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diabetes disease state > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Type 1 diabetes makes up what percentage of all diabetes cases?

A

5-10%

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2
Q

Type 2 diabetes makes up what percentage of all diabetes cases?

A

>90%

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3
Q

What are the 2 recognized states of prediabetes?

A
  1. Impaired Glucose Tolerance (IGT)
  2. Impaired Fasting Glucose (IFG)
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4
Q

In the US, the CDC estimates how many Americans have diabetes?

A

25.8 million

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5
Q

Describe the “honeymoon” period in insulin therapy.

A

a phenomenon where endogenous insulin secretion increases for a short period of time after a newly diagnosed patient is started on insulin therapy.

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6
Q

When about _________% of a patient’s beta cells have been destroyed, clinical diabetes results.

A

60-80%

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7
Q

Describe why severe insulin deficiency can lead to DKA.

A
  • the liver is unable to utilize glucose even though glucose levels are high
  • so the liver begins to metabolize fat for energy
  • the fatty acids from fat metabolism are broken down and create ketones in the process
  • large amounts of ketones lower blood pH (due to their acidity)
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8
Q

What percentage of total diabetic patients are thought to be undiagnosed?

A

about 27%

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9
Q

At the time of diagnosis, what percentage of beta cell function is believed to be lost in patients with type 2 diabetes?

A

50%

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10
Q

What effects does insulin have on adipose cells?

A
  • facilitates uptake of glucose for energy
  • suppresses lipolysis of triglycerides into glycerol and free fatty acids
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11
Q

What is the impact of insulin resistance on adipose cells in a person with type 2 diabetes?

A
  • glucose absorption is decreased
  • lipolysis of tryglycerides into glycerol and fatty acids is no longer suppressed
  • results in rising levels of free fatty acids that impact liver function and glucose uptake in skeletal muscle
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12
Q

Because of their size, skeletal muscles account for about _______% of the glucose uptake that occurs in the body.

A

80%

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13
Q

What does MODY stand for?

A

Maturity-Onset Diabetes of the Young

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14
Q

What does LADA stand for?

A

Latent Autoimmune Diabetes in Adults

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15
Q

According to the ADA, what is the criteria for testing asymptomatic individuals for diabetes?

A
  1. All adults who are overweight (BMI>25) and who have one or more risk factors:
  • physical inactivity
  • first degree relative
  • high-risk race
  • GDM (or >9 lb baby)
  • hypertension (>140/90)
  • HDL <35 and/or triglyceride >250
  • PCOS
  • A1c >5.7%, IGT, IFG on previous test
  • other risk factors for insulin resistance
  • history of CVD
  1. In the absence of above, begin testing at 45 years
  2. If normal, repeat test at 3 year intervals
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16
Q

What lab values indicate impaired fasting glucose (IFG)?

A
  • 100-125 FPG
  • 5.7% - 6.4% A1c
17
Q

What lab values indicate impaired glucose tolerance (IGT)?

A
  • 140-199 2-hr PPG (OGTT)
  • 5.7% - 6.4% A1c
18
Q

What is the definition of metabolic syndrome?

A

The presence of at least 3 of the following:

  1. elevated FPG
  2. hypertension
  3. low HDL
  4. elevated triglycerides
  5. abdominal obesity
19
Q

What percentage of the US population can be classified as having metabolic syndrome?

A

up to 34%

20
Q

What are some of the characteristics of MODY?

A

Maturity-Onset Diabetes of the Young

  • it is an uncommon, atypical type 2 diabetes
  • presents at an early age (usually before age 25)
  • characterized by impaired insulin secretion and insulin resistance
21
Q

Describe LADA.

A

Latent Autoimmune Diabetes in Adults

  • sometimes referred to as type 1.5 diabetes
  • present clinically as having type 2 diabetes, but autoimmune antibodies characteristic of type 1 diabetes are present
  • these patients typically require insulin after several years
22
Q

What does AACE require in order to confirm a diagnosis of diabetes?

A

One of these 3 criteria must be met and then confirmed on a repeated test:

  1. FPG > 126 mg/dL
  2. OGTT > 200 mg/dL
  3. A1c > 6.5%
23
Q

Is routine CAD screening recommended for asymptomatic diabetes patients?

A

No.

24
Q

How often should a lipid profile test and urinalysis be perfomed in patients with diabetes?

A

at least annually

25
Q

DKA is characterized by severe _____________ and acidosis.

A

dehydration

26
Q

DKA is characterized by what 3 physiologic features?

A
  1. uncontrolled hyperglycemia
  2. metabolic acidosis
  3. increased ketone levels
27
Q

What does HHS stand for?

A

Hyperglycemic Hyperosmolar State

28
Q

True or False: HHS is a potentially deadly complication of type 2 diabetes.

A

True.

29
Q

What is the mortality range for patients experiencing HHS?

A

5-20%

30
Q

What are the physiologic characteristics of HHS?

A
  • altered mental state
  • relative insulin deficiency
  • extreme hyperglycemia
  • severe dehydration
31
Q

What triggers HHS?

A

stressors (illness, infection, MI, stroke) that compromise fluid intake and glycemic control

32
Q

What are some examples of macrovascular complications?

A
  • coronary heart disease
  • peripheral arterial disease
  • stroke
  • cardiomyopathy
  • congestive heart failure
33
Q

What are some examples of microvascular complications associated with diabetes?

A
  • retinopathy
  • peripheral neuropathy
  • nephropathy
  • autonomic neuropathy (damage to GI, genitourinary, and CV systems)
34
Q

What is the most frequent cause of death in patients with type 2 diabetes?

A

coronary arterial disease

35
Q

Does ketone accumulation and acidosis occur in HHS?

A

No.

36
Q
A

diabetes disease state (4 decks)

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