Diabetes Mellitus

Question 1

What is DM?

Answer 1

A group of metabolic disorders of glucose metabolism characterized by hyperglycemia and insulin problems (resistance or deficiency)

Question 2

What is the key to diagnosing DM?

Answer 2

Demonstration of significant hyperglycemia.

Question 3

What are general symptoms of DM?

Answer 3

Polyuria
Polydipsia
Polyphagia
Circulatory issues (susceptibility to infection, blurred vision)

Question 4

What are some consequences if DM is left untreated?

Answer 4

Retinopathy/blindness
Neuropathy (foot ulcers, amputation, pruritis)
Ketoacidosis DKA
Atherosclerosis

Question 5

What is Type 1 DM?

Answer 5

It is insulin dependent DM that presents as absolute insulin deficiency.

Question 6

What are the causes of T1DM?

Answer 6

Destruction of pancreatic beta cells that produce insulin which is required for survival
Genetic, autoimmune

Question 7

What is the on,y effective treatment for T1DM?

Answer 7

Insulin supply

Question 8

How does T1DM presents?

Answer 8

Abrupt onset in childhood

Severe hyperglycemia and increased ketone production.

Question 9

What percentage of DM patients are type 1?

Answer 9

Less than 10%. 75% of the, show symptoms before the age of 18

Question 10

If T1DM is uncontrollable, what can it result to?

Answer 10

DKA

Question 11

What does the body do when glucose is in deficit?

Answer 11

The body goes into ketosis.

Question 12

What is ketosis?

Answer 12

The breakdown of fats into ketone bodies (keto acids) for energy.

Question 13

What does extremely high accumulation of ketones leads to?

Answer 13

An acidic pH, resulting to diabetic ketoacidosis.

Question 14

In who is DKA seen mostly in the ER?

Answer 14

Poorly mismanaged T1DM patients, some with adverse conditions.

Question 15

Does DKA occur commonly in T2DM?

Answer 15

No, DKA is rare in T2DM

Question 16

Under what condition does DKA occur in T1DM patients?

Answer 16

When T1DM is not well controlled and patient is under stressful conditions such as starvation, infection.

Question 17

Why do stress conditions cause DKA?

Answer 17

Under stress conditions, the body needs more energy so it causes increased glucose through glycogenesis and gluconeogenesis. When glucose is not enough, it turns to other sources of energy and breaks down lipids causing DKA.

Question 18

What makes DKA worse?

Answer 18

Blood and urine is hyperpsmolar (very concentrated) as kidneys try to excrete much of the glucose in urine, water follows causing dehydration and more concentration.

Question 19

What are the factors showing DKA?

Answer 19

Significantly increased glucose (>300-400mg/dL)
Metabolic acidosis from increased ketoacids (increased anion gap)
Coma

Question 20

What is T2DM?

Answer 20

It is non-insulin dependent, insulin resistant DM.

Question 21

What causes T2DM?

Answer 21

Insufficient insulin from B cells

Insulin resistance of peripheral tissues

Question 22

What is the presentation of T2DM?

Answer 22

Usually in >40 YO obese people

Question 23

What percentage of DM patients have T2?

Answer 23

> 90% patients

Question 24

How is T2DM treated?

Answer 24

Diet, exercise, oral drugs.

Insulin as last resort

Question 25

What happens if T2DM is uncontrolled?

Answer 25

Renal failure Blindness Peripheral neuropathy

Question 26

What is another name for hemoglobin A1C?

Answer 26

Glycohemoglobin | Glycated hemoglobin

Question 27

What is glycation? What is glycated hemoglobin?

Answer 27

It is the non-enzymatic addition of glucose to protein. Non-enzymatic addition of glucose to hemoglobin.

Question 28

How does HgbA1C help in identifying DM?

Answer 28

It is not a direct measure of glucose, but the rate of A1C formation is directly proportional to glucose concentration. By checking HA1C, you can tell if an individual’s blood glucose has been well controlled for the past 2-3 months.

Question 29

What are HA1C values and what do they indicate?

Answer 29

<5.7% normal 5.7-6.4% pre DM >6.5 % diabetes

Question 30

What is gestational diabetes?

Answer 30

This is diabetes observed only during pregnancy in 2-10% of times.

Question 31

How is gestational diabetes diagnosed?

Answer 31

When FBG >105 mg/dL and OGTT is abnormal

Question 32

What causes gestational diabetes?

Answer 32

Predisposing factors like obesity, sedentary or diabetic risk prior to pregnancy. Release of placental lactogen, a hormone that raises glucose during pregnancy by inhibiting the actions of insulin.

Question 33

What is gestational diabetes patients at risk of?

Answer 33

Developing T2DM after their pregnancy

Question 34

Identify other causes of DM

Answer 34

Pancreatic disease Crushing’ disease (cortisol issue) Drugs that kill insulin like Dilantin Genetic defects if B cell function in pancreas

Question 35

What is diabetes insipidus or water diabetes?

Answer 35

It is a condition where there is lack of vasopressin/anti-diuretic hormone (ADH) from the pituitary gland in the brain.

Question 36

What does ADH do?

Answer 36

It regulates urine output by water only. Keeping water in the blood from urine resorption. Decreased blood volume, increases is osmolality then increase in ADH

Question 37

What are the symptoms of diabetes insipidus?

Answer 37

``` Polyuria Polydipsia Severe dehydration High blood osmolality Low urine osmolality SG (1.005) Urine output reaching ~15L/day ```

Question 38

What is impaired glucose tolerance?

Answer 38

This is considered pre diabetes. When fasting blood glucose is less than that of diabetic but an OGTT result is higher than normal.

Question 39

Of what is IGT a risk factor for?

Answer 39

DM and cardiovascular disease | Atherosclerosis and heart disease

Question 40

What are risk factors of developing impaired glucose tolerance?

Answer 40

Unhealthy diet/weight Family history Advanced age Nicotine

Question 41

What is the criteria for diagnosis of DM?

Answer 41

``` Symptoms Non fasting glucose >200 mg/dL Fasting plasma glucose >126 mg/dL Hemoglobin A1C >6.5 % 2 hour Oral glucose tolerance test >200 mg/dL ```

Question 42

What specimen is preferred for testing glucose?

Answer 42

Plasma, serum is okay

Question 43

What time is used?

Answer 43

Gray top containing sodium fluoride which inhibits glycolysis and potassium oxalate additives

Question 44

What is the reference value for plasma glucose?

Answer 44

70-110 mg/dL

Question 45

What does the OGTT do?

Answer 45

Evaluates endogenous insulin reponse to glucose challenge.

Question 46

How is the OGTT procedure performed?

Answer 46

Test given between 7-9 am Fasting blood specimen is drawn 50-75 g glucose given in a beverage over 5 minutes Blood samples are taken at 60 and 120 minutes

Question 47

What are diabetic OGTT values?

Answer 47

>200 mg/dL at 120 minutes

Question 48

What is glucose oxidase lab analysis of glucose?

Answer 48

Glucose is oxidized to form gluconolactone and H2O2. H2O2 oxidizes a chromagen to form a colored product, and then measured spectrophotometrically.

Question 49

How is he Hexokinase lab analysis done?

Answer 49

Hexokinase catalyzes the phosphorylation of glucose by ATP to form G6P and ADP. G6P and NADP react to form NADPH which is formed in direct proportion to the amount of glucose present.

Question 50

Which is most specific between glucose oxidase and hexokinase?

Answer 50

Hexokinase. Far less interferences

Question 51

What is glucose oxidase commonly used in?

Answer 51

Analyzers and dipstick urine testing

Question 52

What are the interferences that can occur with glucose oxidase?

Answer 52

Elevated Uric acid Elevated bilirubin Elevated as orbit acid Acidic pH

Question 53

What can cause false,t deceased glucose values in hexokinase analysis?

Answer 53

Severe hemolysis that alters NADP levels.