Diabetes M Flashcards
What is the result of diabetes milletus?
Impaired metabolism of carbs, fats and proteins
***symptoms of DM?
Polydipsia(inc thirst)
Polyuria
Dry mouth
Blurred vision
Weight loss( no insulin available to move glucose into the body’s cells, kidney removes unused sugar)
Fatigue
Low INR/PTT
Infections
‘PP BID LWF’
***what is the differences between types 1 and 2 diabetes?
1-type1 : sudden, juvenile onset of complete deficiency of insulin due to T-cell mediated autoimmune Beta cells destruction, present with ketoacidosis
2-type2: insidious gradual, adult onset of loss of Beta cells due to insulin resistance
3-specific types DM: due to other illnesses
4-gestational DM: glucose intolerance
pancreatic islet cells?
alpha cells: secrete glucagon to increase glucose
beta cells: secrete insulin to reduce glucose in blood
what is the treatment for type 1 DM?
insulin
what is a common symptom specific to T1DM?
hyperglycemia
Diabetic Ketoacidosis**
what helps differentiate type 1 from type2 DM?
in type 1 u can detect autoantibodies C-peptide against pancreatic cells mediated by T-cells
what is C-peptide? and how does it help in diagnosing T1DM?
shows insulin reserve in the body and it is secreted from beta cells in pancreas and binds to insulin and proinsulin
-when C-peptide lvls are less than 0.2 nmol/l the dx is type 1
***……………are thought to be more imp in development of type 2 DM than type 1
genetic factors
why doesnt type 2 DM patients develop ketoacidosis?
bcz pt with type 2 dont have absolute isnulin deficiency which prevent the formation of ketones and thus acidosis, while in type 1 they have no insulin so they burn fatty acids and ketones for energy which end up in ketosis
how does gestational DM occur?
hormonal changes during pregnancy induce a state of insulin resistance which can lead to hyperglycemia in susceptible women(obese or with history of T2DM)
-inc costisol and estrogen may cause insulin resistance
when is gestational DM diagnosed?
2nd or 3rd trimester
what is the diabetes diagnosed in the 1st trimester called?
pregestational diabetes(1st 3 months of preg)
tx for GDM?
dietary modifications
insulin (not oral anti-diabetics–>fetal side effects)
what do you call type 1 Dm that has an indolent(slow) onset during adult age?
latent autoimmune diabetes of adulthood (LADA):
- initially these pts have sufficient Beta cells to avoid ketosis but may develop insulin therapy dependence overtime as their beta cell mass decrease.
-suspected in young lean adult patients with ketoacidosis
which subgroup of diabetes is characterized by
-onset at the age of 25 yrs
-family history
-no autoantibodies
-defect in glucose-stimulating insulin SECRETION
-no insulin resistance and normal C-peptide
monogenic , Maturity onset diabetes of the young(MODY)
which DM type is associated with glucosuria and hyperglycemia on lab ?
T2DM
***what are the 4 diagnostic tests for diabetes milletus and prediabetes?
1-hbA1C >6.5mmol or >125mg
2-FPG(fasting plasma glucose)>126
3-2hr plasma glucose>200 (11mmol)
4-symptoms of hyperglycemia, random plasma glucose >200
which test tells ur average level of blood sugar over the past 3 months? why 3 mo?
HbA1C(glycated hemoglobin test/glycohemoglobin),
bcz the RBC live up to 3 months
etiology of T1DM?
infection or severe physical stress
what are the DM complications?
diabetic ketoacidosis DKA
hyperglycemic hyperosmolar state HHS
what is DKA?
consists of hyperglycemia, hyperketonemia, metabolic acidosis
management for DKA and HHS
restoration of circulatory vol and tissue perfusion
correction of hyperglycemia, ketogenesis, electrolyte imbalances
what is the diagnostic criteria for DKA and HHS?
DKA: glucosemia>250,g or >14 mmol
ketonemia>3mmol
blood pH<7.3
HCO3 <15
K+<3.5
HHS: glucosemia>300
osmolality>320 (means dehydration)
no keto-acidosis or ketonemia
Tx for diabetic ketoacidosis?
iv fluid
iv insulin
iv potassium
Tx for HSS(Hyperosmolar hyperglycemic state)?
treat hyperglycemia
treat dehydration with iv fluids
***what are the Microvascular complications of diabetes
?
eye: retinopathy
kidney: nephropathy
Neuropathy: sorbitol accumulation on nerve
***what are the Macrovascular complications of diabetes
?
brain: stroke
heart: HT, Coronary heart dis
Peripheral vascular disease: atherosclerosis
first line tx for obese T2DM?
metformin(supresses hepatic glucose prod)
+
2nd line :Glucagon like peptide 1
Tx for MODY?
sulfonylureas(glipizide)(inc secretion of insulin by closing K+ ATP chan on Beta cells)
side effect of sulfonylureas(glipizide)?
hypoglycemia and weight gain
what has similar mech of action as sulfonylureas(glipizide)
meglitinides
PPARγ (gamma) is the main target of the drug class of ………………, used in diabetes mellitus 2 and other diseases that feature insulin resistance. which work on increasing peripheral insulin sensitivity
thiazolidinediones (TZDs)
what Tx is recommended in pt with atherosclerotic CVD/ DKD who suffer from diabetes
GLP-1
+
SGLT-2 inhibitors: inc glucose excretion in urine and reduce reabsorption
***insulin indications? know 5
-inadequate glycemic control
-insulin deficiency
-hyperglycemic
-pt with advanced hepatic or renal disease
-pt with T2DM when diet and oral agents provide inadequate glycemic control
-pregnancy
-clinically severe insulin resistance
-pancreatic insufficiency
in which types is C-peptide high/low?
low in T1DM, LADA
high/normal in T2DM
