DM

Question 1

what ethnicities have increased risk for type 1? type 2?

Answer 1

• Higher risk for type 2 in African-American, Asian American, Latino, Native American, Pacific Islander populations
• Higher risk of type 1 in Caucasian populations

Question 2

what does C peptide indicate on lab tests?

Answer 2

whether it is exogenous or endogenous insulin
(Proinsulin is cleaved into insulin + C-peptide)
Presence of C-peptide = endogenous insulin
Absence of C-peptide = exogenous insulin (injection)

Question 3

geograohy is a stronger risk factor in which type of DM?

Answer 3

type 1

Question 4

Diagnosis of Diabetes: oral glucose? fasting BS? A1C? Random plasma glucose?

Answer 4

Fasting plasma glucose > 126 mg/dl (7.0 mmol/l)

Oral glucose tolerance test OGTT (75 grams): Plasma glucose > 200 mg/dl (11.1 mmol/l) @ 2 hr

Hemoglobin A1c (glycosylated or glycated hemoglobin) > 6.5%

Random plasma glucose > 200 mg/dl (11.1 mmol/l)

Question 5

what are ADA guidelines for screening for DM? USPTF? Canadian DM assoc?

Answer 5

Test for diabetes/prediabetes:
BMI ≥ 25 + one or more additional risk factor
Otherwise begin at age 45
If normal, rescreen in 3 years

USPSTF
Screen for diabetes in adults with blood pressure > 135/80 (treated or untreated)
-Insufficient evidence for adults with normal BP

Canadian Diabetes Association
Screening adults age 40 and over every 3 years
Screen earlier and more frequently when risk factors are present

Question 6

T/F: Pregnancy is accompanied by insulin resistance

Answer 6

true

Question 7

T/F: Distance from equator increases risk overall for type 1 DM?

Answer 7

True

Question 8

Give an example of 4 counter reg hormones that counter the effect of hypoglycemia:

Answer 8

Glucagon
Catecholamines
Cortisol
Growth hormone

Question 9

why are diabetics at increased risk of infection?

Answer 9

hyperglycemia has an effect on leukocytes

Question 10

who is at increased risk of diabetic nephropathy? type 1 or type 2?

Answer 10

type 2

Question 11

what kind of urine test can tell you about micralbuminuria?

what do you give to someone with protein in urine?

Answer 11

Urine microalbumin/creatinine ratio corrects for urine concentration

tx with ACE-inhibitor or ARB

Question 12

T/F: Hypertension is often present in patients with type 2 before diabetes diagnosis

Answer 12

true

Question 13

T/F: Presence of renal disease correlates with presence retinopathy in type 1

Answer 13

true

*more variable in type 2

Question 14

what are some of the cardiovascular side effects of neuropathy in DM?

Answer 14

Postural hypotension, syncope (fainting)

Silent ischemia

Question 15

what are some of the genitourinary side effects of neuropathy in DM?

Answer 15

Bladder dysfunction, sexual dysfunction

Contributes to urinary infection risk

Question 16

what are some commonly involved nerves affected in diabetic neuropathy?

Answer 16

Commonly involved nerves: oculomotor, median, radial

Duration 6 – 8 weeks

Question 17

what is Diabetic amyotrophy?

Answer 17

Asymmetric involvement of spinal nerve root (lumbosacral)
Proximal weakness and pain
Typically resolves

Question 18

what are some meds you can give for pain mgmt in DM?

Answer 18

1) Tricyclic antidepressants (e.g. amitriptyline – Elavil)
2) Seizure medications (e.g. pregabalin – Lyrica; gabapentin – Neurontin)
3) Topical capsaicin

Question 19

what is cellulitis? what are some diabetic risk factors for it?

Answer 19

Infection of dermis and subcutaneous fat

1) Interruption in skin integrity
2) Impaired vascular supply
3) Poor glucose control: Impairs leukocyte function

Question 20

what are some things that increase insulin receptor expression? Decrease it?

Answer 20

Receptor expression increased by exercise, weight loss, sulfonylureas
decreased by obesity, high insulin levels

Question 21

where is Glucagon-like peptide 1 synthesized? released in response to what?

Answer 21

Synthesized in intestinal cells

Released in response to nutrient exposure

Question 22

what are some effects of Glucagon-like peptide 1?

Answer 22

1) Enhances glucose-dependent insulin secretion when you eat
2) Delays gastric emptying
3) Controls postprandial glucagon
4) Diminishes appetite

Question 23

Glucagon-like peptide 1 is given to tx what type of DM?

Answer 23

Approved for monotherapy or add-on therapy in type 2

**Degraded by dipeptidyl peptidase IV enzyme
DPP-IV inhibitors are approved for diabetes type 2 Rx

Question 24

amylin is synthesized where?

Answer 24

• Synthesized in pancretic β cells
• Secreted along with insulin
• *Defective in type 2 diabetes
• *Absent in type 1 diabetes

Question 25

what are some effects of amylin? which type of DM can you give it to?

Answer 25

1) Delays gastric emptying
2) Promotes satiety
3) Controls post-prandial glucagon secretion
* *Indicated only for patients in insulin, Can be used in type 1 or type 2 diabetes

Question 26

Sulfonylureas

Answer 26

enhance insulin secretion

Question 27

Meglitinides

Answer 27

enhance insulin secretion (rapid-acting)

Question 28

Biguanides

Answer 28

lower hepatic glucose production, increase insulin sensitivity

Question 29

Thiazolidinediones

Answer 29

increase insulin sensitivity

Question 30

Alpha glucosidase inhibitors

Answer 30

inhibit intestinal a-glucosidases

delay starch absorption

Question 31

Symptoms usually occur when plasma glucose __mg/dl

Answer 31

Symptoms usually occur when plasma glucose < 55 mg/dl

Question 32

what are some signs/symptoms of hypoglycemia?

Answer 32

Symptoms due to sympathetic neuronal activation:
-Tremor
-Palpitations/tachycardia
-Anxiety				
-Hunger
-Sweating				
-Numbness/tingling  
-Mydriasis				
-Pallor 
Neuroglycopenic symptoms:
-Headache				
-Somnolence
-Weakness				
-Incoordination
-Confusion
-Blurred vision
-Seizures          			
-Psychosis 
-Coma 					
-Death (uncommon)