Diabetes, Peripheral Neuropathy and Metabolic Syndrome Flashcards
Polyuria
Excessive urination
Polydipsia
Excessive thirst
Nocturia
Urination at night
What does diminished foot arterial pulse indicate?
Possible peripheral vascular disease
Why might you order a fasting blood glucose?
If you have a peripheral neuropathy, high BMI we need to exclude diabetes.
How do we diagnose diabetes on one visit?
Patient presents with ketoacidosis, hyperglycemia, plasma glucose of >200mg/dl
What is the reference interval for glucose?
60-99mg/dl
What if we don’t have all the symptoms of diabetes we can only diagnose when?
On two separate visits when glucose is >126 fasting, >200 OGTT, >6.5 A1c
HHS?
More likely in DMT2, poorly controlled, hyperglycemia and hyperosmolality.
Why do T2DM patient not usually experience ketoacidosis?
Even thought they are insulin resistant they produce enough to avoid ketosis.
OGTT?
Measure fasting plasma glucose, administer glucose, measure 2 hours later.
What amount of glucose should we use in children and adults for OGTT
75mg for adults, weight dependent in children
A1c?
A glucose that is added nonenzymatically to hemoglobin - this is glycated hemoglobin. High A1c >6.5 indicates diabetes.
Hemoglobin A1c is an indicator of systemic glycation. What are the physiological effects?
When the retina leaks protein it can cause blindness. When in the kidney it is a marker of kidney failure.
With only hyperglycemia on one occasion we can’t diagnose diabetes. How many visits does it take?
2 visits with hyperglycemia can lead to a diagnosis of?
What defines elevated glucose but not hyperglycemia?
Impaired fasting glucose
What are borderline measurements for predicting increased risk of diabetes?
IFG, IGT, A1c predict increased risk.
What is IFG, IGT and borderline A1c called?
prediabetes (not diagnosis but description)
IFG
Impaired Fasting Glucose
IGT
Impaired Glucose Tolerance
What is indicated in pre diabetes?
More frequent visits, diet, exercise can reduce risk by 60%
What are symptoms for DMT2?
Middle aged, obese, minority, mild hyperglycemia, no ketosis
If a patient presented with complications of diabetes should we test further?
Yes, A1c, OGTT, IFG
What percentage of DMT2 patients present with complications?
15%
Macrovascular disease (what three vessels)?
Coronary artery, Carotid artery, peripheral arteries.
Microvascular disease (what are the manifestations) ?
Kidney and eye problems. Neuropathy.
Neuropothy (What are the manifestations)?
Peripheral = loss of sensation, glove and sock sensation. Debilitation pain, loss of position sense. Mononeuropathy = Cranial nerve infarction. Autnomic = GUT problems leading to diarrhea, impotence.
TIA?
Transient ischemic attack (thrombosis that doesn’t lead to stroke)
Claudication?
Pain, fatigue and tiredness in the extremities.
Postural hypertension?
Dizziness upon standing - this is due to neuropathy in the autonomic nervous system
What are the causes of complications in diabetes?
CVD, retinopathy, nephropathy, neuropathy
What are the risk factors of diabetes?
Male, age, hyperlipidemia, hypertension, smoking, obesity
What does hyperglycemia cause?
Retinopathy, Nephropathy, Neuropathy
What factors other than hyperglycemia cause nephropathy?
Hypertension, familiar diabetic neuropathy, hyperlipidemia
Why does pregnancy increase risks?
Growth factors increase vascular growth, increased need for C-Section, increased hypertension and pre-eclampsia
What the increased risk for unborn babies when the mother has diabetes?
Congenital malformations Fetal Death Inutero Premature birth NICU Hypercalcemia Hyperbilirubinemia DMT2 in adulthood LGA - large for gestation age.
In the first trimester hyperglycemia is a?
Teratogen
Dystocia
pelvic / cephalo disproportionality
What is the most common cause of death in DMT1?
CVD and Renal failure (renal failure has longer to develop)
What is the most common cause of death in DMT2?
CVD
What are common secondary causes of hypertension?
< 5% of hypertension causes Renal failure, hyperaldosterone
Nephrothapy can be caused by?
Diabetes and hypertension