DIABETES TYPE 1 AND TYPE 2 Flashcards
What is a metabolic disorder or disease that is brought about by either the insufficient production of insulin or inadequate activity of insulin receptors?
Diabetes Mellitus
What are the three different categories in which diabetes can be classified?
- Type 1
- Type 2
- Gestational
These are essentials of diagnosis/pathogenesis of what possible disease or disorder?
- Polyuria/polydipsia
- Weight loss
- Plasma glucose of 126mg/dL or higher after an overnight fast, on more than one occasion
- Ketonemia/ketonuria – inadequate insulin leads to inadequate glucose within muscle cells which promotes fat metabolism (source of ketones)
Diabetes Mellitus
What form of diabetes can be characterized by such auto-immune antibodies such as:
- anti-pancreatic islet cells
- anti-insulin
- anti-GAD65
Type 1 diabetes
What form of diabetes primarily occurs in children and adolescence and also may develop in adults up to the age of 30 years old?
Type 1 diabetes
Patients with what form of diabetes have partial or absolute deficiency of endogenous insulin production and require exogenous insulin for survival?
Type 1 Diabetes
These can be some classic signs and symptoms of what?
- polyuria
- polydipsia
- fatigue
- polyphagia
- weight loss
- poor wound healing
- blurred vision
- reccurrent candidal vaginitis/balanitis
- recurrent/severe UTI
- recurrent skin infections
- malignant otitis externa
Diabetes
Presence of any of the classic symptoms associated with diabetes should warrant what test by the IDC?
Blood glucose
Labs for Diabetes
The urine dipstick is typically used to detect what in the urine in a patient suspected of having diabetes?
Glucose
The average renal threshold for glucose is appoximately 150-180mg/dL, above this range is usually detectable in urine and is known as what?
Glucosuria
Plasma glucose of ___ or higher after an over night fast, documented on more than one occasion is indicative of diabetes.
126mg/dL
If the fasting plasma glucose level is greater than 126mg/dL in suspected cases of diabetes what alternative test can be used?
Oral Glucose Tolerance Test (GTT)
Most commonly used to screen for gestational diabetes
The presence of one or more autoantibodies such as those below is indicative of what?
- Anti-insulin
- Anti islet cell
- Anti-glutamic acid decarboxylase (GAD65)
Diabetes
What is the form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over time?
Glycosylated Hemoglobin (Hemoglobin A1) HbA1c
True or False
The advantages of using the HbA1c to diagnose diabetes are that there is no need to fast; and it provides an estimate of glucose control for the proceeding 2-3 months
True
True or False
A fasting plasma glucose greater than or equal to 126mg/dL or HbA1c of 6.5% is diagnostic of diabetes if confirmed by repeat testing
True
A differential diagnosis to diabetes of a catecholamine secreting tumor is referred to as what?
Pheochromocytoma
What is the only medication that is effective in lower blood glucose levels in type 1 diabetes?
Insulin therapy
What is indicated for type 1 as well as for type 2 diabetes with hyperglycemia not adequately controlled with diet alone or combined with other medications?
Insulin therapy
Who should the IDC consult before initiating insulin therapy?
Medical officer
Insulin is supplied in the AMAL in ___ bottles containing ___, which is a short acting insulin.
- 10ml bottles
2. 100un/ml
What is the immediate short term goal treatment for type 1 diabetes?
- control hyperglycemia
- maintain serum electrolytes
- maintain hydration to avoid DKA episodes
What is the frequency of physician monitored blood glucose and HbA1c for long term therapy of Type 1 Diabetes?
every 3 months until at goal and then every 6 months indefinitely
True or False
The therpeutic goal for long term therapy of type 1 diabetes is to maintain normal or near normal glucose levels WITHOUT causing hypoglycemia
True
Is diet and exercise considered a valid long term therapy for type 1 diabetes?
Yes, emphasis placed on minimizing the consumption of simple sugars
What two conditions increase the risk for late complications in type 1 diabetes and require specific attention and appropriate treatment?
- Hypercholesterolemia
2. Hypertension
What are the HTN medications of choice for diabetics because of their renal protection actions?
ACE inhibitors
What is the goal bp for diabetic patients?
<130mmHg systolic and <80mmHg diastolic
True or False
Keeping glucose levels at or near normal in patients with type 1 DM (Hba1C 6.5%; normal 4.0-6.0%) dramatically reduces the risk of developing both the microvascular and macrovascular complications of diabetes
True
True or False
Type 1 diabetes (controlled with insulin) requires a medical board for continued military service. Member is usually not worldwide assignable.
True
Where should patients who have been determined to have new onset diabetes (type 1 or 2) be referred to for further evaluation and management ?
Internal medicine or Endocrinology
What may result in profound hypoglycemia, leading to complications such as seizures, coma or death?
Insulin Overdose
What is the treatment for Insulin overdose?
- Eat or drink some form of sugar
- Recheck pts blood sugar after 15-20 minutes following intervention
- If pt is still symptomatic, provide 15-20 more grams of quick acting sugar/food
- once safe to do so, pt should eat a meal with carbs, fats, and proteins
- MEDADVICE as soon as possible
What are the most common complications of diabetes affecting up to 50% of older patients with type 2 diabetes?
Diabetic neuropathies
The stocking-glove pattern of sensory deficit in diabetic patients is known as what?
Peripheral neuropathy
What is initially manifested by proteinuria; subsequently, as kidney function declines, metabolic acids and waste products such as creatinine and urea accumulate in the blood; hypertension with progressive kidney involvement can occur, and coronary and cerebral atherosclerosis is significantly accelerated?
Nephropathy (end-stage chronic kidney disease)
Due to coronary atherosclerosis what is 3-5 times more common in DM patients?
MI
What is the leading cause of death in Type 2 DM patients?
Heart disease
Diabetic retinopathy
After 10-15 years ____% of type 1 diabetics show some signs of retinopathy. After 15 years, prevalence increases to ____%, and after 30 years it approaches ____%
- 25-50%
- 75-95%
- 100%
What occurs in about 6% of people with diabetes?
glaucoma
What is caused by insulin resistance due to inadequate activity of insulin receptors?
Type 2 Diabetes
True or False
Ketonuria and weight loss are generally uncommon at the time of Type 2 diabetes diagnosis
True
Can candida vaginitis be an initial manifestation of type 2 diabetes in women?
Yes
A patient presents with the following, what may the possible diagnosis be?
- Plasma glucose of 126mg/dL or higher after an overnight fast on more than once occasion
- Random glucose of 200mg/dL or higher
- Hemoglobin A1C of 6.5% or higher
Type 2 Diabetes
What is the resistance to the action of insulin at the receptor level and accounts for 90% of the individuals with DM?
Type 2 Diabetes
Vascular disease is the cause of death in over ___% of Type 2 Diabetes
70%
The clinical findings for type 2 DM is the same as type 1 DM, however what is less likely to accumulate in the blood?
Ketones
What organ initially compensates (incompletely) for the insulin receptor resistance?
pancreas
Glycemic control in type 2 diabetes is staged, what is stage 1?
Diet modification and weight reduction
Glycemic control in type 2 diabetes is staged, what is stage 2?
various oral antidiabetic medications
What is the first line medication for oral antidiabetic meds?
Biguanides (Metformin/Glucophage)
These are medications associated with the treatment of what?
- Sulfonylureas
- meglitinide analogs
- dipeptidyl peptidase derrivative
- thiazolidinediones
- a-Glucosida inhibitors
- Glucagon-like peptide receptor agonist
- Sodium-glucose cotransporter-2 (SGLT2 Inhibitor)
Type 2 diabetes
What stage of the glycemic control of a DM patient represents an insulin requirement due to inability to achieve adequate glucose control with oral medications?
Stage 3
What is the leading cause of Diabetes related deaths, accounting for approximately 40% of deaths in men with diabetes and nearly 32% in women?
Heart disease
What is the leading cause of new cases of blindness in patients aged 25-74 in the US?
Diabetic retinopathy
Patients with diabetic retinopathy are how much more likely to become blind that a patient without this complication?
29 times more likely
Should have annual dilated eye exams
What is one of the leading causes of end-stage renal disease, accounting for approximately 43% of new cases of renal failure each year?
Diabetic nephropathy
Uncontrolled glucose often leads to damage of small arteries and nerves, and is apart of the most common complication of diabetes, affecting 50% of older patients with type 2 diabetes. What is this?
Diabetic neuropathy
Foot and lower extremity ulcers and associated infections are a major source of morbidity in the diabetic population, affecting some ___% of diabetic patients during their life time.
15%
Diabetes related foot and lower extremity ulcers
The complications account for about ___% of diabetes-related admission and nearly ___% of all lower extremity amputations in the US
- 20%
2. 60%
