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252 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What are the sub classifications of type 1 DM?

A

Type 1a and 1b

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2
Q

What are the characteristics of type 1a DM?

A

Most common subtype of type 1 (90-95%) and is immune based (autoimmunity)

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3
Q

What are the characteristics of type 1b DM?

A

Idiopathic and affects approximately 5-10% of people with type 1

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4
Q

How common is type 2 DM?

A

Very common, 90%

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5
Q

What is the etiology of DM?

A

Complex trait (multiple genes and something in the environment)

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6
Q

What are the etiologys for type 1 DM? (3)

A

Familial (immediate family members have a 10x increased risk)
Insulin gene on chromosome 11 (10%)
MHC genes on chromosome 6 (40%)

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7
Q

What is the etiology of type 2?

A

Glucokinase gene on chromosome 7 (50%- codes for enzyme that phosphorases glucose in target cell)

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8
Q

What is prediabetes (for type 2) described by? (3)

A

IFG 6.1-6.9
HbA1C 6-6.4%
IGT 7.8-11

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9
Q

What is metabolic syndrome? Do all features need to be present for it diagnosed?

A

It is a predisposition to type 2 and CV disease and not all features need to be present for it to be diagnosed

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10
Q

What is metabolic syndrome defined by?

A 
IFG
IGT
Insulin resistance 
HTN
Abdominal obesity (f >88cm + m>102cm)
Hyperlipidemia
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11
Q

What is the definition of insulin resistance?

A

Insulin is unable to bring about a hypoglycaemic response in a hyperglycaemic state

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12
Q

What are the characteristics of type 1 DM?

A

Early age onset
Autoimmune destruction of beta cells (insulin autoantibodies and islet cell autoantibodies destroy B cells)
Since it is autoimmune it requires a genetic predisposition + some sort of environmental infection? = complex trait

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13
Q

What are the characteristics of type 2 DM?

A

Adult onset, B cells are mostly intact

Can have normal, increased or decreased levels of insulin

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14
Q

Type 1 DM is ________ insulin deficiency while type 2 DM is ________ insulin deficiency

A

Absolute

Relative

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15
Q

In type 2 DM what are 3 factors that can cause a relative insulin deficiency?

A

Delayed section of insulin
Defective target cell
Insulin resistance

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16
Q

What is something the liver does during hyperglycaemia as a result of the cells feeling they lack glucose?

A

Secrete glucose (glucogenesis)

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17
Q

What is the renal threshold for glucose? At what point would glucose appear in the urine?

A

RT- 10. Anything above 10 and glucose will appear in the urine

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18
Q

What is the patho of type 1 and 2 DM? Note the patho for polyuria & polydipsia

A

Insulin deficiency -> impaired glucose utilization and increased hepatic glucogenesis -> hyperglycaemia -> RT exceeded -> glucosuria -> inc OP in filtrate -> inc fluid enters filtrate -> polyuria -> dehydration -> polydipsia

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19
Q

What is the patho for type 1 and type 2? Note ketoacidosis and polydipsia and polyuria

A

Mobilization of lipid and proteins -> inc lipid and protein metabolites (ketones) -> accumulation of ketones -> ketoacidosis -> ketonuria -> inc OP infiltrate -> inc fluid enters filtrate -> polyuria -> dehydration -> polydipsia

Ketoacidosis -> acidotic coma and death

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20
Q

What are manifestations of DM?

A

3 ps
Weight loss (losing glucose & calories in urine)
Other complications

21
Q

What are acute complications of DM?

A

Hypoglycaemia
Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycaemic state (HHS)

22
Q

What can acute complications lead to quickly?

A

Death

23
Q

What is the etiology of hypoglycaemia?

A

Missed meal
Insulin overdose
Overexertion

24
Q

What is the treatment for hypoglycaemia? Mild and severe.

A

Mild: 15g CHO PO

severe (

25
Q

What is a complication of hypoglycaemia and what is a treatment?

A

Hypoglycaemic coma because the brain is deprived of glucose

1 mg glucagon SC/IM to stimulate glucogenesis

26
Q

What are 3 derangements of DKA

A

Hyperglycaemia
Ketosis
Ketoacidosis

27
Q

What must be in place for DKA to occur?

A

Decreased insulin and excessive glucagon

28
Q

What is the patho of DKA? (Note protein breakdown side of patho)

A

Decreased glucose uptake -> protein breakdown -> gluconeogenesis -> hyperglycaemia -> water and electrolyte loss -> dehydration -> circulatory failure

29
Q

What is the patho of DKA? (Note lipid breakdown portion)

A

Lipolysis -> glycerol and FFA -> gluconeogenesis & circulatory shock from glycerol -> ketones from FFA -> metabolic acidosis -> CNS depression and coma

30
Q

What are the final outcomes of DKA?

A

Circulatory shock, CNS depression & coma

31
Q

Who does HHS most commonly affect?

A

People with type 2 DM and elderly

32
Q

What occurs in HHS and why does it result?

A

Hyperglycaemia causing hyperosmolarity leading to increased glucose concentration in the blood
Results from increased CHO intake

33
Q

What can occur if HHS becomes exacerbated?

A

Increased insulin resistance

34
Q

What is the patho of HHS?

A

Severe hyperglycaemia -> hyperosmolarity -> cellular fluid efflux -> glucosuria -> polyuria (inc op) -> dehydration

35
Q

Does ketoacidosis occur in HHS? Why/why not?

A

No because lipid reserves are not being broken down because CHO are present for metabolism

36
Q

What are chronic complications of DM?

A 
Vascular damage
Retinopathy 
Nephropathy
Neuropathy 
Infection
37
Q

When do the chronic complications set in? Do these eventually lead to death?

A

They set in approximately 15 years after onset and they result in death

38
Q

Why does vascular damage occur as a complication of DM? (3)

A

Altered metabolism -> ketones attach to endothelium in BV -> thicken cap wall and alter trans cap exchange -> inflm and damage

Glycoslated proteins attract platelets which aggregate on them -> impedes perfusion

Growth of anaerobic bacteria

39
Q

What causes retinopathy as a complication of DM?

A

Cap damaged from ketones and glycoslated proteins -> aneurysm -> rupture -> visual impairment

40
Q

What causes nephropathy as a complication of DM?

A

Glomerular damage from build up of precipitates -> decreased renal fx -> renal failure

41
Q

What causes neuropathy as a result of a complication of DM?

A

Neural ischemia as a result of inadequate perfusion to neurons in brain -> some demyelination -> poor conduction -> decreased sensation

42
Q

What causes HTN as a complication of DM?

A

BV wall affected

43
Q

What causes CAD as a complication of DM?

A

Hyperlipidemia due to altered metb -> atherosclerosis -> MI

44
Q

What causes a CVA as a complication of DM?

A

Hyperlipidemia -> atherosclerosis -> CVA

45
Q

Why are people with DM more susceptible to infections? (3)

A

Glucosuria -> UTI
Neuropathy
Impeded perfusion, vascular insufficiency
Impaired leukocyte fx

46
Q

What is the first, second and third ways to control hyperglycaemia?

A

Lifestyle mods must stay in place throughout all treatment

Metformin if a1c >7% after 2-3 months of lifestyle mods

Metformin and insulin if a1c >9%

47
Q

What is the treatment for type 1 DM?

A

Insulin

48
Q

True or false: diabetes is the most common endocrine disorder?

A

True

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