DM Clinical Pt. II

Question 1

proinsulin is composed of

Answer 1

insulin + C peptide

Question 2

three main locations of insulin receptors

Answer 2

fat, muscle, liver

Question 3

insulin mediated glucose uptake is by ____ on the cell surface

Answer 3

Glucose transporter proteins (GLUT)

Question 4

what can cause “down regulation” of insulin receptors?

Answer 4

chronically elevated levels of insulin

Question 5

Main function of insulin is to act as a _______

Answer 5

anabolic hormone

Question 6

how does insulin reduce hepatic glucose output?

Answer 6

inhibits gluconeogenesis and ketogenesis

Question 7

Action of insulin in the liver

Answer 7

promotes glycogen synthesis and inhibits glycogen breakdown in the liver

Question 8

This structure is metabolized by the A cells in the islet of Langerhans

Answer 8

glucagon

Question 9

Action of glucagon

Answer 9

promotes glycogenolysis
promotes hepatic gluconeogenesis
promotes hepatic ketogenesis

Question 10

three things that classify diabetes mellitus

Answer 10

hyperglycemia
insulin deficiency
insulin resistance

Question 11

acute complications of DM

Answer 11

DKA

HHS

Question 12

chronic complications of DM

Answer 12

retinopathy, nephropathy, neuropathy, atherosclerosis, vascular disease

Question 13

4 main categories of DM

Answer 13

type 1
type 2
other specific
gestational

Question 14

ADA criteria for diagnosing DM

Answer 14

A1c > 6.5%
FPG > 126
OGTT > 200
Random plasma glucose > 200

Question 15

Cause of Type 1 DM

Answer 15

autoimmune B cell destruction

Question 16

Autoantibodies present in Type 1 DM

Answer 16

islet cell (ICA) and GAD 65

Question 17

HLA associated with Type 1 DM

Answer 17

B8, Dw3, DR3, DR4

Question 18

clinical symptoms of Type 1 DM

Answer 18

polydipsia, polyuria, nocturia, enuresis, polyphagia, blurred vision, weight loss, fatigue, infections

Question 19

two specific beta cell antibodies

Answer 19

ICA (islet cell)

GAD (glutamic acid decarboxylase)

Question 20

which antibody indicates long term diabetes?

Answer 20

GAD

Question 21

Concordence of T2DM in monozygotic twins and is there an HLA association?

Answer 21

> 90%

no HLA association

Question 22

ethnic groups/race that most commonly get T2DM

Answer 22

blacks, hispanics, south asian immigrants

Question 23

approach that involves rapidly scanning markers across the complete sets of DNA/genomes of people to find find genetic variations associated with a particular disease

Answer 23

genome wide associated scan (GWAS)

Question 24

As of 2011 how many type 2 diabetes susceptibility loci are there?

Answer 24

26

Question 25

what occurs in the adipose tissue due to the resistance to the effects of insulin?

Answer 25

increased lipolysis → elevated plasma free fatty acids (FFA) → increase in hepatic glucose production and decrease in glucose uptake in muscles

Question 26

insulin resistance in the liver results in

Answer 26

increase in hepatic glucose production

Question 27

what is lost or reduced in T2DM?

Answer 27

The Incretin Effect

Question 28

Most important incretin hormone

Answer 28

GLP1

Question 29

hormone in the gut that is released in response to food → "entero-insular axis"

Answer 29

incretin

Question 30

Non-diabetes cause of acanthosis nigricans

Answer 30

PCOS

Question 31

Which DM is ketosis prone?

Answer 31

Type 1

Question 32

what percentage of patients with T1DM have family history of the disease?

Answer 32

< 15%

Question 33

This DM is subset of T1DM that presents later on in life

Answer 33

LADA

Question 34

Insulin deficiency without true immune mechanisms

Answer 34

Type 1B

Question 35

Criteria for metabolic syndrome - need 3 or more

Answer 35

``` increase waist circumference (M > 40; W > 35) TG > 150 HDL (M < 40; W < 50) BP >130/>85 Fasting glucose >110 ```

Question 36

carbohydrate intolerance of varying severity with onset or first recognition during pregnancy

Answer 36

gestational diabetes

Question 37

What causes the insulin resistance in pregnancy?

Answer 37

increase circulating levels of hormones in general

Question 38

rapid shift to fasting or food deprived states to products of fast metabolism, with increase in serum and urinary ketones

Answer 38

accelerated starvation

Question 39

Perinatal complications of gestational diabetes

Answer 39

excessive fetal growth, should dystocia and traumatic birth, hypoglycemia, hypocalcemia, polycythemia, hyperbilirubinemia

Question 40

A woman who gets gestational diabetes is at what risk of subsequently developing diabetes?

Answer 40

40-60% risk

Question 41

A woman who gets GDM is at what risk of getting GDM in another pregnancy?

Answer 41

30-59% risk

Question 42

What type of breathing will you see in a patient in DKA?

Answer 42

Kussmaul Respirations

Question 43

30-50% of DKA cases are caused by: 20-40% of DKA cases are caused by: 3-6% are caused by:

Answer 43

infection inadequate insulin myocardial ischemia/infarction

Question 44

Hyperosmolar Hyperglycemic State (HHS) most commonly occurs in

Answer 44

older patients with T2DM

Question 45

What can precipitate HHS?

Answer 45

MI, stroke, infection, medication

Question 46

Which has higher mortality rate - HHS or DKA?

Answer 46

HHS

Question 47

``` Lab values for DKA plasma glucose serum osm urine/serum ketones arterial pH serum bicarb anion gap ```

Answer 47

``` plasma glucose → > 250 serum osm → variable urine/serum ketones → positive arterial pH → < 7.3 serum bicarb →low (< 18) anion gap → >10 -12 ```

Question 48

``` Lab values for HHS plasma glucose serum osm urine/serum ketones arterial pH serum bicarb anion gap ```

Answer 48

``` plasma glucose → > 600 serum osm → > 320 urine/serum ketones → negative arterial pH → > 7.30 serum bicarb → > 15 anion gap → < 12 ```

Question 49

microvascular complications that result form chronic DM

Answer 49

retinopathy, nephropathy, neuropathy

Question 50

macrovascular complications that result from chronic DM

Answer 50

CAD, CVD, PVD

Question 51

What will you see on eye exam of diabetic patient?

Answer 51

``` microaneurysms cotton wool spots hard exudates macular edema neo-vascularization bleeding retinal detachment fibrovascular traction neovascular glaucoma ```

Question 52

Chronic coplications that result in nephropathy

Answer 52

``` hyperfiltration glomerular BM thickening and permeability proteinuria destruction of glomeruli decreased GFR ```

Question 53

Normal postprandial glucose

Answer 53

< 140

Question 54

What can cause falsely high glycohemoglobin measurements?

Answer 54

prehemaglobin A1c, carbamoylated hemoglobin, hemoglobin F

Question 55

What can falsely lower glycohemoglobin values?

Answer 55

hemaglobinopathies, reduced RBC life span (hemolysis, blood loss)

Question 56

three ketones often measured in the urine or serum

Answer 56

acetoacetate beta-hydroxybutyrate acetone

Question 57

which ketone is the most prevalent in DKA?

Answer 57

B-hydroxybutyrate

Question 58

what is the threshold for glycosuria?

Answer 58

180

Question 59

What sugar can you find in the urine during late pregnancy and lactation?

Answer 59

lactose

Question 60

Urinary AER above normal but below the level of overt proteinuria

Answer 60

microalbuminuria

Question 61

Microalbuminuria is total urinary albumin excretion of ____ over 24 horus

Answer 61

30-300

Question 62

microalbuminuria is urinary albumin/creatinine ratio of

Answer 62

> 30

Question 63

Prognostic marker of increased CV mortality in T2DM patients

Answer 63

microalbuminuria

Question 64

when should you screen for chronic complications in Type 1 and Type 2 DM patient?

Answer 64

Type 1 → within 5 years of diagnosis | Type 2 → at time of diagnosis

Question 65

procedure that can possibly cure T1DM

Answer 65

islet cell transplant