Diabetes Mellitus Flashcards
Leading cause of ESRD?
DM
What two types of Abs in T1DM?
GAD-65 and islet cell Abs
2 etiologies of T1DM?
autoimmune, idiopathic
describe the rate of beta cell destruction in T1DM…
variable, marked decline after immunologic trigger
Insulin resistance in T2DM has what effect on liver glucose?
increased output
Abnormal fat metabolism (increased lipolysis) in T2DM leads to what two conditions?
dyslipidemia (increased LDL/TGs)
FLD/NASH
Pre-diabetes is defined as…
insulin insensitivity with impaired glucose tolerance
Describe the 4 steps of progression in T2DM…
peripheral insulin resistance
IGT
overt T2DM (fasting hyperglycemia)
Beta cell failure
The following are indications of what condition?
elevated post-prandial glucose
decreased insulin secretion
increased hepatic glucose production
impaired glucose tolerance
When should intervention be made in the progression of T2DM
IGT
The below presentation is suspicious for T1DM or T2DM?
polyuria polydipsia nocturia blurred vision acanthosis nigracans
T2DM
FHx is a powerful predictor of which type of DM?
T2DM
Who should get DM screening?
BMI 25+ and 1+ RF
45+ yo
Women with what two conditions have increased risk for DM?
PCOS, Gestational DM
What three medication classes put patients at higher risk for DM?
GCs
HIV meds
atypical antipsychotics
What CV conditions increase risk for DM?
dyslipidemia (HDL < 25, TGs > 250)
HTN
CVD hx
three tests for DM
FPG
OGTT
HbA1c
Prediabetes and DM for FPG test
pre-DM: 100-125
DM: 126+
Prediabetes and DM for OGTT
Pre-DM: 140-199
DM: 200+
Prediabetes and DM for HbA1c
Pre-DM: 5.7-6.4
DM: 6.5+
as A1c rises, DM risk rises in what fasion?
disproportionate (curvilinear relationship)
How often should prediabetes pts be tested?
at least annually
what medication can be started for pre-DM?
metformin
What are 2 non-medical approaches to pre-DM?
education/prevention
behavioral/lifestyle intervention
Normal DM screen should be retested at minimum of…
3 year intervals
What three vaccinations should be up to date with DM?
HBV
Flu
Pneumococcal
T1DM often coincides with what comorbidity?
autoimmune disorders
7 lab tests for DM…
HbA1c lipids LFTs Urinary albumin:Cr BMP B12 TSH
What is the leading cause of morbidity and mortality from DM?
ASCVD (CHD, CVD, PAD)
Other than ASCVD, what is another major cardiovascular cause of morbidity/mortality in DM?
HF
How often should ASCVD risk be calculated w. DM patients?
at least annually
5 treatment strategies for ASCVD and DM…
lifestyle
BP & Lipid control
Anti-Platelet (ASA, plavix)
Three microvascular complications of DM?
Diabetic nephropathy
diabetic retinopathy
diabetic neuropathy
Diabetic nephropathy is related to…when does it develop
chronic hyperglycemia
10 years of T1DM
Albuminuria +/- reduced eGFR…
diabetic kidney disease
Diabetic nephropathy progression…
progressive albuminuria (> 300), HTN, decreased eGFR
What is screening for diabetic nephropathy, and how often should it occur?
urinary albumin:Cr (UACR) + eGFR
at least annually
2-3 abnormal specimens of UACR collected between 3-6 weeks indicates…
diabetic nephropathy
When should diabetic nephropathy screening begin w. T1DM and T2DM
T1DM: 5+ years into dz
T2DM: at time of dx
What can be used to tx diabetic nephropathy
ACE/ARBs
What is the leading cause of new blindness between 20-74 yo?
diabetic retinopathy