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clin med II, exam 4 > Diabetes lecture 1 > Flashcards

Diabetes lecture 1 Flashcards

1
Q

What is type I diabetes

A
  • destruction of pancreatic beta cells -> absolute insulin deficiency
    • autoimmune: defined by autoimmune markers
    • idiopathic
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2
Q

Which type of Diabetes is more associated with diabetic ketoacidosis (DKA)

A

type I

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3
Q

exogenous insulin is REQUIRED in what type of diabetes

A

type I

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4
Q

What are the 2 autoimmune markers associated with autoimmune type I diabetes

A
  • islet cell autoantibodies
  • autoantibodies to insulin
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5
Q

What test is used to diagnose acute onset of type I diabetes

A

blood glucose

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6
Q

clinical presentation

  • Polyuria
  • Polydipsia
  • Polyphagia
  • nocturia
  • weight loss
  • fatigue
  • blurry vision
  • paresthesias
  • DKA
A

type I DM

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7
Q

What causes type II diabetes

A
  • variable degrees of insulin deficiency and resistance -> hyperglycemia
  • genetic and environmental influences
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8
Q

type 2 diabetes prevalence increases with what type of obestiy

A
  • visceral or central obesity
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9
Q

list the 4 characteristics of type 2 DM

A
  1. insulin resistance
  2. impaired insulin secretion
  3. excessive hepatic glucose production
  4. abnormal fat metabolism
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10
Q

insulin resistance causes

A
  • impaired glucose tolerance -> hyperglycemia
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11
Q

List the stages leading to type 2 diabetes

A
  • peripheral insulin resistance -> hyperinsulinemia -> impaired glucose tolerance -> increased hepatic glucose production -> overt diabetes -> fasting hyperglycemia -> B-cell failure
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12
Q

Clinical presentation

  • Polyuria
  • Polydipsia
  • blurry vision
  • chronic skin infections
  • paresthesia
  • poor wound healing
  • vulvovaginitis
A

type II DM

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13
Q

Having a family history of DM is more common in type I or type 2 DM

A
  • type 2 DM
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14
Q

Who should be screened for DM

A
  • asymptomatic adults of any age who are overweight or obest (BMI >25) and who have one or more additional risk factors
  • all adults beginning at age 45, regardless of weight
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15
Q

what ethnicities are at a higher risk for diabetes

A
  • african american
  • latino
  • native american
  • asian american
  • pacific islander
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16
Q

Name the risk factors: criteria for testing for DM or prediabetes in asymptomatic adults

A
  • physical inactivity
  • first degree relative with DM
  • high risk ethnicity
  • woman who delivered a baby > 9lbs or diagnosed with GDM
  • HTN
  • HDL < 35; Triglyceride level >250
  • women with PCOS
  • severe obesity
  • CVD
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17
Q

What are the 4 criteria for diagnosing diabetes

A
  1. FPG > or = 126 mg/dl*
  2. 2-hr plasma glucose > or = 200 mg/dl during 75 g OGTT (oral glucose tolerance test)*
  3. A1C > or = 6.5% *
  4. in a patient with classic sx of hyperglycemia with a random glucose > or = 200 mg/dl

* in absence of unequivocal hyperglycemia, results should be confirmed by repeat testing

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18
Q

What are the 3 diagnostic criteria for prediabetes

A
  1. impaired fasting glucoseFPG 100-125 mg/dl
  2. impaired glucose tolerance: 2-hr plasma glucose after 75 g OGTT 140-199 mg/dl
  3. ​increaed average blood glucose level: A1C 5.7-6.4%
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19
Q

if tests are normal, current recommendation is to rescreen every

A

3 years

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20
Q

managment of prediabetes

A
  • prevention
    • ​lifestyle modification
    • counseling
    • metformin therapy ?
    • annual monitoring
21
Q

What are common comorbidities with DM

A
  • fatty liver disease
  • obstructive sleep apnea
  • low testosterone
  • periodontal disease
  • hearing impairment
22
Q

physical exam for a diabetic patient must include

A
  • BMI
  • BP
  • fundoscopic exam
  • thyroid
  • skin exam
  • comprehensive foot exam
23
Q

What does the A1C measure

A
  • the average blood glcose for the past 2-3 months
  • no fasting required
24
Q

how often should A1C be checked

A
  • performed at least twice a year for those who meet tx goals
  • every 3 months when therapy has changed or not meeting glycemic goals
25
Q

Only blood glucose, not A1C, should be used to dx people with

A
  • conditions associated with increased RBC turnover
    • hemoglobinopathies
    • anemia
26
Q

a jump of 1 A1C (e.g. 6-7) means what

A
  • mean plasma glucose has increased 30 mg/dl
    • A1C of 6% => mean plasma glucose 126 mg/dl
27
Q

recommendations for A1C, preprandial plasma glucose, and peak postprandial glucose for nonpregnant adults with DM

A
  • A1C: < 7.0%
  • preprandial plasma glucose: 80-130
  • peak postprandial glucose: <180
28
Q

insulin level is helpful in evaluating a patient with

A
  • hypoglycemia
    • would normally see insulin levels low, but if insulin excess is present => insulinoma?
29
Q

what is C-peptide

A

fragment of endogenously produced proinsulin -> split from proinsulin as insulin is formed

30
Q

low or undetectable levels of plasma C-peptide means

A

little or no insulin secretion

  • helpful in differentiating type 1 from type 2 DM
31
Q

What are the 3 microvascular complications of DM

A
  1. retinopathy
  2. neuropathy
  3. nephropathy
32
Q

What are the macrovascular complications of DM

A

atherosclerotic cardiovascular disease

33
Q

diabetic retinopathy can result in

A
  • glaucoma, cataracts or blindness
34
Q

what are the two types of diabetic retinopathy

A
  1. nonproliferative: retinal hemorrhage, lipid exudates, cotton wool spots
  2. proliferative: neovascularization at the disc
35
Q

nonproliferative diabetic retinopathy is associated with

A
  • retinal hemorrhage
  • lipid exudates
  • cotton wool spots
36
Q

what are the 2 main categories of diabetic neuropathy

A
  1. diabetic periphearl neuropathy
  2. diabetic autonomic neuropathy
37
Q

clinical presentation

  • “stocking-glove” sensory loss
  • impairment of pain, light touch, and temp
  • burning
  • tingling
  • numbness
  • loss of vibratory sensation
  • decreased ankle reflexes
  • loss of protective sensation
A

diabetic peripheral neuropathy

38
Q

complications of diabetic peripheral neuropathy

A
  • ulceration
  • amputation
39
Q

what foot deformity puts a person at risk for developing ulcers or amputations

A

charcot foot

40
Q

what clinical tests can be done to assess for diabetic neuropathy

A
  • 10-g monofilament test
  • temp
  • vibration sensation
  • ankle-brachial index
41
Q

clinical manifestations

  • hypoglycemia unawareness
  • resting tachycardia
  • orthostatic hypotension
  • gastroparesis
  • constipation
  • diarrhea
  • ED
  • neurogenic bladder
  • increased or decreased sweating
A
  • diabetic autonomic neuropathy
    • can affect CV, GI, GU, or neuroendocrine systems
42
Q

who is at risk for developing ulcers or amputations

A
  • h/o foot ulcer or amputation
  • charcot foot
  • peripheral neuropathy
  • callus or corn
  • visual impairment
  • diabetic nephropathy
  • cigarette smoking
  • PAD
43
Q

What is the leading cause of ESRD

A

diabetic kidney disease

44
Q

how is diabetic kidney disease screened for

A
  • albuminuria
    • ​urinary albumin-to-creatinine ratio (UACR)
      • 2-3 specimens collected within 3-6 month period
      • albuminuria > or = 300 are likely to -> ESRD
45
Q

tx diabetic kidney disease

A
  • glycemia and BP control
    • ACE-I/ARB
46
Q

What conditions fall under atherosclerotic cardiovascular disease

A
  • ACS
  • h/o MI
  • stable/unstable angina
  • stroke/ TIA
  • PAD
47
Q

what is the leading cause of morbidity and mortality for those with diabetes

A

atherosclerotic cardiovascular disease

48
Q

risk factors for atherosclerotic cardiovascular disease

A
  • dyslipidemia
  • HTN
  • smoking
  • FH premature coronary dz
  • albuminuria

clin med II, exam 4 (6 decks)

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