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CDE & BC-ADM Test Prep > Diagnosis and Pathophysiology > Flashcards

Diagnosis and Pathophysiology Flashcards

0
Q

Acanthosis Nigricans occurs in ____% of kids with Type 2.

A

90

Most common in dark skinned obese kids

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1
Q

Skin condition with brown/black patches velvety to touch, usually behind the neck or in body folds. May be a ring around the neck.

A

Acanthosis Nigricans

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2
Q

Difference between whole blood and plasma glucose levels

A

Plasma is 10-15% higher than whole blood

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3
Q

Drugs that impair insulin secretion (and precipitate diabetes in insulin-resistant people)

A 
nicotinic acid
glucocorticoids
alpha-interferon
thiazides
Dilantin
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4
Q

What hormones antagonize insulin, and therefore excess production of them may cause diabetes?

A

Growth hormone
cortisol
glucagons
epinephrine

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5
Q

What diseases/events can lead to Diabetes?

A 
Pancreatitis
Trauma
Infection
Cancer
Hemochromatosis
Cystic Fibrosis
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6
Q

Which Viral infections may induce diabetes?

A

Congenital rubella
coxsackievirus B
cytomegalovirus
mumps

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7
Q

Genetic syndromes associated with Diabetes

A

Down syndrome
Klinefelter syndrome
Turner Syndrome

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8
Q

Impaired Fasting Glucose (IFG)

A

Fasting Plasma glucose of 100-125 mg/dl

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9
Q

Impaired Glucose Tolerance (IGT)

A

Manifested by 2 hour oral glucose tolerance test of 140 mg/dl - 199 mg/dl

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10
Q

IFG and IGT are also known as _____.

A

prediabetes

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11
Q

Diagnostic criteria for Diabetes

A

A1C >6.5

FPG >= 126 mg/dl

2 hour plasma glucose >= 200 mg/dl during Oral Glucose Tolerance Test (OGTT)

Random plasma glucose >= 200 mg/dl when patient has hyperglycemia (polydipsia and polyuria)

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12
Q

Children overweight and with 2 risk factors should be tested for Type 2 diabetes beginning at age _________ or ___________.

A

age 10 or puberty

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13
Q

Risk factors for children (Type 2):

A

Family history (1st or 2nd degree relative)

Native American, African American, Hispanic, Asian, Pacific Islander

Insulin resistance signs (acanthosis nigricans, HTN, dyslipidemia, PCOS)

Maternal history of gestational diabetes during their gestation

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14
Q

Overweight for children:

A

BMI >85th percentile for age/sex

Weight for height >85th percentile

Weight >12-30% above ideal

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15
Q

How soon should a child be retested for diabetes

A

Every 3 years

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16
Q

DPP study showed that __-__% reduction of initial body weight reduced body weight by 58%.

A

5 to 7

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17
Q

Waist circumference of __for men or __ for women is shown to be a greater predictor for diabetes risk than BMI and Body weight.

A

40 or 35

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18
Q

What percent reduction of beta cell mass is present in people with Type 2?

A

50%

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19
Q

Insulin resistance description

A

Insulin receptors, mostly in muscle and liver, are resistant. Present for years before onset hypergycemia.

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20
Q

Over production of glucose by liver/insulin resistance description

A

Normally insulin levels increasing will suppress hepatic glucose. With insulin resistance, hepatic receptors result in continued hepatic glucose production despite insulin.

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21
Q

MODY is associated with genetic defects on chromosomes __, ___, and ___.

A

7, 12, and 20

22
Q

Pathophysiology of MODY

A

Beta cell function impaired due to defects, which leads to mild hyperglycemia. Insulin secretion is impaired/insulin action and sensitivity are unaffected.

23
Q

What are Insulin and Amylin in Fuel Metabolism?

A

Glucoregulatory hormones secreted by pancreatic beta cells in response to increase in blood glucose.

24
Q

Insulin actions

A

Taken up by receptors in the peripheral and hepatic tissue, allowing glucose into cell from blood. Also inhibits glucose production liver and inhibits release of glucagon from alpha cells of the pancreas.

25
Q

Amylin actions

A

Also secreted by the pancreatic beta cells, it inhibits glucagon secretion. Also regulates appearance of glucose in blood by slowing gastric emptying (also possible appetite suppressant).

26
Q

During fasting state, blood glucose is maintained through ____ sources.

A

Hepatic

27
Q

Glucose made by the liver is made by ____.

A

gluconeogenesis

28
Q

Glycogen in liver converted to glucose is called ____.

A

glycogenolysis

29
Q

Levels of plasma insulin are ____ during “fed state” and help move glucose from the blood.

A

High

30
Q

During fed state, glucagon levels are ____.

A

Low

31
Q

Main role of glucagon

A

Stimulate gluconeogenesis.

32
Q

Post-absorptive state occurs ___ to ___ hours after food is consumed

A

4 to 16 hours

33
Q

Levels of insulin ___ as glucagon increases.

A

Decrease

34
Q

True or false, people with insulin deficiency are also amylin deficient

A

True

35
Q

What is the role of amylin?

A

Reduces postprandial hyperglucemia and cause satiety, leading to weight loss. It is secreted from beta cells with insulin.

36
Q

What is an example of an amylin analog?

A

Pramlintide (given as injection)

37
Q

What is a major concern with pramlintide?

A

Insulin induced hypoglycemia, and therefore decrease dose when starting. Also test numerous times per day.

38
Q

Which counter-regulatory hormones are responsible for producing the physical symptoms of hypoglycemia?

A

epinephrine and glucagon

39
Q

What are the symptoms of hypoglycemia?

A

palpitations, sweating, and anxiety

40
Q

What is hypoglycemic unawareness caused by?

A

Little or no release of counter-regulatory hormones, so the patient may not feel the symptoms. Or the symptoms may occur at a much lower blood glucose level

41
Q

What should happen to a patient on a bolus regimen of insulin if they have hypoglycemic unawareness?

A

Consider greater use of long-acting and smaller boluses.

42
Q

What is the goal for sick day management in Type 1 Kids?

A

Hydration and prevent severe hyperglycemia; 1/2 to 1 cup of sugar-free fluid per hour. If not eating, then fluids containing sugar should be given.

43
Q

When should ketones be checked to monitor sick day response?

A

If blood glucose >300 mg/dl. Then large amounts of ketones may mean additional insulin is needed.

44
Q

How should sick days be managed with regard to eating and insulin/medications?

A

Continue to take oral diabetes meds and insulin, even if not eating.
If not eating, drink 1/2 to 1 cup of sugar containing fluid every hour.
Stop metformin if dehydrated.

45
Q

If an insulin pump is discontinued due to surgery, what should be given and when?

A

Sub-Q or IV insulin PRIOR to discontinuation of the pump

46
Q

What happens with counter-regulatory hormones during illness in diabetics?

A

Secretion is increased, which can lead to hyperglycemia

47
Q

How should blood glucose be monitored during surgery of a insulin pump user?

A

Monitor blood glucose every 30-60 minutes and ketones checked every 4-6 hours.

48
Q

What diabetes med should be stopped 48-72 hours before surgery in Type 2?

A

chlorpropamide (longer acting sulfonylurea)

49
Q

When traveling and on insulin, what should be done with insulin therapy if time change is 3 or fewer hours?

A

Adjust timing of insulin by 1/2 hour ahead or back, depending on the direction of travel, until resumption of normal schedule

50
Q

When traveling and on insulin, what should be done with insulin therapy if traveling eastbound overseas?

A

Reduce basal insulin on day of travel as it will be shorter day. Maintain bolus regimen.

51
Q

When traveling and on insulin, what should be done with insulin therapy if traveling westbound overseas?

A

Add injections of short-acting every 4-6 hours, before meals, to compensate for the longer day

52
Q

Glipizide or glyburide: which sulfonylurea is preferred in elderly and why?

A

Glipizide, because shorter acting and fewer hepatic metabolites.
Don’t use first generation (such as tolazamide) due to long half life

53
Q

Meds not commonly used in geriatrics

A

Metformin (liver and kidney) and TZDs (haven’t been studied)

CDE & BC-ADM Test Prep (13 decks)

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