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CLASS 22010 Endocrine > DIABETES TYPE 1 AND TYPE 2 > Flashcards

DIABETES TYPE 1 AND TYPE 2 Flashcards

1
Q

What is a metabolic disorder or disease that is brought about by either the insufficient production of insulin or inadequate activity of insulin receptors?

A

Diabetes Mellitus

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2
Q

What are the three different categories in which diabetes can be classified?

A
  1. Type 1
  2. Type 2
  3. Gestational
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3
Q

These are essentials of diagnosis/pathogenesis of what possible disease or disorder?

  1. Polyuria/polydipsia
  2. Weight loss
  3. Plasma glucose of 126mg/dL or higher after an overnight fast, on more than one occasion
  4. Ketonemia/ketonuria – inadequate insulin leads to inadequate glucose within muscle cells which promotes fat metabolism (source of ketones)
A

Diabetes Mellitus

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4
Q

What form of diabetes can be characterized by such auto-immune antibodies such as:

  1. anti-pancreatic islet cells
  2. anti-insulin
  3. anti-GAD65
A

Type 1 diabetes

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5
Q

What form of diabetes primarily occurs in children and adolescence and also may develop in adults up to the age of 30 years old?

A

Type 1 diabetes

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6
Q

Patients with what form of diabetes have partial or absolute deficiency of endogenous insulin production and require exogenous insulin for survival?

A

Type 1 Diabetes

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7
Q

These can be some classic signs and symptoms of what?

  1. polyuria
  2. polydipsia
  3. fatigue
  4. polyphagia
  5. weight loss
  6. poor wound healing
  7. blurred vision
  8. reccurrent candidal vaginitis/balanitis
  9. recurrent/severe UTI
  10. recurrent skin infections
  11. malignant otitis externa
A

Diabetes

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8
Q

Presence of any of the classic symptoms associated with diabetes should warrant what test by the IDC?

A

Blood glucose

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9
Q

Labs for Diabetes

The urine dipstick is typically used to detect what in the urine in a patient suspected of having diabetes?

A

Glucose

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10
Q

The average renal threshold for glucose is appoximately 150-180mg/dL, above this range is usually detectable in urine and is known as what?

A

Glucosuria

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11
Q

Plasma glucose of ___ or higher after an over night fast, documented on more than one occasion is indicative of diabetes.

A

126mg/dL

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12
Q

If the fasting plasma glucose level is greater than 126mg/dL in suspected cases of diabetes what alternative test can be used?

A

Oral Glucose Tolerance Test (GTT)

Most commonly used to screen for gestational diabetes

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13
Q

The presence of one or more autoantibodies such as those below is indicative of what?

  1. Anti-insulin
  2. Anti islet cell
  3. Anti-glutamic acid decarboxylase (GAD65)
A

Diabetes

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14
Q

What is the form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over time?

A

Glycosylated Hemoglobin (Hemoglobin A1) HbA1c

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15
Q

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

A

True

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16
Q

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

A

True

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17
Q

A differential diagnosis to diabetes of a catecholamine secreting tumor is referred to as what?

A

Pheochromocytoma

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18
Q

What is the only medication that is effective in lower blood glucose levels in type 1 diabetes?

A

Insulin therapy

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19
Q

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?

A

Insulin therapy

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20
Q

Who should the IDC consult before initiating insulin therapy?

A

Medical officer

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21
Q

Insulin is supplied in the AMAL in ___ bottles containing ___, which is a short acting insulin.

A
  1. 10ml bottles

2. 100un/ml

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22
Q

What is the immediate short term goal treatment for type 1 diabetes?

A
  1. control hyperglycemia
  2. maintain serum electrolytes
  3. maintain hydration to avoid DKA episodes
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23
Q

What is the frequency of physician monitored blood glucose and HbA1c for long term therapy of Type 1 Diabetes?

A

every 3 months until at goal and then every 6 months indefinitely

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24
Q

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

A

True

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25
Q

Is diet and exercise considered a valid long term therapy for type 1 diabetes?

A

Yes, emphasis placed on minimizing the consumption of simple sugars

26
Q

What two conditions increase the risk for late complications in type 1 diabetes and require specific attention and appropriate treatment?

A
  1. Hypercholesterolemia

2. Hypertension

27
Q

What are the HTN medications of choice for diabetics because of their renal protection actions?

A

ACE inhibitors

28
Q

What is the goal bp for diabetic patients?

A

<130mmHg systolic and <80mmHg diastolic

29
Q

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

A

True

30
Q

True or False
Type 1 diabetes (controlled with insulin) requires a medical board for continued military service. Member is usually not worldwide assignable.

A

True

31
Q

Where should patients who have been determined to have new onset diabetes (type 1 or 2) be referred to for further evaluation and management ?

A

Internal medicine or Endocrinology

32
Q

What may result in profound hypoglycemia, leading to complications such as seizures, coma or death?

A

Insulin Overdose

33
Q

What is the treatment for Insulin overdose?

A
  1. Eat or drink some form of sugar
  2. Recheck pts blood sugar after 15-20 minutes following intervention
  3. If pt is still symptomatic, provide 15-20 more grams of quick acting sugar/food
  4. once safe to do so, pt should eat a meal with carbs, fats, and proteins
  5. MEDADVICE as soon as possible
34
Q

What are the most common complications of diabetes affecting up to 50% of older patients with type 2 diabetes?

A

Diabetic neuropathies

35
Q

The stocking-glove pattern of sensory deficit in diabetic patients is known as what?

A

Peripheral neuropathy

36
Q

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?

A

Nephropathy (end-stage chronic kidney disease)

37
Q

Due to coronary atherosclerosis what is 3-5 times more common in DM patients?

A

MI

38
Q

What is the leading cause of death in Type 2 DM patients?

A

Heart disease

39
Q

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 ____%

A
  1. 25-50%
  2. 75-95%
  3. 100%
40
Q

What occurs in about 6% of people with diabetes?

A

glaucoma

41
Q

What is caused by insulin resistance due to inadequate activity of insulin receptors?

A

Type 2 Diabetes

42
Q

True or False

Ketonuria and weight loss are generally uncommon at the time of Type 2 diabetes diagnosis

A

True

43
Q

Can candida vaginitis be an initial manifestation of type 2 diabetes in women?

A

Yes

44
Q

A patient presents with the following, what may the possible diagnosis be?

  1. Plasma glucose of 126mg/dL or higher after an overnight fast on more than once occasion
  2. Random glucose of 200mg/dL or higher
  3. Hemoglobin A1C of 6.5% or higher
A

Type 2 Diabetes

45
Q

What is the resistance to the action of insulin at the receptor level and accounts for 90% of the individuals with DM?

A

Type 2 Diabetes

46
Q

Vascular disease is the cause of death in over ___% of Type 2 Diabetes

A

70%

47
Q

The clinical findings for type 2 DM is the same as type 1 DM, however what is less likely to accumulate in the blood?

A

Ketones

48
Q

What organ initially compensates (incompletely) for the insulin receptor resistance?

A

pancreas

49
Q

Glycemic control in type 2 diabetes is staged, what is stage 1?

A

Diet modification and weight reduction

50
Q

Glycemic control in type 2 diabetes is staged, what is stage 2?

A

various oral antidiabetic medications

51
Q

What is the first line medication for oral antidiabetic meds?

A

Biguanides (Metformin/Glucophage)

52
Q

These are medications associated with the treatment of what?

  1. Sulfonylureas
  2. meglitinide analogs
  3. dipeptidyl peptidase derrivative
  4. thiazolidinediones
  5. a-Glucosida inhibitors
  6. Glucagon-like peptide receptor agonist
  7. Sodium-glucose cotransporter-2 (SGLT2 Inhibitor)
A

Type 2 diabetes

53
Q

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?

A

Stage 3

54
Q

What is the leading cause of Diabetes related deaths, accounting for approximately 40% of deaths in men with diabetes and nearly 32% in women?

A

Heart disease

55
Q

What is the leading cause of new cases of blindness in patients aged 25-74 in the US?

A

Diabetic retinopathy

56
Q

Patients with diabetic retinopathy are how much more likely to become blind that a patient without this complication?

A

29 times more likely

Should have annual dilated eye exams

57
Q

What is one of the leading causes of end-stage renal disease, accounting for approximately 43% of new cases of renal failure each year?

A

Diabetic nephropathy

58
Q

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?

A

Diabetic neuropathy

59
Q

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.

A

15%

60
Q

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

A
  1. 20%

2. 60%

CLASS 22010 Endocrine (15 decks)

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