Diabetes M

Question 1

What is the result of diabetes milletus?

Answer 1

Impaired metabolism of carbs, fats and proteins

Question 2

***symptoms of DM?

Answer 2

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’

Question 3

***what is the differences between types 1 and 2 diabetes?

Answer 3

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

Question 4

pancreatic islet cells?

Answer 4

alpha cells: secrete glucagon to increase glucose
beta cells: secrete insulin to reduce glucose in blood

Question 5

what is the treatment for type 1 DM?

Answer 5

insulin

Question 6

what is a common symptom specific to T1DM?

Answer 6

hyperglycemia
Diabetic Ketoacidosis**

Question 7

what helps differentiate type 1 from type2 DM?

Answer 7

in type 1 u can detect autoantibodies C-peptide against pancreatic cells mediated by T-cells

Question 8

what is C-peptide? and how does it help in diagnosing T1DM?

Answer 8

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

Question 9

***……………are thought to be more imp in development of type 2 DM than type 1

Answer 9

genetic factors

Question 10

why doesnt type 2 DM patients develop ketoacidosis?

Answer 10

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

Question 11

how does gestational DM occur?

Answer 11

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

Question 12

when is gestational DM diagnosed?

Answer 12

2nd or 3rd trimester

Question 13

what is the diabetes diagnosed in the 1st trimester called?

Answer 13

pregestational diabetes(1st 3 months of preg)

Question 14

tx for GDM?

Answer 14

dietary modifications
insulin (not oral anti-diabetics–>fetal side effects)

Question 15

what do you call type 1 Dm that has an indolent(slow) onset during adult age?

Answer 15

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

Question 16

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

Answer 16

monogenic , Maturity onset diabetes of the young(MODY)

Question 17

which DM type is associated with glucosuria and hyperglycemia on lab ?

Answer 17

T2DM

Question 18

***what are the 4 diagnostic tests for diabetes milletus and prediabetes?

Answer 18

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

Question 19

which test tells ur average level of blood sugar over the past 3 months? why 3 mo?

Answer 19

HbA1C(glycated hemoglobin test/glycohemoglobin),
bcz the RBC live up to 3 months

Question 20

etiology of T1DM?

Answer 20

infection or severe physical stress

Question 21

what are the DM complications?

Answer 21

diabetic ketoacidosis DKA
hyperglycemic hyperosmolar state HHS

Question 22

what is DKA?

Answer 22

consists of hyperglycemia, hyperketonemia, metabolic acidosis

Question 23

management for DKA and HHS

Answer 23

restoration of circulatory vol and tissue perfusion
correction of hyperglycemia, ketogenesis, electrolyte imbalances

Question 24

what is the diagnostic criteria for DKA and HHS?

Answer 24

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

Question 25

Tx for diabetic ketoacidosis?

Answer 25

iv fluid
iv insulin
iv potassium

Question 26

Tx for HSS(Hyperosmolar hyperglycemic state)?

Answer 26

treat hyperglycemia
treat dehydration with iv fluids

Question 27

***what are the Microvascular complications of diabetes
?

Answer 27

eye: retinopathy
kidney: nephropathy
Neuropathy: sorbitol accumulation on nerve

Question 28

***what are the Macrovascular complications of diabetes
?

Answer 28

brain: stroke
heart: HT, Coronary heart dis
Peripheral vascular disease: atherosclerosis

Question 29

first line tx for obese T2DM?

Answer 29

metformin(supresses hepatic glucose prod)
+
2nd line :Glucagon like peptide 1

Question 30

Tx for MODY?

Answer 30

sulfonylureas(glipizide)(inc secretion of insulin by closing K+ ATP chan on Beta cells)

Question 31

side effect of sulfonylureas(glipizide)?

Answer 31

hypoglycemia and weight gain

Question 32

what has similar mech of action as sulfonylureas(glipizide)

Answer 32

meglitinides

Question 33

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

Answer 33

thiazolidinediones (TZDs)

Question 34

what Tx is recommended in pt with atherosclerotic CVD/ DKD who suffer from diabetes

Answer 34

GLP-1
+
SGLT-2 inhibitors: inc glucose excretion in urine and reduce reabsorption

Question 35

***insulin indications? know 5

Answer 35

-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

Question 36

in which types is C-peptide high/low?

Answer 36

low in T1DM, LADA
high/normal in T2DM