Diabetes Mellitus Flashcards
DM
- define
- factors contributing to hyperglycemia (3)
Group of common metabolic disorders that share the phenotype of hyperglycemia
Reduced insulin secretion
Decr glucose utilization
Incr glucose production
DM
-leading cause of (3)
End-stage renal disease
Non-traumatic lower extremity amputations
Adult blindness
DM classification
-type 1
Result of autoimmunity against insulin-producing beta cells -> complete/near-total insulin deficiency
DM classification
-type 2
Heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and incr hepatic glucose production
DM classification
- both are preceded by
- what preceding stage is called in DM2
Period of progressive worsening of glucose hemoeostasis -> development of hyperglycemia that exceeds threshold for dx
Prediabetes:
- impaired fasting glucose (IFG)
- impaired glucose tolerance (IGT)
DM classification
-ages
DM1: usually <30
- autoimmunity against betas can develop at any age
- roughly 5-10% of those with DM after 30 have DM1
DM2: usually increasing age
DM classification
-other etiologies (4)
Specific genetic defects in insulin secretion/action
Metabolic abnormalities that impair insulin secretion
Mitochondrial abnormalities
Host of condns that impair glucose tolerance
DM classification
-maturity-onset diabetes of the young (MODY) and monogenic diabetes are subtypes of DM characterized by (3)
Autosomal dominant inheritance
Early onset hyperglycemia
- usually <25
- sometimes in neonatal period
Impaired insulin secretion
DM classification
-viruses
Viral infections have been implicated in pancreatic islet destruction
Fulminant diabetes: a form of acute-onset DM1 noted in Japan, may be related to viral infection of the islets
DM classification
-gestational (GDM)
Glucose intolerance in 2nd/3rd trimester
Related to metabolic changes in pregnancy = incr insulin demeand -> IGT/DM
Epidemiology
Worldwide prevalence risen drastically over last 2 decades (30 million -> 415 million)
Microvascular complications
-list the 3
Renal nephropathy
Renal hyperfiltration
Ophthalmologic
Microvascular complications
-renal nephropathy
—prevalence
—risk factors (3)
40% of diabetics
Poor glycemic control
HTN
Ethnicity
-Blacks, Mexicans, Pima Indians
Microvascular complications
-renal hyperfiltration
—glomerular hyperfiltration
Hallmark of early renal hemodynamic disturbance
Independent predictor of development/progression of diabetic nephropathy in hypertensive DM2 when only microalbuminuria is present
Microvascular complications
-ophthlamologic (3)
Diabetic ret is the most prevalent microvascular complication
DM remains the leading cause of vision loss in adults
Vision loss from DM occurs either as a result of a proliferative retinopathy or macular edema
MACROvascular complications
-list (5)
CHD Acute coronary syndromes Chronic CAD Diabetes-related cardiomyopathy Cerebrovascular disease
MACROvascular complications
-coronary heart disease
Strongly assoc DM2
2-4x incr relative risk of CVD in DM2 than general population
Impaired glucose tolerance incr risk
MACROvascular complications
-acute coronary syndromes
DM pts are high-risk group for developing acute MI
DM1 has worse outcome than DM2
Women have ~2x risk of death vs men
MACROvascular complications
-chronic CAD
Strong association - screening is important
Silent MI and ischemia are markedly incr
Development of sudden cardiac death
MACROvascular complications
-cardiomyopathy
LV failure - both systolic and diastolic function
Framingham
- DM men with CHF = 2x non-diabetic
- DM females 5x
MACROvascular complications
-cerebrovascular disease
Mortality from stroke in DM pts =3x
DM incr likelihood of severe carotid atherosclerosis
DM pt show incr brain damage with carotid emboli that would result in a TIA in a non-DM pt
Glucose tolerance assessment (2)
FPG - fasting plasma glucose
HbA1c - hemoglobin A1c
Diagnosis
- random plasma glucose concentration
- 3 things (poly)
11.1+ mmol/L (200 mg/dL)
Polyuria
Polydipsia (excessive thirst)
Weight loss
Diagnosis
- current criteria emphasize (2)
- new recommendations
HbA1c or FPG - most reliable and convenient
Testing of individuals IDd as being at incr risk
Screening
- why use FPG or HbA1c for DM2 (2)
- type 2 complications
Asymptomatic, present for up to a decade before dx
Have 1+ DM-specific complications at time of dx
