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Medical Pathology > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What is insulin and timeline of how it works?

A

controls blood glucose levels in the body

Once a meal is eaten, glucose enters the bloodstream which increases blood sugar concentration and insulin is released from pancreas

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2
Q

What does insulin do?

A

helps glucose go from the blood to cells or stops the liver from releasing glucose from storage and liver converts it to glycogen

once blood sugar levels are normal, insulin is blocked

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3
Q

What is diabetes mellitus

A

hyperglycemia (increased blood glucose) due to excessive glucose production or impaired glucose clearance

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4
Q

What are the types of DM

A 
T1DM 
T2DM
Gestational Diabetes 
LADA
MODY
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5
Q

What are the different ways to test blood sugar levels?

A

Fasting Blood Glucose
Random Blood Glucose
HbA1c
OGTT (Oral Glucose Tolerance Test)

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6
Q

What are the blood glucose levels for FBG

A

Normal: 70-99mg/dl
Pre-DM: 100-125mg/dl
DM: >126mg/dl

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7
Q

What are the blood glucose levels for RBG

A

Normal: <140mg/dl
Pre-DM: 140-199mg/dl
DM: >200mg/dl

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8
Q

What are the blood glucose levels for HbA1c

A

Normal: <5.7%
Pre-DM: 5.7-6.4%
DM: >6.5%

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9
Q

What are the blood glucose levels for OGTT

A

Normal: <140mg/dl
Pre-DM: 140-199 mg/dl
DM: >200mg/dl

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10
Q

How does the HbA1c test work

A

A1c is the component of the hemoglobin that binds to glucose and so the more A1c = the more complications you have

It does an average reading over 2-3 months (life of a platelet)

At 6% = 125 mg/dl and every 1% increase is 30mg/dl

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11
Q

How does the OGTT test work?

A

Patient ingests 75-100g of glucose and we measure the 1,2,3 hour mark and see the chart

A diabetic will have a large spike and take more time to bring the levels down

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12
Q

What are the symptoms of DM

A

polyuria, polydipsia, polyphagia, blurred vision, weight loss, extreme fatigue, slow healing sores, frequent infection, and tingling/numb extremities

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13
Q

What is the epidemiology of DM

A

most common endocrine disorder in US (#7 in death)

incidence increases with age, obesity, sedentary lifestyle

US: Natives > AA > Hispanics > Asian > White

Leading cause of kidney failure, non-traumatic limb amputee, and blindness

Contributes to heart disease + stroke

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14
Q

What happens in pre-DM stage and its risk factors?

A

usually asymptomatic but body is developing insulin resistance and increased risk of CV pathology

50% within 10 years progress to T2DM

obesity, sedentary, 45+, family history, race, BMI >25, GDM, baby over 9 lbs, HTN, hyperlipidemia

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15
Q

What happens in T1DM

A

absolute deficit of insulin from pancreatic atrophy and loss of beta cells

5-10% cases usually diagnosed as kids where they lose function of pancreas

idiopathic or immune-mediated

M=F; older mothers, pre-eclampsia, and autoimmune disorders (hashimoto, graves, addison, pernicious anemia, MS)

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16
Q

How do you treat T1DM

A

Insulin injection or pump

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17
Q

What happens in T2DM

A

most common form (90-95%) where people have peripheral insulin resistance and insufficient insulin production

Polygenic disorder from sedentary lifestyle, obesity, family history, GDM, impaired glucose metabolism, Age, Race

Manifestations: CV damage, vision loss, neuropathy, recurrent infections, and renal failure

18
Q

How do you treat T2DM

A

Diet, Exercise and Meds (oral + injection)

19
Q

What is gestational DM

A

happens during pregnancy where you have glucose intolerance from estrogen and progesterone antagonizing insulin

2-10% pregnancies and usually temporary but can lead to T2DM (50%)

Risk Factors: AA, Hispanic, American Indian, Obesity and family history

20
Q

How do you treat GDM

A

insulin or 2nd line (metformin and glyburide)

21
Q

What is LADA

A

latent autoimmune diabetes of Adults (T1.5)

slow progression B-cell failure of pancreas

onset around 30 years old

Treated with insulin

22
Q

What is MODY

A

Maturity Onset Diabetes of Young

Early T2DM - autosomal dominant

ineffective production of insulin

onset around late teens or early 20s

Treated with oral meds and maybe insulin

23
Q

What is metabolic syndrome

A

a cluster of conditions that increase your risk for CHD, DM, and Stroke

FBG > 100 
TG > 150 
HDL < 40
BP > 135/85
Waistline: >40 and >35
Associated with sedentary life, obesity, insulin resistance, BUT preventable with diet, exercise, and meds

NEED MORE THAN 3**

24
Q

What are the effects of chronic hyperglycemia

A

Glycation of Proteins (abnormal cross-linking)
- protein + glucose over time (becomes permanent) = AGE (cross-linking proteins)

Accumulation of Sorbitol (cellular edema bc it loves H20)
- elevated glucose gets converted to sorbitol (30%) in hyperglycemia vs normoglycemia (3%)

Increased activation of Protein Kinase C (increased DAG to increased PKC) DAG: diacyl glycerol

  • vasoconstriction (impede blood flow)
  • vascular permeability (angiogenesis)
  • thicker BM (decrease O2 transmission)
  • capillary or vascular occlusion
25
Q

What are the macrovascular effects of hyperglycemia

A

Heart (CAD, MI, CHF), Cerebrovascular Disease (TIA, Stroke), Peripheral Artery Disease (Amputations)

26
Q

What are the most common causes of death in T2DM

A

coronary artery disease + stroke

27
Q

What are the microvascular effects of hyperglycemia

A

Retinopathy, Nephropathy, and Neuropathy

28
Q

what is endothelial glycation (think abnormal cross linking, pericytes, and glycated RBC)

A

abnormal cross linking damages the endothelium and causes the basement membrane to thicken and decreases O2 transmission

the loss of pericytes over time lead to weak blood vessels and micro-aneurysms (leaks)

Glycated RBC or platelets stick to the vessel wall which becomes a thrombus and leads to obstruction or rupture and then exudate / hemorrhaging / ischemia

29
Q

What is diabetic nephropathy

A

most common death in T1DM (AA, Asian, NA > White)

DM is leading cause of renal failure + ESRD due to glomerulosclerosis (scarring of renal tissue) leading to albuminuria

TX: hemodialysis + treat underlying conditions

Chronic hyperglycemia leads to kidney wanting to filter out the glucose but with time that causes problems and damages the glomeruli leading to decreased GFR and renal failure

30
Q

What is diabetic neuropathy

A

demyelination of nerves throughout body and affects 60-70% of DM

caused by hyperglycemia, lack of insulin, ischemia, and duration / control of DM

31
Q

What are the types of neuropathy

A

peripheral (most common) - sensory before motor

autonomic: bladder incontinence, impotence, diarrhea, and perspiration

Proximal: thighs, legs, hips

Focal: can affect ANY nerve in body (CN palsy)

32
Q

What is diabetic retinopathy

A

1 cause of blindness in working population (20-65)

pericytes break down around the blood vessels and are part of the BBB so when they break down, retinal microvasculature becomes leaky

Dx > 10 years: 50% chance of retinopathy
Dx > 15 years: 90% chance of retinopathy

want the A1c to be less than 7%

33
Q

How do cataracts form from DM

A

the accumulation of sorbitol makes the lens swell and lead to apoptosis and free radical formation

lenticular swelling + vacuole formation + lenticular opacification

a posterior subcapsular cataract can affect vision

34
Q

What are some other ocular manifestations from DM

A

myopic shift, decrease in amp, early onset presbyopia, 2x risk of glaucoma, and decreased corneal sensitivity

35
Q

What are the effects of acute hyperglycemia

A

hypoglycemia and DKA

36
Q

What is DKA

A

diabetic ketoacidosis: when there is no insulin, glucagon is not suppressed and glycogen will be depleted and then the body will produce excess ketones (acidic) and make the blood acidic

Hyperglycemia + Hyperketosis + Acidosis (T1»T2)

TG > 200mg/dl + Ketones in blood/urine and a pH of <7.3

37
Q

What are the symptoms of DKA

A

fruity breath from acetone, altered mental status, and hyperventilation because of the attempt to stabilize blood pH to decrease CO2

38
Q

What is the treatment for DKA

A

normalize blood glucose levels or rapid insulin

39
Q

What is hypoglycemia? T2 or T2? What are the BG levels?

A

most often with T1&raquo_space; T2

When BG is <70mg/dl or 50-55 mg (SEVERE)

2-10% of all DM experience this once / year

40
Q

What are the symptoms of hypoglycemia

A

nervous, sweat, tremor, muscle weakness, HA, confusion, coma (25%)

41
Q

What is the treatment for hypoglycemia

A

rapid glucose infusion or glucagon infusion

Medical Pathology (13 decks)

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