Endocrine DM Flashcards
DM diagnosis criteria
FPG =/>126mg/dL (8 hr)
2hr PG =/> 200mg/dL
A1C =/> 6.5%
RPG =/> 200mg/dL PLUS symptoms of hyperglycemia
Prediabetes
FPG: 100-125 mg/dL
2hr PG: 140-199 mg/dL
A1C: 5.7-6.4%
Normal Blood Glucose
FBG: <100 mg/dL
2hr PG: <140 mg/dL
A1C: 5.7%
T1DM
Beta cell destruction, immune mediated or idiopathic
T2DM
Progressive insulin secretary defect plus insulin resistance
Specific/secondary DM
T
GDM
Glucose intolerance developing during the second or third trimester (>24 weeks)
T2DM risk factors
- family history
- obesity (BMI>25)
- physical inactivity
- race/ethnicity
- prediabetes
- history of GDM or delivery of baby >4kg
- hypertension
- HDL <35, triglyceride >250mg/dL
- polycystic ovarian syndrome, acanthodians nigricans
- history of CVD
Immunologic markers of T1DM
Anti-GAD
IAA (insulin)
IA-2 (tyrosine phosphatase)
T1DM autoimmune response triggers
Infections: viruses, coxackie, rubella, enteroviruses Bovine milk protein Nitrosurea compounds Microbiome Viramin D deficiency
Pathogenesis of T2DM
Impaired insulin secretion
Increased insulin resistance
Increased hepatic glucose production
Abnormal fat metabolism
C peptide
C-peptide is a substance made in the pancreas, along with insulin.
C-peptide test can show how much insulin your body is making.
Good way to measure the level of insulin bc it tends to stay in the body longer.
Amylin
Peptide hormone that is consecrated with insulin.
Inhibits glucagon secretion, slows gastric emptying and promoted satiety (satiety hormone) -> prevents post prandial spikes in blood glucose level
Forms amyloid fibrillation deposit in islet cells
Metabolic syndrome/syndrome X/insulin resistance syndrome
Insulin resistance Hypertension Dyslipidemia Central/visceral obesity T2DM or IGT/IPG Accelerated CVD
Incretin
R
The Ominous Octet for T2DM
Decreased insulin secretion Increased hepatic glucose production Decreased glucose uptake Increased lipolysis Decreased incretin effect Increased glucagon secretion Increased glucose reabsorption (kidney) Neurotransmitter dysfunction
T1DM is associated with other endocrine disease such as
Addison’s disease
Autoimmune hypothyroidism
Pernicious anemia
Vitiligo
T1DM
Beta cell destruction, immune mediated or idiopathic
T2DM
Progressive insulin secretary defect plus insulin resistance
Specific/secondary DM
T
GDM
Glucose intolerance developing during the second or third trimester (>24 weeks)
T2DM risk factors
- family history
- obesity (BMI>25)
- physical inactivity
- race/ethnicity
- prediabetes
- history of GDM or delivery of baby >4kg
- hypertension
- HDL <35mg/dL, triglyceride >250mg/dL
- polycystic ovarian syndrome, acanthosis nigricans
- history of CVD
Immunologic markers of T1DM
Anti-GAD
IAA (insulin)
IA-2 (tyrosine phosphatase)
T1DM autoimmune response triggers
Infections: viruses, coxackie, rubella, enteroviruses Bovine milk protein Nitrosurea compounds Microbiome Viramin D deficiency
Symptoms of DM
Polyuria Polydypsia (excessive thirst) Constant hunger Weight loss Fatigue Blurred vision
*50% of T2DM patients are asymptomatic
Physical examination of DM patients MUST
BP Eyes Peripheral nerves Cardiovascular system Peripheral arterial disease Foot examination
Lab investigation of DM patients
FBS RBS HbA1C LFT RFT Lipids ECG Islet cell antibodies
Sx of hypoglycemia
Y
Ddx of DM (polysymptoms)
Diabetes insipidus Resolving acute kidney necrosis Diuretics Psychogenic polydipsia Hypothalamic disease
Acute complications of DM
Hypoglycemia
DKA
HHS
Chronic vascular complications of DM
Micro-vascular:
Retinopathy
Neuropathy
Nephropathy
Macro-vascular:
Coronary arterial disease
Cerebrovascular accident
Peripheral arterial disease
Ddx of DM (polysymptoms)
Diabetes insipidus Resolving acute kidney necrosis Diuretics Psychogenic polydipsia Hypothalamic disease
Acute complications of DM
Hypoglycemia
DKA
HHS
Chronic vascular complications of DM
Micro-vascular:
Retinopathy
Neuropathy
Nephropathy
Macro-vascular:
Coronary arterial disease
Cerebrovascular accident
Peripheral arterial disease
Chronic non-vascular complications of DM
GI: gastroparesis, diarrhea
GU: Uropathy, sexual dysfunction
Dermatological: Skin ulcers, hypopigmentation
Infections: Respiratory, UTI, ear, GI, bone
Cataract
Glaucoma
Periodontal disease: Tooth decay, tooth loss
Wagner staging of foot ulcer
Grade 1-5:
- Superficial diabetic ulcer
- Ulcer extension to ligament, tendons and joint capsule. No abscess or osteomyelitis
- Deep ulcer with abscess and osteomyelitis
- Localized gangrene
- Extensive localized gangrene
Symptoms of DKA
Nausea/vomiting
Thirst/polyuria
Abdominal pain
Shortness of breath
Precipitating factors of DKA
Inadequate insulin administration
Infection (pneumonia, UTI, gastroenteritis, sepsis)
Infarction (cerebral, coronary, mesenteric, peripheral)
Drugs (cocaine)
Pregnancy
Physical findings of DKA
Tachycardia Dehydration/hypotension Tachypnea/Kussmaul breathing Abdominal tenderness Lethargy, coma
