Diabetes Part 1 Flashcards
Good simple definition of diabetes, not just type 1?
Metabolic disorder leading to hyperglycemia because we cant secret insulin or insulin isn’t having an effect.
In the US, diabetes is the leading cause of what 3 conditions?
End stage renal disease, adult onset blindness, and non traumatic lower extremity amputations because of atherosclerosis
What are the 4 criteria for the diagnosis of diabetes?
A1C over 6.5
Fasting glucose over 126
Random glucose over 200
2 hour glucose after oral tolerance test over 200
What are the prediabetes criteria?
Fasting glucose between 100 and 125
2 hour glucose after test 140-199
A1C between 5.7 and 6.4
Which 3 ethnic groups are at higher risk for diabetes?
Blacks, Hispanics and native Americans
What is the patho of type 1 diabetes?
T cells destroying beta cells
What is the gene and chromosome for the most common association for type 1 diabetes?
HLA gene cluster on chromosome 6p21.
What are the two most common haplotypes?
HLA DR3 and DR4
How much of the beta cells must be destroyed before overt Type 1 diabetes symptoms?
90%
Two big time risk factors for type 2 diabetes?
Obesity is number one
Sedentary lifestyle
2 main things going on with the patho of type 2 diabetes?
B cell dysfunction, meaning inadequate insulin secretion
Insulin resistance in the peripheral tissue
Explain the reasoning for beta cell dysfunction?
Because of the insulin resistance, the signal back to the pancreas is to pump our more insulin. Eventually there is exhaustion and failure of the beta cells to the increasing demand.
What are the three major tissues that are most insulin resistant in type 2 diabetes?
Skeletal muscle, fat and liver
What is one of the major issues with the liver being resistant to insulin?
Insulin uptake turns off gluconeogensis. If we can’t turn it off, the liver is continually secreting glucose into the blood. That’s why we have an elevated fasting glucose.
What is the problem with fat cells being resistant to insulin?
Remember, insulin is an anabolic hormone. So, if we cant bring it in to build, then hormone sensitive lipase will be going and breaking down TRIs, causing FFAs to be pumped into the blood.
What is a big time histo feature of type 2?
Amyloid deposits in islets.
3 features of MODY that make it resemble type 2 and what is the most common mutation of the condition? What is the big difference between MODY and type 2?
Increased blood insulin
NO autoantibodies
Nonketotic
Loss of function of glucokinase
Happens in youth
Why can diabetes occur in the setting of pregnancy?
Pregnancy favors a state of insulin resistance
3 risks to the baby when mom is diabetic during pregnancy?
Still birth
Big baby
Congenital malformations
What is the requirement for diagnosing pre existing diabetes for a pregnant lady?
In the first prenatal visit, if the lady has an A1C over 6.5, fasting over 126 or random over 200 she is preexisitng .
How do we perform the test to see if she has gestational diabetes?
Perform an oral glucose test and measure fasting, 1 hour post test, and 2 hour post test.
Greater than 82, 180 and 153 is gestational diabetes.
