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Clin Med: Final Material > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Diabetes Mellitus: Overview

A

Decreased ability to control blood glucose levels = glucose is primary energy source

Heterogeneous disorder defined by the presence of hyperglycemia and hypoglycemia = dysregulation of plasma glucose

Although type 1 and type 2 diabetes mellitus each have characteristic features, there is some overlap between the two conditions

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2
Q

Type 1 =

A

due to absence of insulin production

no cure

body fails to produce enough insulin

genetics can be a reason for its occurance

require insulin injections for a lifetime

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3
Q

Type 2 =

A

due to cellular insulin resistance

lifestyle changes help

human body resists to produce insulin resistance

insulin is required, oral or injected

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4
Q

Fasting blood glucose

A

no food or fluid for 8+ hours

normal: less than 100 mg/dL
high risk: 100-125 mg/dL
diabetes: 126 mg/dL or higher

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5
Q

Hemoglobin A1c

A

percent of Hgb bound to glucose

normal: less than 5.7%
high risk: 5.7-6.4%
diabetes: 6.5% or higher

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6
Q

Oral Glucose Tolerance Test (OFTT)

A

Adult OGTT Procedure:
Blood draw pre-glucose solution
Drink 8 oz glucose solution
Blood draw 2 hours post

3 tests:
2 hour - adult
2 hour - child
3 hour - pregnancy

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7
Q

OGTT levels and diagnosis

A

less than 140 mg/dL = normal

140 - 199 mg/dL = prediabetes

200 mg/dL or higher = diabetes

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8
Q

2-hour test - adult
OGTT

A

blood drawn before drinking and 2 hours after

8-ounce solution with 75 grams of sugar

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9
Q

2-hour test - child
OGTT

A

blood drawn before drinking and 2 hours after

1.75 grams of sugar per kilogram of body weight

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10
Q

2-hour test - pregnancy
OGTT

A

blood drawn before drinking and at 1, 2, and 3 hours after

8-ounce solution with 100 grams of sugar

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11
Q

Diabetes Mellitus: Diagnostic Criteria

A

A single random glucose level > 200 mg/dL

Two 2-hour (75 g glucose) oral glucose tolerance tests (OGTT) with a level > 200 mg/dL

A fasting glucose level > 126 mg/dL

A1C >6.5%

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12
Q

Important point: Hemoglobin A1C is a determination of ____ and is used for monitoring the disease process

A

the percent of glycosylated hemoglobin

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13
Q

A1C test:

A

a common blood test used to diagnose type 1 and type 2 diabetes and to monitor how well you’re managing your diabetes

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14
Q

A1C test result =

A

reflects your average blood sugar level for the past two to three months

Specifically, the A1C test measures what percentage of your hemoglobin is coated with sugar

The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications

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15
Q

A1C - Why it’s done

A

Identify prediabetes

Diagnose type 1 and type 2 diabetes

Monitor your diabetes treatment plan

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16
Q

Identify prediabetes

A

If you have prediabetes, you have a higher risk of developing diabetes and cardiovascular disease = early detection

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17
Q

Diagnose type 1 and type 2 diabetes

A

To confirm a diabetes diagnosis in conjunction with glucose tolerance test

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18
Q

Monitor your diabetes treatment plan

A

A1C results are used to establish a baseline A1C level and to monitor therapeutic response to treatment

Example: A1C of 8.5 with diabetes dx = intervention = A1C of 7.5 at 3 month follow up

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19
Q

Higher A1C

A

Higher A1C percentage corresponds to higher average blood sugar levels

Higher A1C levels = higher risk of developing diabetes or complications of diabetes

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20
Q

Normal A1C level:

A

<5.7 percent

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21
Q

A1C level: 5.7 - 6.4 percent

A

prediabetes or impaired fasting glucose = high risk of developing diabetes

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22
Q

A1C level: > 6.5 percent

A

two separate occasions = diabetes

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23
Q

A1C level: > 8 percent

A

diabetes is not well-controlled and higher risk of developing complications of diabetes

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24
Q

For most adults who have diabetes, an A1C level of ____ is a common treatment target.

A

7 percent or less

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25
Q

A1C levels and glucose level

A

6% = 126 mg/dL
7% = 154 mg/dL
8% = 183 mg/dL
9% = 212 mg/dL
10% = 240 mg/dL
11% = 269 mg/dL
12% = 298 mg/dL

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26
Q

symptoms of type 1 diabetes

A

abnormal thirst and dry mouth

frequent urination

lack of energy, fatigue

blurred vision

constant hunger

sudden weight lost

bed-wetting

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27
Q

symptoms of type 2 diabetes

A

excessive thirst and dry mouth

frequent and abundant urination

lack of energy, extreme tiredness

blurred vision

recurrent fungal infections of the skin

slow healing wounds

tingling or numbness in hands and feet

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28
Q

___ of all cases of diabetes are type 1

A

5-10%

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29
Q

___ of all cases of diabetes are type 2

A

90-95%

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30
Q

Diabetes Mellitus: Type 1 and Type 2

A

Worldwide prevalence of type 1 DM and type 2 DM has been increasing over the past three decades = 9.3% in 2019 in adults 20 years or older

United States = 13% adults 18 and older

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31
Q

Hyperglycemia: Diabetes Mellitus Type 1 and Type 2

A

Hyperglycemia in all cases is due to a functional deficiency of insulin action

Type 1= decrease in insulin secretion by the β cells of the pancreas

Type 2 = decreased response to insulin by target tissues insulin resistance

Increase in the counter-regulatory hormones = glucagon = oppose the effects of insulin

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32
Q

Glucosuria

A

excretion of glucose in the urine

renal threshold for glucose reabsorption (approximately 200 mg/dL)

norm = no glucose in urine

This causes an osmotic diuresis manifested clinically by polyuria and nocturia = Dehydration results

33
Q

Hyperglycemia: Clinical Manifestations

A

Glucosuria, Polydipsia, Polyuria, Polyphagia

Stimulating thirst that results in polydipsia

A significant loss of calories can result from glucosuria: urinary glucose losses can exceed 75 g/d (75 g × 4 kcal/g = 300 kcal/d)

34
Q

Polyphagia

A

excessive hunger

high glucose levels lead to increased hunger, increased hunger & eating leads to increased glucose levels

cravings are strongest for sugary food

35
Q

Polydipsia

A

excessive thirst

excess glucose excreted in urine, fluids depleted with elimination of glucosuria, endocrine system signals thirst

36
Q

Glucosuria, Polyuria, polydipsia, and polyphagia are common presenting symptoms in

A

both type 1 and symptomatic type 2 patients

37
Q

G & 3 Ps =

A

Weight loss can also occur as a result of both dehydration, loss of calories in the urine, and breakdown of fats and protein

38
Q

Type 1 diabetes mellitus

A

B-cell destruction, usually leading to absolute insulin deficiency

autoimmune

idopathic

39
Q

Type 2 diabetes mellitus

A

ranges from predominantly insulin resistant with relative insulin deficiency to a predominant secretory defect with insulin resistance

40
Q

Gestational diabetes mellitus

A

any degree of glucose intolerance occurring or first being recognized during pregnancy, a time when insulin resistance and B-cell hyperplasia occur normally

women diagnoses with gestational DM have a high risk for later developing type 2 DM

41
Q

Type 1 Diabetes Mellitus
Epidemiology:

A

Approximately 10% of all DM cases

usually occurs in younger patients but can occur at any age

42
Q

Type 1 Diabetes Mellitus
Pathogenesis:

A

Insulin producing pancreatic β-cell destruction

may be caused by genetic susceptibility, autoimmune process or viral infection resulting in insulin deficiency

Genetic susceptibility in combination with environmental factors is thought to play a critical role in development of type 1 DM

43
Q

Beta cell autoantigens

A

are thought to be released from beta cells by cellular turnover or damage and are processed and presented to T helper cells by antigen-presenting cells

Resulting in Beta cell destruction

44
Q

Glycogenesis:

A

monosaccharides to glycogen for storage in muscle & liver = excess glucose stored for use later

45
Q

Lipogenesis:

A

fatty acid + glycerol = fat

excess carbohydrates consumed results in fat storage

46
Q

Gluconeogenesis:

A

formation of glucose in the liver from non-carbohydrate sources

47
Q

High Blood Glucose =

A

insulin secretion & glucagon inhibition

48
Q

Low Blood Glucose =

A

glucagon secretion & insulin inhibition

49
Q

DKA:

A

potentially life-threatening, not enough insulin to allow glucose into cells; liver breaks down fat for fuel = ketone byproduct

50
Q

HHS:

A

serious state

occurs with hyperglycemic state; glucose passes into urine pulling excess fluid out of the body; severe dehydration

51
Q

Diabetic Ketoacidosis (DKA)

A

Life-threatening problem that affects people with diabetes: Type 1»»Type2

Increased serum glucose levels stimulates the body to break down fat at a rate that is much too fast. The liver processes the fat into an energy source = byproduct is ketones = causes the blood to become acidic

52
Q

blood pH

A

Normal blood pH is tightly regulated between 7.35 and 7.45

Lower the pH = acidosis

Higher pH = alkalosis

53
Q

Diabetic Ketoacidosis
Diagnosis

A

Hyperglycemia: > 250 mg/dL

Ketosis

Characterized by a combination of insulin deficiency and glucagon excess

Decreased peripheral glucose uptake secondary to insulin deficiency coupled with excess glucagon = hyperglycemia

Type 1»>Type 2

Diabetic ketoacidosis = medical emergency resulting from ketosis and emergent low pH blood level

Precipitating factors: Infection, new-onset diabetes mellitus, stress, and insulin deficiency or non-compliance

54
Q

Ketosis:

A

normal metabolic process - When the body does not have enough glucose for energy, it burns stored fats instead

results in a build-up of acids called ketones within the body

Some people encourage ketosis by following a diet called the ketogenic or low-carb diet

Ketosis leads to diabetic ketoacidosis = build up of ketone bodies

55
Q

DKA: Clinical Presentation

A

Symptoms: Nausea, vomiting, thirst, abdominal pain, weakness, and fatigue, dehydration

Signs: Tachycardia; poor skin turgor and warm and dry skin = Patients also have ketones on breath and altered mental status

Laboratory findings:
> Hyperglycemia
> Metabolic acidosis: pH <7.35 & low HCO3
> Serum ketones: blood & urine

56
Q

Type II Diabetes Mellitus
Epidemiology:
Clinical presentation:

A

90-95% of cases of diabetes mellitus = usually occurs in older patients (> 40 years) and obese individuals

can occur in children as young as 6 years of age

clinical presentation: Weakness, weight loss, and susceptibility to infections

57
Q

Type II Diabetes Mellitus
Risk factors:
Pathogenesis:

A

Risk factors: sedentary lifestyle, poor nutrition,overweight and obesity

Pathogenesis of type 2 diabetes mellitus: Genetic factors play a more important role in type 2 diabetes mellitus than in type 1 diabetes mellitus = Type 2 diabetes mellitus is due to peripheral resistance to insulin and often times inadequate secretion of insulin

58
Q

Diabetes Mellitus: Type II
Hyperglycemia

A

Primary: Target tissue resistance to the effects of insulin = hallmark

Secondary: Inadequate pancreatic Beta-cell insulin secretion

59
Q

Diabetes Mellitus Type II: Obesity

A

Major driver of the worldwide increase in diabetes prevalence

85% of patients with type 2 DM are obese

A 5–10% weight loss in obese individuals with type 2 DM can minimize the disorder

Insulin resistance ~ obesity = type 2 DM

60
Q

Type II: Stages of development

A

Insulin sensitivity decreases = insulin-mediated glucose breakdown after a meal is impaired despite increased pancreatic insulin secretion

With continued insulin resistance = pancreatic insulin secretion begins to fail = insufficient insulin production

Type II DM can become Type II & Type I

61
Q

Hyperosmolar Hyperglycemic Leads to Hyperosmolar Nonketonic Coma

A

Life-threatening = caused by extremely high blood sugar levels

Most commonly occurs in people with type 2 diabetes

Often triggered by illness or infection

Body tries to rid itself of the excess blood sugar by passing it into your urine

Untreated = can lead to life-threatening dehydration

Urgent medical care

Marked hyperglycemia = no metabolic acidosis or ketoacidosis

62
Q

Hypoglycemia

A

A complication of insulin treatment in both type 1 DM and type 2 DM

Cause: oral hypoglycemic drugs that stimulate insulin secretion, exercise or fasting

63
Q

Hypoglycemia - NON-DIABETIC Individual

A

low insulin levels with exercise or fasting allow the counter-regulatory hormone-mediated gluconeogenesis, increased hepatic glucose output, and stimulus for increased glucagon secretion = to restore blood glucose levels

64
Q

Hypoglycemia - DIABETIC Individual

A

exogenous insulin dosing & limited glucagon counter-regulation

65
Q

Hypoglycemia: Acute Treatment

A

Rapid oral administration of glucose at the onset of warning symptoms or the intramuscular administration of exogenous glucagon

Rebound hyperglycemia can occur after hypoglycemia due to rapid intake of oral glucose and/or actions of counter-regulatory hormones

66
Q

Diabetes Mellitus = Increased Risk of Atherosclerosis & Cardiovascular Disease

A

Not completely understood = diabetes influences atherosclerosis & CVD

High blood glucose & High blood pressure = increased risk of endothelial cell damage of blood vessels

Decreases HDLs & Increases LDLs

Greatest risk Associated with Diabetes: Nephropathy, Retinopathy, Neuropathy, CVD, Skin

65%+ of individuals with uncontrolled diabetes die from heart disease or stroke

67
Q

Diabetes Mellitus: Complications
pancreas, vessels, kidney, eye

A

Pancreas: Reduction in number and size of islets

Vessels: contributor to atherosclerosis in large & small blood resulting in hypertension

Kidney: Microalbuminuria = associated with 10 to 20 x increased risk of progression to diabetic nephropathy = number one cause of ESRD

Eye: Retinopathy or retinal vascular disease

68
Q

Diabetes Mellitus: Complications
PNS, skin (soft tissues), pregnancy

A

Peripheral nervous system: Peripheral neuropathies (sensory loss&raquo_space; motor loss); decreased sensation causes diabetics to be more prone to injury, falls & non-traumatic amputations

Skin and soft tissue of extremities: Diabetics often develop ulcers and gangrene of the legs, requiring amputation. Decreased sensation causes diabetics to be prone to injury. These patients are unable to feel the damage occurring, and associated damage to vessels leads to poor perfusion that impairs healing

Pregnancy: Large-for-gestational age infants are often born to diabetic mothers

69
Q

Macrovascular (Large Vessel) Complications

A

Atherosclerotic macrovascular disease occurs with increased frequency in diabetes = increased incidence of myocardial infarction, stroke, claudication and gangrene of the lower extremities

Accounts for significant morbidity and mortality in both types of diabetes

Type 2 DM = responsible for approximately 75% of deaths

Protective effect of gender is lost in women with diabetes = risk of atherosclerosis is equal to that of men

70
Q

Macrovasuclar Disease: Atherosclerosis

A

Increased risk of atherosclerosis in diabetes = independent risk factor

Incidence of hypertension and hyperlipidemia increases 50% and 30% respectively vs age and gender matched norms

Diabetes is synergistic with multiple known risk factors to increase atherosclerosis
> Smoking
> Physical Inactivity
> HTN
> Hyperlipidemia
> Overweight or Obese

71
Q

Retinopathy or Retinal Vascular Disease

A

Leading cause of blindness in developed countries

Diabetic retinopathy is present in one-third of all diabetics

Increasing in frequency with disease duration = lifetime risk of 90% for type 1 diabetics vs. 60% for type 2 diabetics

72
Q

Nephropathy

A

Most common cause of end-stage renal disease (ESRD) worldwide

ESRD occurs more frequently in Type 1»>Type 2

type 2 DM accounts for more than half of the diabetic population with ESRD because of its greater prevalence

Occurs in about 60% of both type 1 and type 2 DM patients

Major cause of morbidity

73
Q

Diabetic neuropathy can be divided into three major types:

A

distal, primarily sensory, symmetric polyneuropathy = most common (50% incidence)

autonomic neuropathy, occurring frequently in individuals with distal polyneuropathy (>20% incidence)

much less common, transient asymmetric neuropathies involving specific nerves, nerve roots, or plexuses

74
Q

Diabetic Foot Ulcers

A

Occur in 10% of diabetics = can be complicated by osteomyelitis

Amputation associated with high mortality = 50% by 3 years post-amputation

Diabetic foot ulcers account for over 60% of nontraumatic amputations in the United States

75
Q

Risk factors for ulcer development include:

A

increased injuries in insensate feet owing to symmetric polyneuropathy present in 75–90% of diabetics with foot ulcers

can be detected clinically by decreased vibratory and cutaneous pressure sensation and the absence of ankle reflexes

macrovascular and microvascular disease present in 30–40% of those with foot ulcers

infections caused by alterations in neutrophil function and vascular insufficiency

faulty wound healing caused by unknown factors

76
Q

Neuropathy: Systemic Distal Polyneuropathy

A

Demyelination of peripheral nerves = hallmark of diabetic polyneuropathy, affects distal nerves preferentially

Usually manifested clinically by a symmetric sensory loss in the distal lower extremities = stocking distribution
> Numbness & tingling = paresthesias
> Sx begin distally and move proximally
> In the hands = Glove Distribution

77
Q

Neuropathy: Systemic Distal Polyneuropathy
Pathologic features:

A

demyelination and loss of nerve fibers, accompanied by microvascular lesions, microvascular disease

presence of antibodies to autoantigens in patients with neuropathy also suggests a possible immune component to this disorder

78
Q

Neuropathy: Autonomic

A

often accompanies symmetric peripheral neuropathy

Occurs more frequently in type 1 DM

Can affect all aspects of autonomic functioning = most notably cardiovascular, genitourinary, and GI systems

Cardiovascular: Fixed, resting tachycardia and orthostatic hypotension

Erectile dysfunction occurs in more than 50% of diabetic men

Overflow IncontinenceL Neurogenic Bladder = Loss of bladder sensation and difficulty emptying the bladder

Gastroparesis: Motor disturbances can occur throughout the GI tract, resulting in delayed gastric emptying, constipation, or diarrhea

Anhidrosis: in the lower extremities can lead to excessive sweating in the upper body as a means of dissipating heat, including increased sweating in response to eating

Clin Med: Final Material (6 decks)

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