Disorders of the endocrine pancreas: Howell

Question 1

Type 1 DM incidence

Answer 1

-familial predisposition (HLA-D)
-sometimes after infection: cox sackie, mumps, rubella

Question 2

type 1 DM onset

Answer 2

usually in the first 2 decades of life
-first peak: 5-7 years old
2nd peak: puberty `

Question 3

type 1 dm etiology

Answer 3

autoimmune destruction of beta cells
-antibodies against those cells found in 80% of pts

Question 4

twin to twin concordance in type 1 DM

Answer 4

Less than 50% of the time the second time has the condition

Question 5

sx of type 1 DM

Answer 5

-Polydipsia, polyuria, dehydration, polyphagia, wt loss, fatigue, abdominal pain, nausea, glycosuria possible , metabolic acidosis

Question 6

dx of type 1 DM

Answer 6

-measure fasting blood glucose:
greater than 126 mg.dl after fasting on 2 occasions
-glucose is usually 300
- Glycosylated hb (HBA1C):
- Good: less than 6%, bad 9-12%

Question 7

incidence of type II DM

Answer 7

adult onset, usually
-10X more common than type 1

Question 8

twin to twin concordance in type 2 dm

Answer 8

greater than 90%, meaning that this is much more familial than type 1

Question 9

sx of type 2 DM

Answer 9

-Mostly Asx
-women may develop recurrent vaginal candidiasis

Question 10

average time to dx type 2 DM

Answer 10

usually 5-7 year lapse occurs before dx is confirmed

Question 11

clinical presentation of hyperosmolar hyperglycemic non-ketonic syndrome

Answer 11

osmotic duresis leads to dehydration

Question 12

what leads to hyperosmolar hyperglycemic non-ketonic syndrome

Answer 12

type 2 DM

Question 13

DIagnostic for hyperosmolar hyperglycemic nonketotic syndrome

Answer 13

-glucose over 1,000 mg/dl
lack of significant ketosism

Question 14

Mortality rate of hyperosmolar hyperglycemic non-ketonic syndrome

Answer 14

50% mortality rate

Question 15

Causes of DKA

Answer 15

-Complication of type 1 dm
- absolute insulin deficiency
-precipitated by stress, trauma, insulin withholding

Question 16

sx of DKA

Answer 16

abdominal pain
-severe dehydration and hypotension
-polyuria and polydipsia
-anion gap acidosis
-kussmals respirations (depp, gasping respirations)
-fruity breath
-coma

severe sx:
- cv collapse
-profound severe metabolic acidosis, hypokalemia
cerebral edema which leads to death

Question 17

labs in DKA

Answer 17

PH less than 7.3
glucose greater than 250 mg/dl
ketonuria
false hyperkalemia and false hyponatremia

Question 18

Complications of DM

Answer 18

Microvascular disease:

retinopathy : #1 prevenable cause of blindness in the US
-85% of diabetics develop retinopathy

-nephropathy: after 5 years with type 1 DM, there are detectable levels of albumin in urine

Macrovascular disease

-coronary artery disease, strokes
-peripheral neuropathic
-foot ulcers
-infections

Question 19

Dawn phenomenon

Answer 19

increase in blood glucose in the morning due to increased cortisol in the morning
- tx: increase night insulin

Question 20

Somogy effect

Answer 20

rebound hyperglycemia due to excess insulin at night
tx: decreased night insulin

Question 21

honeymoon period with Type 1 DM

Answer 21

50-70% of patients , 2-3 months after dx will require less insulin
-things seem better, this lasts about 3-6 months
-make patients aware that this does not mean the condition is cured