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
Acanthosis nigricans is indicative of_____________
Insulin resistance
Family history of diabetes is more common in type (1/2)
2 ***
Most common age at diagnosis
Type 1:
Type 2:
Type 1: <25, but can occur at any age
Type 2: >25, but increasing in younger people
Body type
Type 1:
Type 2:
Type 1: thin
Type 2: overweight
Autoantibodies present?
Type 1:
Type 2:
Type 1: yes
Type 2: no
Insulin dependent?
Type 1:
Type 2:
Type 1: yes
Type 2: no
Insulin sensitivity
Type 1:
Type 2:
Type 1: normal when controlled
Type 2: decreased
Risk of DKA
Type 1:
Type 2:
Type 1: high
Type 2: low
Who needs to be tested for type 2 diabetes?
Everyone over 45
People who are overweight/obese who have one or more additional risk factors****
What are the risk factors for type 2 diabetes?
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!)
What are the 3 test that can be done to screen for diabetes?
Fasting plasma glucose
2-hr oral glucose tolerance test
HbA1C
Which diabetes measurement has a strong predictive value for diabetes complications?
HbA1C
Fasting plasma glucose levels
Normal:
Prediabetes:
Diabetes:
Normal: <100
Prediabetes: 100-125 (IFG)
Diabetes: 126+
2 hr oral glucose tolerance test levels:
Normal:
Prediabetes:
Diabetes:
Normal: <140
Prediabetes: 140-199
Diabetes: 200+
HbA1C levels
Normal:
Prediabetes:
Diabetes:
Normal: <5.7
Prediabetes: 5.7-6.4
Diabetes: 6.5+
When can a single random plasma glucose be diagnostic for diabetes?
If it is over 200 and they have classic symptoms of hyperglycemia
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?
No, you would need a second test for confirmation
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?
Yes, because you had 2 positive tests
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?
Repeat it right away
You don’t need to wait 3 months. You’re just trying to rule out lab error
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?
Whichever one came back above the threshold
Ex: if only HbA1C came back high, you only need to repeat HbA1C (immediately)
What HbA1C levels are considered “prediabetic”?
5.7-6.4%
Prediabetes puts you at increased risk for:
Type 2 diabetes lol
Heart disease
Stroke
You diagnosed your patient with Prediabetes. Now what?
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 ***
How often do prediabetics need to be screened for diabetes?
yearly ****
As HbA1C goes up, risk goes up (linearly/curvilinear)
Curvilinear continuum of risk for HbA1C
As A1C rises, the risk for diabetes rises disproportionately ****
If you decide to screen a patient for diabetes and they’re not prediabetic or diabetic, how often do you need to repeat testing?
Every 3 years at a minimum
Is someone with gestational diabetes always at a higher risk of regular diabetes
Yes
What do you need to ask when you’re taking a history from a patient with DM?
(Long list sorry)
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
What vaccinations do diabetics need
Hep B
Flu
Pneumococcal
What are some comorbidities commonly seen in diabetics?
Autoimmune disease (Type 1)
Fatty liver
Obstructive sleep apnea**
Cancer**
Fractures*
Low testosterone in men
Dental disease
Hearing impairment
Depression/anxiety
What do you need to do during your physical exam on someone who is diabetic?
Height, weight, BMI
BP
Fundoscopic exam
Thyroid palpation
Skin exam
FOOT EXAM
What labs do you need to order when your diabetic patient comes in for a checkup
HbA1C***
Fasting lipid panel
LFTs
Urinary albumin to creatinine ratio
BMP
B12 (if on metformin)
TSH (Type 1 DM prone to other autoimmune)
What vitamin deficiency may someone on metformin devleop ?
B12– which would cause ~paresthesias~ just like dieabteic neuropathy would whaoaaaaoaaa
What is the leading cause of morbidity and mortality for diabetics
ASCVD
What 3 conditions fall under the classification of ASCVD?
Coronary heart disease (which may progress to HF and kill them that way)
Stroke/TIA
PAD (of atherosclerotic origin)
Diabetes itself confers independent _______ for ASCVD
Risk
What causes diabetic nephropathy
Chronic hyperglycemia
Uncontrolled for a looong time- at least 10 years for type 1 DM, but may be present at diagnosis of Type 2
What is the difference between diabetic Kidney disease and Diabetic nephropathy
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)
When do you need to start annual screening of diabetic patients for diabetic nephropathy?
Type 1- after they’ve had DM for 5 years
Type 2- at time of diagnosis
How do you screen for diabetic nephropathy?
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)
How do you prevent diabetic nephropathy
ACE/ARB
Control blood sugar
Control BP
What is the leading cause of blindness for people 20-74 yrs old?
Diabetic retinopathy wow bet you didn’t see that coming
Lololololol
Prevalence of diabetic retinopathy is strongly related to _________ and _________
Duration of diabetes
Level of glycemic control
What are the 2 types of diabetic retinopathy?
Nonproliferative- hemorrhages, lipid exudates, cotton wool spots
Proliferative- all of the above plus NEOVASCULARIZATION due to ischemia
********
What kind of vision loss will diabetic retinopathy cause?
Central vision loss
Vast majority of patients who develop diabetic retinopathy have (many symptoms/no symptoms)
No symptoms***
Very important to do dilated eye exams yearly
When do diabetics need to start doing annual dilated eye exams?
Type 1- within 5 years of DM diagnosis
Type 2- at the time of diagnosis
If you discover diabetic retinopathy, should you try to handle it all on your own
Refer to ophthalmologist!
What are the two types of diabetic neuropathy?
Peripheral neuropathy
Autonomic neuropathy
Prevalence of diabetic neuropathy varies with both severity and duration of _____________
Hyperglycemia (need high sugar for a looong time)
What pattern of sensory loss will someone with diabetic peripheral neuropathy have?
SYMMETRIC STOCKING GLOVE***
What are the the signs/sx of diabetic peripheral neuropathy?
Burning/tingling
Numbness and loss of protective sensation*
Loss of vibratory sensation and altered proprioception**
Decreased ankle reflexes
Why are diabetics at increased risk of foot ulcers?
Loss of protective sensation= hurt themselves and don’t know it
Poor wound healing
What are risk factors for developing foot ulcers/amputation of your foot?
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
What is Charcot Arthropathy?
A “rocker bottom” foot due to their weird weight distribution
How often do you need to do a comprehensive foot evaluation in diabetics?
At least once a year
Type 1- starting at 5 years after diagnosis
Type 2- starting at time of diagnosis
Should you look at DM patients feet at every visit?
Yes
How do you do a comprehensive foot evaluation?
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
How do you do a monofilament test?
Poke bottom of foot in different places with enough pressure til the monofilament bends
(Their eyes should be closed)
What is the most useful test to diagnose loss of protective sensation?
Monofilament test
What is autonomic neuropathy?
They have dysfunction with their autonomic nervous system
What are clinical manifestations of autonomic neuropathy?
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
In the spirit of 1 health, who do you need to refer diabetic patients to?
Endocrinologist
Ophthalmologist
Family planning if they wanna b a mom
Dietician
Diabetes self-management education
Dentist
Podiatrist 👣
Mental health professional
