Diabetes Overview- FINAL Flashcards
Quick diabetes overview
-Pancreas produces peptide
hormones—insulin, glucagon and
somatostatin
-It is in the islets of Langerhans that
all of this creation takes place
*Alpha cells—glucagon
*Beta cells—insulin
*Delta cells—somatostatin
*Epsilon cells—ghrelin
Diabetes epidemiology overview
-Diabetes is higher in non-Hispanic black and Hispanic adults than in white adults
-Native Americans and Alaskan Natives have the highest risk for developing diabetes—their risk is >2
times greater than white Americans
-Since 2000, the most rapid increase in prevalence has been adolescents
-CDC predicts that children born in this millennium will have a 1 in 3 chance of developing DM in their life
American Diabetes Association recognizes what 4 types of diabetes?
- Type I Diabetes Mellitus
- Type II Diabetes Mellitus
- Gestational Diabetes Mellitus
- Diabetes due to other causes
Type 1 DM
-Absolute insulin deficiency
-Autoimmune process
-No beta cell function—there is no basal insulin secreted or a prandial response
Treatment:
-Exogenous insulin
-Goal—maintain glucose as close to normal as possible
Type II DM
-90% of DM cases
-Lack of sensitivity of target organs to insulin
-Pancreas has some beta cell function intact (initially), but the secretion and action is not sufficient to keep sugar normal
-Obese states contribute to the insulin resistance
-Tx: Usually START with oral agents (lifestyle mods FIRST= weight loss, exercise, dietary changes)
-As beta cell function declines, will need injectables
-Goal: Sugar in normal range and prevent long term complications
Insulin resistance
-Causes–>
-Obesity
-Aging
-Meds
-Rare disorders
Associated conditions–>
-PCOS
-Atherosclerosis/ Dyslipidemia/ HTN
-DM
How does Glucagon factor in?
-Exact opposite of insulin
-Low blood glucose–> pancreases releases glucagon–> liver breaks down glycogen–> Blood sugar rises
Gestational DM
-Defined as DM diagnosed in 2nr or 3rd trimester in women who did not have DM before pregnancy
-Adequate BS control is needed to prevent adverse effects to the
fetus— elevated bilirubin, respiratory distress syndrome, low calcium, polycythemia, and neonatal low BS
-Lifestyle modifications FIRST treatment–> INSULIN if not (orals cross placenta)
-Goals: Before meals and at bedtime—less than 95 mg/dL
* One hour postprandial—less than 140 mg/dL
* Two hours postprandial—less than 120 mg/dL (TIGHT CONTROL)
What are considered as the “other” types of diabetes?
-Maturity Onset of the Young [MODY]
aka Latent Onset of the young [LODY]
-Related to disease of the exocrine pancreas—cystic fibrosis
-From other endocrine dysfunction—Cushing syndrome, acromegaly, chromocytoma
-Drug induced diabetes—high
dose corticosteroids
Heart failure and DM
-Hospitalizations for HF are twice as
common in diabetics
-TZDs, DPP4 inhibitors, SGLTs inhibitors– DO NOT USE IN THOSE WITH HF
HTN recommendations for DM
-Less than 130/80 for diabetics with high CV risk
-Less than140/90 for diabetics with low CV risk
-ACE inhibitors, ARBs are considered first line—but thiazides and CCBs have also been shown to reduce CV events
Lipids and DM
-DM/ insulin resistance will lower HDL /increase LDL/ raise triglycerides
-In diabetics <40 with atherosclerotic disease —treat with a high intensity statin—the goal is to lower the LDL by 50% (crestor/ lipitor)
-If on a maximally tolerated statin and LDL is 70 mg/dL or more—consider adding PCSK-9 inhibitor or Ezetimibe for further LDL reduction
-If they’re older >75, regardless of risk, consider moderate intensity statin
Aspirin update for DM
-ADA now recommends that ASA 72-162 mg/day be used for secondary
prevention in diabetics with ASCVD
-ASA can be considered for primary
prevention in diabetics who are at
increased risk of ASCV
-Diabetics less than age 50 and have no other ASCVD risk factors are considered low risk (Don’t give)
Who should we screen for DM?
-All adults >45 should be screened every 3 years (2 years w/ risk factors)
-Regardless of age who are at risk/
suspected of having DM should be screened
-Risk factors:
-AA/ Native American/ Hispanic/ Pacific Islanders
-BMI > 25
-Inactivity
-Age >45
-BP > 140/90
-Elevated cholesterol
-PCOS
-Vascular disease
DM diagnostic criteria
-Dx:
-Fasting > 126
-Post prandial> 200
-A1C > 6.5%
-In a patient with classic symptoms of hypoglycemia/ hyperglycemic crisis, a random plasma glucose ≥200 mg/dL.
-Diagnosis requires TWO abnormal test results.
