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Z Clinical Medicine - Midterm > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

DM

  • define
  • factors contributing to hyperglycemia (3)
A

Group of common metabolic disorders that share the phenotype of hyperglycemia

Reduced insulin secretion
Decr glucose utilization
Incr glucose production

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2
Q

DM

-leading cause of (3)

A

End-stage renal disease
Non-traumatic lower extremity amputations
Adult blindness

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3
Q

DM classification

-type 1

A

Result of autoimmunity against insulin-producing beta cells -> complete/near-total insulin deficiency

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4
Q

DM classification

-type 2

A

Heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and incr hepatic glucose production

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5
Q

DM classification

  • both are preceded by
  • what preceding stage is called in DM2
A

Period of progressive worsening of glucose hemoeostasis -> development of hyperglycemia that exceeds threshold for dx

Prediabetes:

  • impaired fasting glucose (IFG)
  • impaired glucose tolerance (IGT)
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6
Q

DM classification

-ages

A

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

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7
Q

DM classification

-other etiologies (4)

A

Specific genetic defects in insulin secretion/action

Metabolic abnormalities that impair insulin secretion

Mitochondrial abnormalities

Host of condns that impair glucose tolerance

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8
Q

DM classification

-maturity-onset diabetes of the young (MODY) and monogenic diabetes are subtypes of DM characterized by (3)

A

Autosomal dominant inheritance

Early onset hyperglycemia

  • usually <25
  • sometimes in neonatal period

Impaired insulin secretion

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9
Q

DM classification

-viruses

A

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

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10
Q

DM classification

-gestational (GDM)

A

Glucose intolerance in 2nd/3rd trimester

Related to metabolic changes in pregnancy = incr insulin demeand -> IGT/DM

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11
Q

Epidemiology

A

Worldwide prevalence risen drastically over last 2 decades (30 million -> 415 million)

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12
Q

Microvascular complications

-list the 3

A

Renal nephropathy
Renal hyperfiltration
Ophthalmologic

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13
Q

Microvascular complications
-renal nephropathy
—prevalence
—risk factors (3)

A

40% of diabetics

Poor glycemic control
HTN
Ethnicity
-Blacks, Mexicans, Pima Indians

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14
Q

Microvascular complications
-renal hyperfiltration
—glomerular hyperfiltration

A

Hallmark of early renal hemodynamic disturbance

Independent predictor of development/progression of diabetic nephropathy in hypertensive DM2 when only microalbuminuria is present

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15
Q

Microvascular complications

-ophthlamologic (3)

A

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

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16
Q

MACROvascular complications

-list (5)

A 
CHD
Acute coronary syndromes
Chronic CAD
Diabetes-related cardiomyopathy
Cerebrovascular disease
17
Q

MACROvascular complications

-coronary heart disease

A

Strongly assoc DM2

2-4x incr relative risk of CVD in DM2 than general population

Impaired glucose tolerance incr risk

18
Q

MACROvascular complications

-acute coronary syndromes

A

DM pts are high-risk group for developing acute MI

DM1 has worse outcome than DM2

Women have ~2x risk of death vs men

19
Q

MACROvascular complications

-chronic CAD

A

Strong association - screening is important

Silent MI and ischemia are markedly incr

Development of sudden cardiac death

20
Q

MACROvascular complications

-cardiomyopathy

A

LV failure - both systolic and diastolic function

Framingham

  • DM men with CHF = 2x non-diabetic
  • DM females 5x
21
Q

MACROvascular complications

-cerebrovascular disease

A

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

22
Q

Glucose tolerance assessment (2)

A

FPG - fasting plasma glucose

HbA1c - hemoglobin A1c

23
Q

Diagnosis

  • random plasma glucose concentration
  • 3 things (poly)
A

11.1+ mmol/L (200 mg/dL)

Polyuria
Polydipsia (excessive thirst)
Weight loss

24
Q

Diagnosis

  • current criteria emphasize (2)
  • new recommendations
A

HbA1c or FPG - most reliable and convenient

Testing of individuals IDd as being at incr risk

25
Q

Screening

  • why use FPG or HbA1c for DM2 (2)
  • type 2 complications
A

Asymptomatic, present for up to a decade before dx

Have 1+ DM-specific complications at time of dx

Z Clinical Medicine - Midterm (9 decks)

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