DM Flashcards
what ethnicities have increased risk for type 1? type 2?
- Higher risk for type 2 in African-American, Asian American, Latino, Native American, Pacific Islander populations
- Higher risk of type 1 in Caucasian populations
what does C peptide indicate on lab tests?
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)
geograohy is a stronger risk factor in which type of DM?
type 1
Diagnosis of Diabetes: oral glucose? fasting BS? A1C? Random plasma glucose?
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)
what are ADA guidelines for screening for DM? USPTF? Canadian DM assoc?
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
T/F: Pregnancy is accompanied by insulin resistance
true
T/F: Distance from equator increases risk overall for type 1 DM?
True
Give an example of 4 counter reg hormones that counter the effect of hypoglycemia:
Glucagon
Catecholamines
Cortisol
Growth hormone
why are diabetics at increased risk of infection?
hyperglycemia has an effect on leukocytes
who is at increased risk of diabetic nephropathy? type 1 or type 2?
type 2
what kind of urine test can tell you about micralbuminuria?
what do you give to someone with protein in urine?
Urine microalbumin/creatinine ratio corrects for urine concentration
tx with ACE-inhibitor or ARB
T/F: Hypertension is often present in patients with type 2 before diabetes diagnosis
true
T/F: Presence of renal disease correlates with presence retinopathy in type 1
true
*more variable in type 2
what are some of the cardiovascular side effects of neuropathy in DM?
Postural hypotension, syncope (fainting)
Silent ischemia
what are some of the genitourinary side effects of neuropathy in DM?
Bladder dysfunction, sexual dysfunction
Contributes to urinary infection risk
what are some commonly involved nerves affected in diabetic neuropathy?
Commonly involved nerves: oculomotor, median, radial
Duration 6 – 8 weeks
what is Diabetic amyotrophy?
Asymmetric involvement of spinal nerve root (lumbosacral)
Proximal weakness and pain
Typically resolves
what are some meds you can give for pain mgmt in DM?
1) Tricyclic antidepressants (e.g. amitriptyline – Elavil)
2) Seizure medications (e.g. pregabalin – Lyrica; gabapentin – Neurontin)
3) Topical capsaicin
what is cellulitis? what are some diabetic risk factors for it?
Infection of dermis and subcutaneous fat
1) Interruption in skin integrity
2) Impaired vascular supply
3) Poor glucose control: Impairs leukocyte function
what are some things that increase insulin receptor expression? Decrease it?
Receptor expression increased by exercise, weight loss, sulfonylureas
decreased by obesity, high insulin levels
where is Glucagon-like peptide 1 synthesized? released in response to what?
Synthesized in intestinal cells
Released in response to nutrient exposure
what are some effects of Glucagon-like peptide 1?
1) Enhances glucose-dependent insulin secretion when you eat
2) Delays gastric emptying
3) Controls postprandial glucagon
4) Diminishes appetite
Glucagon-like peptide 1 is given to tx what type of DM?
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
amylin is synthesized where?
- Synthesized in pancretic β cells
- Secreted along with insulin
- *Defective in type 2 diabetes
- *Absent in type 1 diabetes
