DM Flashcards
Def of dm?
Insulin structure?
Prepro insulin
Pro insulin (endoplasmic reticulum)
Insulin + C peptide (golgi apparatus of beta cells)
Insulin secretion?
5
Insulin receptor structure?
3
Mechanism of insulin transport glucose into the cells?
5
Then
Metabolism (glycolysis,lipogenesis)
Storage (glycogenesis)
Funtions of incretine?
Glucose dependent ,
- Increase insulin from beta cells (GLP-1 N GIP)
- reduce glucagon from alpha cells (GLP-1)
Diagnosis of dm?
4
Pre diabetic values?
Impaired fasting glycaemia
FPG- 5.6-7 (6.9) mmol/l
2HR PG during OGTT -7.8-11(10.9)
Factors interfere with HBA1C measurement?
- genetic varients (Hbs,Hbc)
- elevated Fhb n checmically modified derivatives of hb (carbamethylated hb in RF)
- And condition that shortens erythrocyte lifestyle (recover from blood loss,hemolytic anemia)
- IDA (high)
- ^ red cell turnover
- transfusion
- iron replacement therapy (lowers)
- late preg (high)
- in CKD, renal anemia,erythropoietin intake etc
- Dialysis (low)
Type 1 n type 2 differences?
Deficiency Age Presentation Complications at diagnosis- not in 1,25% in 2 Fhx Fasting C peptides Ab- HLA DR3 n DR4 in >90% , anti GDA (glutamic acid decarboxylase) in type 1 Genetic (1-HLA DQB1,DR3,DR4 2-TCF7L2) Association Tx
Type 1 dm features?
- Presence of 2 or more ab
- Rate of progression dependent on, age at first detection og ab,no.of ab, ab specificity,ab titer
- tupe qA had ab where as 1B has no ab
- 3stages
3 stages of type 1 dm?
Stage 1- Autoimmunity Normoglycemia Presymptomatic Multiple ab (dx)
Stage 2- Autoimmunity Dysglycemia(pre dm) Presymptomatic Multiple ab,dysglycemia (dx)
Stage 3-
New onset hyperglycemia
Symptomatic
Clinical symptoms,dm usual criteria (dx)
Causes of insulin resistance?
13
Types of dm?
Monogenic
- neonatal diabetes
- MODY (maturity onset diabetes of the young)
LADA (latent autoimmune diabetes in adults)
Gestational dm
Secondary causes
Post transplant dm
Neonatal diabetes?
<6 months of age
80-85% hv am underlying monogenic cause
MODY?
Monogenic dm (1-2%) <25 yrs AD (>2generations) Ab - C peptide + (ar dx and even after potential honeymoon period of 5yrs) Low insulin requirement 4 types (1,2,3 most common,5)
When to suspect monogenic dm?
In a setting of T1 DM,
- absent ab at presentation
- normal C peptide (even after 5yrs
- Fhx of parent having normal c peptide levels
In the settings of T2Dm,
Absence of obesity,acanthosis nigricans,PCOS
-N or high HDL (suggest 3, hdl low in mody 1)
-elevated high sensitive CRP favours T2DM over MODY
Stab,e mild fasting hyperglycemia,stable A1c netween 5.6-7.6%
LADA?
- Adult onset diabetes
- Auto ab +
- Treatable with oral hypoglycemics at onset
- need insulin within 6 months-few years (in type 1 need from beginning)
- higher titers predict earlier need for insulin
GDM?
Lifelong screening at least every 3 yrs
Use metformin/intensive lifestyle interventions in pre diabetic
Secondary causes of dm?
- Pancreatic- chronic pancreatitis,CF, hereditary hemachromatosis
- endocrine- cushings, thyrotoxicosis, phaechromocyyoma, glucanoma, acromegaly
- drugs- thiazide, beta blockers steroids
- Genetic - friedrich’s ataxia,dystropia mytonica
Criteria of testing dm?
- obese adults who have 1 or more risk factors (8)
- prediabetic-yearly
- gdm -3 yearly
- 45 yrs
- If normal should repeat min 3 yr interval
Pre diabetic mx? 3 places of prediabetic where metformin is used?
Lifestyle interventions
- 7% loss of body weight
- moderate intensity physical activity (150min/week)
- BMI:35 kg/mw
- > 60yrs
- prior GDM
long term metformin-periodic measurement of vit B12
HbA1c goals?
- diagnosis->6.5%
- diabetic <7%
- <8% if hx of hypoglycemia,elderly,complications etc
Glycemic recommendation in diabetics?
Hba1c <7
Preprandial capillary plasma glucose- 80-130 mg/dl
Peak postprandial capillary plasma glucose <180 mg/dl
