Diabetes lecture 1 Flashcards
What is type I diabetes
- destruction of pancreatic beta cells -> absolute insulin deficiency
- autoimmune: defined by autoimmune markers
- idiopathic
Which type of Diabetes is more associated with diabetic ketoacidosis (DKA)
type I
exogenous insulin is REQUIRED in what type of diabetes
type I
What are the 2 autoimmune markers associated with autoimmune type I diabetes
- islet cell autoantibodies
- autoantibodies to insulin
What test is used to diagnose acute onset of type I diabetes
blood glucose
clinical presentation
- Polyuria
- Polydipsia
- Polyphagia
- nocturia
- weight loss
- fatigue
- blurry vision
- paresthesias
- DKA
type I DM
What causes type II diabetes
- variable degrees of insulin deficiency and resistance -> hyperglycemia
- genetic and environmental influences
type 2 diabetes prevalence increases with what type of obestiy
- visceral or central obesity
list the 4 characteristics of type 2 DM
- insulin resistance
- impaired insulin secretion
- excessive hepatic glucose production
- abnormal fat metabolism
insulin resistance causes
- impaired glucose tolerance -> hyperglycemia
List the stages leading to type 2 diabetes
- peripheral insulin resistance -> hyperinsulinemia -> impaired glucose tolerance -> increased hepatic glucose production -> overt diabetes -> fasting hyperglycemia -> B-cell failure
Clinical presentation
- Polyuria
- Polydipsia
- blurry vision
- chronic skin infections
- paresthesia
- poor wound healing
- vulvovaginitis
type II DM
Having a family history of DM is more common in type I or type 2 DM
- type 2 DM
Who should be screened for DM
- 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
what ethnicities are at a higher risk for diabetes
- african american
- latino
- native american
- asian american
- pacific islander
Name the risk factors: criteria for testing for DM or prediabetes in asymptomatic adults
- 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
What are the 4 criteria for diagnosing diabetes
- FPG > or = 126 mg/dl*
- 2-hr plasma glucose > or = 200 mg/dl during 75 g OGTT (oral glucose tolerance test)*
- A1C > or = 6.5% *
- 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
What are the 3 diagnostic criteria for prediabetes
- impaired fasting glucoseFPG 100-125 mg/dl
- impaired glucose tolerance: 2-hr plasma glucose after 75 g OGTT 140-199 mg/dl
- increaed average blood glucose level: A1C 5.7-6.4%
if tests are normal, current recommendation is to rescreen every
3 years
managment of prediabetes
-
prevention
- lifestyle modification
- counseling
- metformin therapy ?
- annual monitoring
What are common comorbidities with DM
- fatty liver disease
- obstructive sleep apnea
- low testosterone
- periodontal disease
- hearing impairment
physical exam for a diabetic patient must include
- BMI
- BP
- fundoscopic exam
- thyroid
- skin exam
- comprehensive foot exam
What does the A1C measure
- the average blood glcose for the past 2-3 months
- no fasting required
how often should A1C be checked
- performed at least twice a year for those who meet tx goals
- every 3 months when therapy has changed or not meeting glycemic goals
Only blood glucose, not A1C, should be used to dx people with
- conditions associated with increased RBC turnover
- hemoglobinopathies
- anemia
a jump of 1 A1C (e.g. 6-7) means what
- mean plasma glucose has increased 30 mg/dl
- A1C of 6% => mean plasma glucose 126 mg/dl
recommendations for A1C, preprandial plasma glucose, and peak postprandial glucose for nonpregnant adults with DM
- A1C: < 7.0%
- preprandial plasma glucose: 80-130
- peak postprandial glucose: <180
insulin level is helpful in evaluating a patient with
- hypoglycemia
- would normally see insulin levels low, but if insulin excess is present => insulinoma?
what is C-peptide
fragment of endogenously produced proinsulin -> split from proinsulin as insulin is formed
low or undetectable levels of plasma C-peptide means
little or no insulin secretion
- helpful in differentiating type 1 from type 2 DM
What are the 3 microvascular complications of DM
- retinopathy
- neuropathy
- nephropathy
What are the macrovascular complications of DM
atherosclerotic cardiovascular disease
diabetic retinopathy can result in
- glaucoma, cataracts or blindness
what are the two types of diabetic retinopathy
- nonproliferative: retinal hemorrhage, lipid exudates, cotton wool spots
- proliferative: neovascularization at the disc
nonproliferative diabetic retinopathy is associated with
- retinal hemorrhage
- lipid exudates
- cotton wool spots
what are the 2 main categories of diabetic neuropathy
- diabetic periphearl neuropathy
- diabetic autonomic neuropathy
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
diabetic peripheral neuropathy
complications of diabetic peripheral neuropathy
- ulceration
- amputation
what foot deformity puts a person at risk for developing ulcers or amputations
charcot foot
what clinical tests can be done to assess for diabetic neuropathy
- 10-g monofilament test
- temp
- vibration sensation
- ankle-brachial index
clinical manifestations
- hypoglycemia unawareness
- resting tachycardia
- orthostatic hypotension
- gastroparesis
- constipation
- diarrhea
- ED
- neurogenic bladder
- increased or decreased sweating
-
diabetic autonomic neuropathy
- can affect CV, GI, GU, or neuroendocrine systems
who is at risk for developing ulcers or amputations
- h/o foot ulcer or amputation
- charcot foot
- peripheral neuropathy
- callus or corn
- visual impairment
- diabetic nephropathy
- cigarette smoking
- PAD
What is the leading cause of ESRD
diabetic kidney disease
how is diabetic kidney disease screened for
-
albuminuria
-
urinary albumin-to-creatinine ratio (UACR)
- 2-3 specimens collected within 3-6 month period
- albuminuria > or = 300 are likely to -> ESRD
-
urinary albumin-to-creatinine ratio (UACR)
tx diabetic kidney disease
- glycemia and BP control
- ACE-I/ARB
What conditions fall under atherosclerotic cardiovascular disease
- ACS
- h/o MI
- stable/unstable angina
- stroke/ TIA
- PAD
what is the leading cause of morbidity and mortality for those with diabetes
atherosclerotic cardiovascular disease
risk factors for atherosclerotic cardiovascular disease
- dyslipidemia
- HTN
- smoking
- FH premature coronary dz
- albuminuria
