Disorders of the endocrine pancreas: Howell Flashcards
Type 1 DM incidence
-familial predisposition (HLA-D)
-sometimes after infection: cox sackie, mumps, rubella
type 1 DM onset
usually in the first 2 decades of life
-first peak: 5-7 years old
2nd peak: puberty `
type 1 dm etiology
autoimmune destruction of beta cells
-antibodies against those cells found in 80% of pts
twin to twin concordance in type 1 DM
Less than 50% of the time the second time has the condition
sx of type 1 DM
-Polydipsia, polyuria, dehydration, polyphagia, wt loss, fatigue, abdominal pain, nausea, glycosuria possible , metabolic acidosis
dx of type 1 DM
-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%
incidence of type II DM
adult onset, usually
-10X more common than type 1
twin to twin concordance in type 2 dm
greater than 90%, meaning that this is much more familial than type 1
sx of type 2 DM
-Mostly Asx
-women may develop recurrent vaginal candidiasis
average time to dx type 2 DM
usually 5-7 year lapse occurs before dx is confirmed
clinical presentation of hyperosmolar hyperglycemic non-ketonic syndrome
osmotic duresis leads to dehydration
what leads to hyperosmolar hyperglycemic non-ketonic syndrome
type 2 DM
DIagnostic for hyperosmolar hyperglycemic nonketotic syndrome
-glucose over 1,000 mg/dl
lack of significant ketosism
Mortality rate of hyperosmolar hyperglycemic non-ketonic syndrome
50% mortality rate
Causes of DKA
-Complication of type 1 dm
- absolute insulin deficiency
-precipitated by stress, trauma, insulin withholding
sx of DKA
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
labs in DKA
PH less than 7.3
glucose greater than 250 mg/dl
ketonuria
false hyperkalemia and false hyponatremia
Complications of DM
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
Dawn phenomenon
increase in blood glucose in the morning due to increased cortisol in the morning
- tx: increase night insulin
Somogy effect
rebound hyperglycemia due to excess insulin at night
tx: decreased night insulin
honeymoon period with Type 1 DM
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
