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Endocrinology > Disorders of the Pancreas > Flashcards

Disorders of the Pancreas Flashcards

1
Q

What condition is described below?

25% of this general non-obese nondiabetic population have insulin
resistance of a magnitude similar to that seen in type 2 diabetes

A

Insulin Resistance Syndrome

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2
Q

These insulin resistant non-diabetic individuals are at much higher
risk for developing what than insulin-sensitive subjects?

A

type 2 diabetes

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3
Q

Patients with insulin resistance syndrome are at higher risk for what other comorbidities?

A

Elevated triglycerides
Decreased HDLs
Hypertension
atherosclerosis
increased cerebrovascular and cardiac morbidity and mortality

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4
Q

What is the leading cause of kidney failure, non-traumatic lower
limb amputations, and new cases of blindness amount adults in the
United States?

A

Diabetes

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5
Q

What is a major cause of heart disease and stroke?

A

Diabetes

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6
Q

What is the seventh leading cause of death in the United States?

A

Diabetes

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7
Q

List some of the high risk populations for the development of diabetes

A

African Americans
Hispanics/Latinos
American Indians
Alaska Natives
Pacific Islanders

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8
Q

Which type of diabetes is 5-10% of diagnosed cases of diabetes?

A

Type I

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9
Q

Which type of diabetes is 90-95% diagnosed cases of diabetes?

A

Type II

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10
Q

Gestational diabetes accounts for what percentage of all U.S. pregnancies?

A

Gestational: 7% of all U.S. pregnancies

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11
Q

Normally, postprandial hyperglycemia is regulated by what?

A

Clearance of ingested glucose by the liver
Suppression of hepatic glucose production
Peripheral clearance of glucose

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12
Q

In impaired glucose tolerance or diabetes, glucose regulation is
impaired by what?

A

Delayed and reduced insulin secretion
Lack of suppression of glucagon
Hepatic and peripheral insulin resistance

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13
Q

Condition in which individuals have blood glucose or A1C levels
higher than normal but not high enough to be classified as diabetes

Increased risk of developing type 2 diabetes, heart disease, and
stroke

A

Pre-Diabetes

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14
Q

Prediabetes who do what can prevent or delay type 2 diabetes and in some cases return their blood glucose levels to normal?

A

lose weight and increase their physical activity

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15
Q

Measures of Hyperglycemia:

Reflects mean glucose over 2-3 month period

A

Hemoglobin A1c

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16
Q

Measures of Hyperglycemia:

Without regard to time of last meal

A

Random plasma glucose

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17
Q

Measures of Hyperglycemia:

Before breakfast

A

Fasting plasma glucose

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18
Q

Measures of Hyperglycemia:

Post-prandial plasma glucose

A

2 hours after a meal

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19
Q

Mainly a characteristic of insulin resistance syndrome

Features are: High serum triglyceride level: 300-400 mg/dL, Low HDL: <30mg/dL, Small dense LDL that carries supernormal quantities of cholesterol

Treatment consists of diet, exercise, and hypoglycemic control

A

Diabetic Dyslipidemia

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20
Q

In type 2 patients, successful what remains the key to achieving control of hyperglycemia, hypertension, and dyslipidemia?

A

successful weight management

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21
Q

Occurs predominately in adults, but becoming more common in
children and adolescents

90% of all diabetes

There is a deficiency in the response of pancreatic β cells to glucose

Genetic and environmental factors

A

Diabetes Type II

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22
Q

What is the most important environmental factor in diabetes type II?

A

Obesity

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23
Q

What is the pathophysiology of diabetes type II?

A

Less insulin production and resistance to open the gate (Circulating insulin is enough to prevent ketoacidosis but not to prevent hyperglycemia)

Beta cell dysfunction/loss

Insulin resistance

Hepatic sensitivity to insulin is decreased

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24
Q

List some risk factors for diabetes type II

A

Older age
Overweight (BMI ≥25 or >20% over ideal body weight)
Hypertension
Abnormal lipid levels (HLD <35, TG >250)
Family history of diabetes
History of gestational diabetes
History of vascular disease
Signs of insulin resistance
PCOS
Previous IGT or IFG (impaired)
Inactive lifestyle
Race (African Americans, Native Americans, Hispanics, Pacific Islanders)

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25
Q

List the essentials of diagnosis for diabetes type II

A

Polyuria

Polydipsia

Ketonuria and weight loss generally are uncommon at time of
diagnosis

Plasma glucose of ≥126mg/dL after an overnight fast on more than
one occasion

After 75g oral glucose, diagnostic values are ≥200mg/dL 2 hours after
the oral glucose

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26
Q

What may be the initial manifestation of diabetes type II in women?

A

Candida vaginitis

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27
Q

Visceral obesity, due to accumulation of fat in the omental and mesenteric regions, correlated with what?

A

insulin resistance

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28
Q

What A1c value is diagnostic of diabetes type II?

A

> 6.5 diagnostic for diabetes

29
Q

What class of medication(s) is described below that treats diabetes type II:

Work by stimulating the pancreas to secrete more insulin

May cause weight gain

Generally contraindicated in patients with hepatic or renal impairment

Rapidly absorbed from the intestine and is metabolized in the liver, giving it a short plasma half life which causes a brief but rapid pulse of insulin

A

Sulfonylureas

30
Q

What class of medication(s) is described below that treats diabetes type II:

Decreases both the FBG and postprandial hyperglycemia in type 2 diabetics but has not effect on FBG in normal patients

It is not bound to plasma proteins or metabolized but is excreted
unchanged by the kidneys (Make sure kidneys are functioning well)

Improves hypertriglyceridemia in obese diabetes without the weight
gain associated with insulin or sulfonylurea therapy

A

Biguanides (Metformin (Glucophage))

31
Q

What class of medication(s) is described below that treats diabetes type II:

Sensitize peripheral tissues to insulin and potentiate insulin action on muscle and adipose tissue

Liver function tests should be performed every 2 months for the first year and periodically thereafter

A

Thiazolidinediones

32
Q

In diabetes type II, what is the first line drug if kidneys are normal?

A

Biguanides (Metformin (Glucophage))

33
Q

What class of medication(s) is described below that treats diabetes type II:

Oral glucose intake causes a release of gut hormones like GLP-1
(glucagon like peptide) that amplify the glucose induced insulin release

Suppresses glucagon secretion

A

GLP-1 Receptor Agonists

DPP4 Inhibitors

34
Q

What is the A1c goal in diabetics?

A

A1c <7%

35
Q

What medication is preferred second-line medication for patients with A1c >8.5 or with symptoms of hyperglycemia despite metformin titration?

A

Insulin

36
Q

Which medication can be considered initial therapy for all patients with type 2 diabetes, particularly patients presenting with A1c >10, FPG >250, random glucose consistently >300, or ketonuria?

A

Insulin

37
Q

Which type of diabetes is described below?

25-30% are type II (Less symptomatic than type I)

African, Asian, Hispanic patients higher risk (genetic component)

Look for signs: obesity, acanthosis nigricans

Causes: increased childhood obesity

Treatment: Lifestyle modifications with family involvement – diet and exercise, Metformin

A

Maturity-Onset Diabetes of Youth (MODY)

38
Q

What are some macrovascular complications of diabetes type II?

A

Coronary heart disease
Cerebrovascular disease
Peripheral arterial disease

39
Q

What are some microvascular complications of diabetes type II?

A

Retinopathy
Nephropathy
Neuropathy

40
Q

Which type of diabetes is described below?

95% immune-mediated (Type 1a)
<5% idiopathic (Type 1b)

Pancreatic B cell destruction 🡪 variable

Ketosis occurs when untreated- Show up in ER with DKA

Most common in juveniles – can occur at any age

A

Diabetes Type I

41
Q

What is the pathophysiology of diabetes type I?

A

Severe defect in insulin production

Beta cell destruction = complete lack of insulin

Results from damage to the insulin-producing beta cells of the pancreatic islets 🡪 damage occurs over months to years and symptoms do not appear until about 90% of cells are destroyed

42
Q

What are the essentials of diagnosis for diabetes type I?

A

Polyuria, polydipsia, and weight loss associated with random plasma
glucose ≥200mg/dL (Wont see weight loss with type 2)

Plasma glucose of ≥126 mg/dL after an overnight fast, documented
on more than one occasion

Ketonemia, ketonuria, or both

Islet autoantibodies are frequently present

43
Q

What is the treatment for diabetes type I?

A

Insulin ONLY! No oral agents

44
Q

What is the most common pediatric endocrine disease?

A

Type I DM

45
Q

What is the second most common chronic illness?

A

Type I DM

46
Q

Serious complication of diabetes

Can be a presentation of diabetes type 1 or type 2 noncompliance

A

Diabetic Ketoacidosis (DKA)

47
Q

What are some risk factors for DKA?

A

Infection – 30%
Lapse in insulin administration
Recent onset diabetes
Medical illnesses
Trauma, alcohol, steroid use
idiopathic

48
Q

What percentage of Type I DM children will have at least one episode of DKA?

A

50-60% of children

49
Q

What is the pathophysiology of DKA?

A

DKA happens when the body is unable to produce enough insulin so
the body is unable to use glucose for fuel, so it breaks down fat as
alternative fuel source

Leads to a rise in ketones (toxic acid) that builds faster than usage or
excretion (Fat 🡪 free fatty acids 🡪 ketones)

Spirals down until the patient is acidotic (metabolic acidosis) and
severely dehydrated

50
Q

The most numerous ketone in DKA is what?

A

acetoacetate

51
Q

What are some early symptoms of DKA?

A

Nausea/vomiting
Polyuria
Dehydration
tachycardia
1-2 day prodrome of hyperglycemia symptoms
Fruity breath/acetone breath

52
Q

What are some late symptoms of DKA?

A

Kussmaul’s breathing
Abdominal pain/rigidity
Altered mental status/lethargy/coma
Severe dehydration

53
Q

What are the key labs in working up DKA?

A

Urinalysis: Ketonuria, Glycosuria, Look for presence of UTI – may have set off DKA

Serum glucose

Serum pH

Serum bicarb

Serum acetone

Serum potassium

54
Q

What are the essentials of diagnosis for DKA?

A

Hyperglycemia >250mg/dL

Acidosis with blood pH <7.3

Serum bicarbonate <15 meq/L

Serum positive for ketones

55
Q

What is the first treatment that needs to be given in DKA patients?

A

FLUIDS (either NS or ½ NS)

56
Q

What is the treatment for DKA?

A

FLUIDS (Restore circulating plasma volume – first and most important!)

Insulin infusion therapy as needed - 0.1 units/kg/hour

If acidosis is refractory, consider bicarbonates

Replace/monitor potassium closely

Search for precipitating cause

57
Q

Hypoglycemia is a glucose level of what?

A

Glucose <55

58
Q

List some common causes of hypoglycemia

A

Tight glucose control
Too much insulin
Too little food
Too much activity
Alcohol
Oral hypoglycemic agents
Other medications
Menstrual cycle
gastroparesis

59
Q

List some neurogenic symptoms of hypoglycemia

A

Hunger
Diaphoresis
Anxiety
Tremors
Tachycardia
palpitations

60
Q

List some neuroglycopenic symptoms of hypoglycemia

A

Behavior/cognitive changes
Drowsiness
Confusion
Blurred vision
Headaches
Amnesia
Seizures
coma

61
Q

Normal or high 0200-0300 glucose

Circadian increase in insulin resistance and insulin requirements between 0300 and 0800

Attributed to excessive GH secretion

A

Dawn phenomenon (Morning Fasting Hyperglycemia)

62
Q

Low 0200-0300 glucose

Nocturnal hypoglycemia due to excessive insulin causes a reflex
secretion of epinephrine which leads to hepatic glucose release

A

Somogyi (Rebound) Phenomenon

63
Q

High mortality rate due to insidiousness, organ dysfunction,
and delayed diagnosis

Not going to be acidotic (Blood pH >7.3)

Common etiologies: New diagnosis of diabetes in patients >65 years (30-40%), Infection (35-60%), Iatrogenic causes (10-15%)

A

Hyperosmotic Nonketotic Syndrome

64
Q

What are some signs and symptoms of Hyperosmotic Nonketotic Syndrome?

A

Symptoms:
Insidious onset of polyuria and polydipsia
Reduced fluid intake
Lethargy/confusion/coma

Signs:
Profound dehydration
Lethary/coma
Absence of Kussmaul respirations
No acetone breath odor

65
Q

List some complications of diabetes

A

Diabetic cataracts
Diabetic retinopathy
Glaucoma
Diabetic nephropathy
Gangrene of the feet
Diabetic Neuropathy
Charcot’s joint
Chronic pyogenic infections
Eruptive xanthomas
Candida infections
Necrobiosis lipoidica diabeticorum
Cardiovascular disorders (MI, stroke, atherosclerosis, PVD, etc)
Infections
Macrovascular complications

66
Q

What is the most common diabetic neuropathy type?

A

Distal symmetric polyneuropathy is the most common

67
Q

A foot condition that affects people with diabetes who lose some of the feeling in their feet due to neuropathy and crush their own bones and joints

A

Charcot’s joint

68
Q

Yellow-surfaced, irregularly shaped pretibial plaques

A

Necrobiosis lipoidica diabeticorum

Endocrinology (7 decks)

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