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Diabetes Mellitus > DM Clinical Pt. II > Flashcards

DM Clinical Pt. II Flashcards

1
Q

proinsulin is composed of

A

insulin + C peptide

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2
Q

three main locations of insulin receptors

A

fat, muscle, liver

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3
Q

insulin mediated glucose uptake is by ____ on the cell surface

A

Glucose transporter proteins (GLUT)

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4
Q

what can cause “down regulation” of insulin receptors?

A

chronically elevated levels of insulin

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5
Q

Main function of insulin is to act as a _______

A

anabolic hormone

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6
Q

how does insulin reduce hepatic glucose output?

A

inhibits gluconeogenesis and ketogenesis

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7
Q

Action of insulin in the liver

A

promotes glycogen synthesis and inhibits glycogen breakdown in the liver

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8
Q

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

A

glucagon

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9
Q

Action of glucagon

A

promotes glycogenolysis
promotes hepatic gluconeogenesis
promotes hepatic ketogenesis

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10
Q

three things that classify diabetes mellitus

A

hyperglycemia
insulin deficiency
insulin resistance

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11
Q

acute complications of DM

A

DKA

HHS

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12
Q

chronic complications of DM

A

retinopathy, nephropathy, neuropathy, atherosclerosis, vascular disease

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13
Q

4 main categories of DM

A

type 1
type 2
other specific
gestational

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14
Q

ADA criteria for diagnosing DM

A

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

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15
Q

Cause of Type 1 DM

A

autoimmune B cell destruction

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16
Q

Autoantibodies present in Type 1 DM

A

islet cell (ICA) and GAD 65

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17
Q

HLA associated with Type 1 DM

A

B8, Dw3, DR3, DR4

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18
Q

clinical symptoms of Type 1 DM

A

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

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19
Q

two specific beta cell antibodies

A

ICA (islet cell)

GAD (glutamic acid decarboxylase)

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20
Q

which antibody indicates long term diabetes?

A

GAD

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21
Q

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

A

> 90%

no HLA association

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22
Q

ethnic groups/race that most commonly get T2DM

A

blacks, hispanics, south asian immigrants

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23
Q

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

A

genome wide associated scan (GWAS)

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24
Q

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

A

26

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25
Q

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

A

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

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26
Q

insulin resistance in the liver results in

A

increase in hepatic glucose production

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27
Q

what is lost or reduced in T2DM?

A

The Incretin Effect

28
Q

Most important incretin hormone

A

GLP1

29
Q

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

A

incretin

30
Q

Non-diabetes cause of acanthosis nigricans

A

PCOS

31
Q

Which DM is ketosis prone?

A

Type 1

32
Q

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

A

< 15%

33
Q

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

A

LADA

34
Q

Insulin deficiency without true immune mechanisms

A

Type 1B

35
Q

Criteria for metabolic syndrome - need 3 or more

A 
increase waist circumference (M > 40; W > 35)
TG > 150 
HDL (M < 40; W < 50)
BP >130/>85
Fasting glucose >110
36
Q

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

A

gestational diabetes

37
Q

What causes the insulin resistance in pregnancy?

A

increase circulating levels of hormones in general

38
Q

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

A

accelerated starvation

39
Q

Perinatal complications of gestational diabetes

A

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

40
Q

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

A

40-60% risk

41
Q

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

A

30-59% risk

42
Q

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

A

Kussmaul Respirations

43
Q

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

A

infection
inadequate insulin
myocardial ischemia/infarction

44
Q

Hyperosmolar Hyperglycemic State (HHS) most commonly occurs in

A

older patients with T2DM

45
Q

What can precipitate HHS?

A

MI, stroke, infection, medication

46
Q

Which has higher mortality rate - HHS or DKA?

A

HHS

47
Q 
Lab values for DKA 
plasma glucose
serum osm
urine/serum ketones 
arterial pH
serum bicarb 
anion gap
A 
plasma glucose → > 250
serum osm → variable 
urine/serum ketones → positive 
arterial pH → < 7.3 
serum bicarb →low (< 18)
anion gap → >10 -12
48
Q 
Lab values for HHS
plasma glucose
serum osm
urine/serum ketones 
arterial pH
serum bicarb 
anion gap
A 
plasma glucose → > 600 
serum osm → > 320 
urine/serum ketones → negative 
arterial pH → > 7.30
serum bicarb  → > 15
anion gap → < 12
49
Q

microvascular complications that result form chronic DM

A

retinopathy, nephropathy, neuropathy

50
Q

macrovascular complications that result from chronic DM

A

CAD, CVD, PVD

51
Q

What will you see on eye exam of diabetic patient?

A 
microaneurysms 
cotton wool spots 
hard exudates 
macular edema 
neo-vascularization 
bleeding 
retinal detachment 
fibrovascular traction 
neovascular glaucoma
52
Q

Chronic coplications that result in nephropathy

A 
hyperfiltration
glomerular BM thickening and permeability
proteinuria
destruction of glomeruli 
decreased GFR
53
Q

Normal postprandial glucose

A

< 140

54
Q

What can cause falsely high glycohemoglobin measurements?

A

prehemaglobin A1c, carbamoylated hemoglobin, hemoglobin F

55
Q

What can falsely lower glycohemoglobin values?

A

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

56
Q

three ketones often measured in the urine or serum

A

acetoacetate
beta-hydroxybutyrate
acetone

57
Q

which ketone is the most prevalent in DKA?

A

B-hydroxybutyrate

58
Q

what is the threshold for glycosuria?

A

180

59
Q

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

A

lactose

60
Q

Urinary AER above normal but below the level of overt proteinuria

A

microalbuminuria

61
Q

Microalbuminuria is total urinary albumin excretion of ____ over 24 horus

A

30-300

62
Q

microalbuminuria is urinary albumin/creatinine ratio of

A

> 30

63
Q

Prognostic marker of increased CV mortality in T2DM patients

A

microalbuminuria

64
Q

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

A

Type 1 → within 5 years of diagnosis

Type 2 → at time of diagnosis

65
Q

procedure that can possibly cure T1DM

A

islet cell transplant

Diabetes Mellitus (4 decks)

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