Diabetes Pre-Lecture (Kania) Flashcards
Egregious 11
1) pancreatic B-cells: decreased ___ , ___ and ___
2) decreased ___ effect
3) ___ cell defect leading to increased ___
4) adipose: increased ___
5) muscle: decreased peripheral muscle ___
6) liver: increased ___ production
7) brain: increased ___, decreased morning ___ surge, increased ___ tone
8) colon/biome: abnormal microbiota, possible decreased ___ secretion
9) immune ___ / inflammation
10) stomach/small intestine: increase rate of ___ absorption
11) kidney: increased ___ reabsorption due to upregulation of ___
- mass, function, insulin
- incretin
- alpha, glucagon
- lipolysis
- uptake
- glucose
- appetite, dopamine, sympathetic
- GLP-1
- dysregulation
- glucose
- glucose, SGLT-2
The Egregious 11 is the concept that there are multiple different potential mechanisms for diabetes, and at the heart of it all is the ___
B-cell
Type I
- IDDM
- ___% of diabetic population
- age of onset: < ___ peaks at ___ yo
- family history: ___
- weight: ___
- ketoacidosis: ___ of pts
- pancreatic function: ___
- patho: ___
- clinical presentation: Polys (especially in ___ pts), 1/3 have ___
- 5-10%
- 30, 12-14
- not common
- usually not obese
- 1/3 of pts
- none (80-90% beta cells destroyed when first diagnosed)
- autoimmune
- younger, ketoacidosis
Type II
- NIDDM
- ___% of diabetic population
- age of onset: > ___ (new gen of young pts as well)
- family history: ___
- weight: 70-90% are ___
- ketoacidosis: ___
- pancreatic function: insulin can be ___ , ___ , or ___
- patho: progressive loss of insulin secretion with resistance; increases hepatic ___ production
- clinical presentation: polyuria, nocturia, polydipsia, ___ , HTN, obesity, dyslipidemia
- 90-95%
- 40
- common
- obese
- rare
- low, normal, or high
- glucose
- fatigue
Risk factors
- family history ( ___ degree)
- obesity
- physical inactivity
- race/ethnicity
- CVD
- IGT, IFG, A1C ___ - ___ %
- HTN > ___ or on therapy
- HD: < ___ and/or TG > ___
- PCOS
- 1st
- 5.7-6.4
- 130/80
- 35, 250
Diagnostic criteria
normal:
- FBG < ___ mg/dL
- 2 hour OGTT < ___ mg/dL
Diagnosis
- FBG > ___ mg/dL x2
- A1C > ___ % *
- random glucose > ___ with symptoms
- 2h-PPG > ___ mgdL during an OGTT
*not for diagnosis with high RBC turnover
- 100
- 140
- 126
- 6.5%
- 200
- 200
- normal A1C is less than ___
- risk for DM goes up when A1C is ___ - ___ %
- diabetes is A1C greater than or equal to ___ %
- 5.7%
- 5.7-6.4%
- 6.5%
ADA criteria for screening patients
pre-symptomatic type I diabetes screening
- ___ to insulin
- ___ (GAD)
- tyrosine phosphatase islet antigen 2 ( ___ ) and ( ___ )
- ___ transporter ___
- presence of 2 ___. has been linked to future development of type I
- autoantibodies
- glutamic acid decarboxylase
- IA-2, IA-2B
- zinc, 8
- autoantibodies
ADA criteria (cont.)
- screening for prediabetes and diabetes should begin at age ___
- test any asymptomatic adults of any age who have BMI greater than ___ kg/m^2 ( or ____ kg/m^2 for asian americans) AND have one or more ___
- test women who are overweight or obese and planning ___ and/or have one or more ___
- screen in ___ pts
- 35
- 25, 23, risk factors
- pregnancy, risk factors
- HIV
ADA criteria (cont.)
- if normal results, test again in min of ___ year intervals
- prediabetic results (by ___ , ___ , or ___) should be tested ___
- ___ pts should have lifelong testing at least every ___ years
- test overweight children who have one or more risk factors starting at age ___ or onset of ___ if that occurs first
- 3
- A1C, IGT, IFG, annually
- GDM, 3
- 10, puberty
prevention of type II diabetes
- weight loss of ___ % body weight
- increase physical activity to ___ min/week
- inititation of ___ in select pts (prediabetic, BMI > ___ , less than ___ years old , women with prior ___ )
- long term use of ___ can lead to vit ___ deficiency
- 7%
- 150
- metformin, 35, 60, GDM
- metformin, B12
4 components of therapy
4 Ms
- meals
- monitoring
- movement
- medications
what does IFG stand for?
impaired fasting glucose
what does IGT stand for?
impaired glucose tolerance
Non-PCOL (Diet)
Caloric resticition: ___ cal/day cut back
carb intake: individualize
- men: ___ gm/meal
- women: ___ gm/meal
saturated fat: ___ % of total calories
- ZERO ___ fat
- increased ___ fats
< ___ mg cholesterol
- < ___ mg for pts with elevated levels
whole grains: increase
- 20-35 gm ___ per day
- 500-750
- 60
- 45
- 7%
- trans
- 300
- 200
- fiber
Non-PCOL (screening)
Foot care
- clean, dry, not cracked
- examine ___
___ eye exam
dental care every ___ months
Annual screening for ___
___ risk factor prevention
- daily
- annual
- 6 months
- microalbuminuria
- CV
Normal plasma glucose: ___ - ___ mg/dL
minimum [ ] of ___ - ___ mg/dL is needed for ___ to function
- brain obtains glucose ___ of insulin activity
resorptive capacity of kidneys is ___ mg/dL; above this point, osmotic ___ occurrs
- 60-140
- 40-60, CNS
- independent
- 180
- diuresis
muscle and fat are insulin ___ for glucose uptake
- without glucose, ___ and __ will be used for fuel
- and increase of ___ will occur
dependent
- fatty acids and amino acids
- ketones
T or F: polys are more common in type II
F; more common in type 1 and younger pts
signs and symptoms
- polys ( ___ , ___ , and ___ )
- weight ___
- ___ : postprandial hyperglycemia (thanksgiving)
- recurrent ___ (urinary, respiratory, etc)
- ___acidosis
- blurred ___
- polyuria, polydipsia, polyphagia
- loss
- fatigue
- infections
- ketoacidosis
- vision
Drug induced diabetes
drugs that increase hepatic glucose (3)
- glucocorticoids
- sympathomimetics
- niacin (only higher doses)
Drug induced diabetes
drugs that decrease insulin secretion (4)
- phenytoin
- beta blockers
- calcium channel blockers
- immunosuppressants
Drug induced diabetes
drugs that increase insulin resistance (4)
- thiazides diuretics
- glucocorticoids
- oral contraceptives
- antipsychotics
Drug induced diabetes
drugs that are toxic to beta cells (1)
drugs that stimulate appetite (3)
___ inhibitors to treat HIV
pentamidine - prevents insulin secretion
- phenothiazines, marijuana, androgens
protease (mechanism unclear)
- normal values: fasting blood glucose < ___ mg/dL
- 2 hr OGTT: < ___ mg/dL
- A1C: < ___ %
- random glucose: < ___
- 100
- 140
- 5.7
- 200
