Diabetes Lecture 1 Flashcards
Epidemiology of Diabetes
25.8 million Americans have DM
33-40% of males/females born in 2000 respectively will have DM (type 1 or type 2) in their lifetime
Pt.diagnosed at<40y/o will have a life expectancy by about 12-19 years
7th leading cause of death in the US
Diabetes is the number one cause:
1. Non-traumatic amputation
2. Kidney disease
3. BlindnessClassification of Type 1 Diabetes
Absolute deficiency of insulin secretion
Autoimmune destruction of the pancreatic cells
Viruses that cause cell destruction; congenital rubella, coxsackievirus B, cytomegalovirus, adenovirus, and mumps
Prevalence: <10% of all DM cases
Classification of Type 2 Diabetes
Combination of complex metabolic disorders
1. Insulin resistance in muscle and adipose tissue
2. Progressive decline in pancreatic insulin secretion
3. Unrestrained hepatic glucose production
4. Other hormonal deficiencies
Amylin and incretin
Prevalence: >90% of all DM Cases
Action of alpha cells, beta cells and amylin
alpha cell secrete glucagon
Beta cells secrete insulin
amylin suppresses insulin
Signs and Symptoms of Hyperglycemia
Polyuria: Frequent urination
Polydipsia: Inability to quench thirst
Polyphagia: Losing weight while eating a lot
Fatigue
Risk Factors for Type 2 Diabetes
- Overweight or obese state
- Sedentary lifestyle
- Family history of diabetes
- Cardiovascular disease
- Latino/Hispanic, NonñHispanic black, Asian American, Native American, or Pacific Islander ethnicity
- Previously identified impaired glucose tolerance or impaired fasting glucose
- Hypertension (>140/90 or on HTN meds)
- Increased levels of triglycerides (>250), low concentrations of high-density lipoprotein cholesterol (<35), or both
Risk Factors for GDM
History of gestational diabetes
History of delivery of an infant with a birth weight >9 lbs
Polycystic ovary syndrome
Diabetes Screening
- Asymptomatic people with a BMI greater than or equal to 25 kg/M2 in adults of any age and who have one or more additional risk factors for DM
- In those without these risks, testing should start at age 45
- If tests are negative with these risk factors, test again at 3 year intervals
A1C and Daily Blood Glucose
A1C Mean Glucose 6 126 7 154 8 183 9 212 10 240 11 269 12 298
Diagnostic Criteria for Type 1 and 2 Diabetes
Lab Normal Pre-Diabetes Diabetes
A1C < 5.7 % 5.7-6.4% ≥ 6.5%
Fasting
Plasma
Glucose < 100 mg/dL 100-125 mg/dL ≥ 126 mg/dL
Oral Glucose
Tolerance Test <140 mg/dL 140-199 mg/dL ≥ 200 mg/dL
Random Glucose
+ Symptoms N/A N/A ≥ 200 mg/dL
Treatment Goals
-A1C: <180mg/dL
Pre- Diabetes
If a patient is determined to have pre-diabetes (IGT, IFG, or A1C 5.7-6.4%), then metformin could be considered as a therapy, especially if any of the following are met:
1. BMI > 35kg/m2
2. <60 years of age
3. Women with prior GDM
Annual monitoring for development of DMComplications of Diabetes
Macrovascular Complications
1. Coronary artery disease
2. HTN
3. Dyslipidemia
Microvascular Complications
1. Retinopathy
2. Neuropathy
3. NephropathyNon- Pharmacological Therapy
Exercise
1. 30 minutes for most days of the week
Diet
1. Avoid foods high in saturated fats, carbohydrates and sugar 2. Increase fiber
CAD Complication Management
ASA 81mg daily
Men >50 years of age or women >60 years of age with at least one additional risk factor (family history of CVD, HTN, smoking, dyslipidemia, or albunemia)
