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Internal Medicine > Endocrine DM > Flashcards

Endocrine DM Flashcards

1
Q

DM diagnosis criteria

A

FPG =/>126mg/dL (8 hr)

2hr PG =/> 200mg/dL

A1C =/> 6.5%

RPG =/> 200mg/dL PLUS symptoms of hyperglycemia

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2
Q

Prediabetes

A

FPG: 100-125 mg/dL

2hr PG: 140-199 mg/dL

A1C: 5.7-6.4%

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3
Q

Normal Blood Glucose

A

FBG: <100 mg/dL

2hr PG: <140 mg/dL

A1C: 5.7%

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4
Q

T1DM

A

Beta cell destruction, immune mediated or idiopathic

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5
Q

T2DM

A

Progressive insulin secretary defect plus insulin resistance

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6
Q

Specific/secondary DM

A

T

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7
Q

GDM

A

Glucose intolerance developing during the second or third trimester (>24 weeks)

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8
Q

T2DM risk factors

A
  • 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
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9
Q

Immunologic markers of T1DM

A

Anti-GAD
IAA (insulin)
IA-2 (tyrosine phosphatase)

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10
Q

T1DM autoimmune response triggers

A 
Infections: viruses, coxackie, rubella, enteroviruses
Bovine milk protein 
Nitrosurea compounds
Microbiome
 Viramin D deficiency
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11
Q

Pathogenesis of T2DM

A

Impaired insulin secretion
Increased insulin resistance
Increased hepatic glucose production
Abnormal fat metabolism

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12
Q

C peptide

A

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.

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13
Q

Amylin

A

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

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14
Q

Metabolic syndrome/syndrome X/insulin resistance syndrome

A 
Insulin resistance 
Hypertension
Dyslipidemia 
Central/visceral obesity 
T2DM or IGT/IPG
Accelerated CVD
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15
Q

Incretin

A

R

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16
Q

The Ominous Octet for T2DM

A 
Decreased insulin secretion
Increased hepatic glucose production
Decreased glucose uptake
Increased lipolysis
Decreased incretin effect
Increased glucagon secretion
Increased glucose reabsorption (kidney)
Neurotransmitter dysfunction
17
Q

T1DM is associated with other endocrine disease such as

A

Addison’s disease
Autoimmune hypothyroidism
Pernicious anemia
Vitiligo

18
Q

T1DM

A

Beta cell destruction, immune mediated or idiopathic

19
Q

T2DM

A

Progressive insulin secretary defect plus insulin resistance

20
Q

Specific/secondary DM

A

T

21
Q

GDM

A

Glucose intolerance developing during the second or third trimester (>24 weeks)

22
Q

T2DM risk factors

A
  • 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
23
Q

Immunologic markers of T1DM

A

Anti-GAD
IAA (insulin)
IA-2 (tyrosine phosphatase)

24
Q

T1DM autoimmune response triggers

A 
Infections: viruses, coxackie, rubella, enteroviruses
Bovine milk protein 
Nitrosurea compounds
Microbiome
 Viramin D deficiency
25
Q

Symptoms of DM

A 
Polyuria 
Polydypsia (excessive thirst)
Constant hunger
Weight loss
Fatigue 
Blurred vision

*50% of T2DM patients are asymptomatic

26
Q

Physical examination of DM patients MUST

A 
BP
Eyes
Peripheral nerves 
Cardiovascular system 
Peripheral arterial disease
Foot examination
27
Q

Lab investigation of DM patients

A 
FBS
RBS
HbA1C
LFT
RFT
Lipids
ECG
Islet cell antibodies
28
Q

Sx of hypoglycemia

A

Y

29
Q

Ddx of DM (polysymptoms)

A 
Diabetes insipidus 
Resolving acute kidney necrosis 
Diuretics 
Psychogenic polydipsia
Hypothalamic disease
30
Q

Acute complications of DM

A

Hypoglycemia
DKA
HHS

31
Q

Chronic vascular complications of DM

A

Micro-vascular:
Retinopathy
Neuropathy
Nephropathy

Macro-vascular:
Coronary arterial disease
Cerebrovascular accident
Peripheral arterial disease

32
Q

Ddx of DM (polysymptoms)

A 
Diabetes insipidus 
Resolving acute kidney necrosis 
Diuretics 
Psychogenic polydipsia
Hypothalamic disease
33
Q

Acute complications of DM

A

Hypoglycemia
DKA
HHS

34
Q

Chronic vascular complications of DM

A

Micro-vascular:
Retinopathy
Neuropathy
Nephropathy

Macro-vascular:
Coronary arterial disease
Cerebrovascular accident
Peripheral arterial disease

35
Q

Chronic non-vascular complications of DM

A

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

36
Q

Wagner staging of foot ulcer

A

Grade 1-5:

  1. Superficial diabetic ulcer
  2. Ulcer extension to ligament, tendons and joint capsule. No abscess or osteomyelitis
  3. Deep ulcer with abscess and osteomyelitis
  4. Localized gangrene
  5. Extensive localized gangrene
37
Q

Symptoms of DKA

A

Nausea/vomiting
Thirst/polyuria
Abdominal pain
Shortness of breath

37
Q

Precipitating factors of DKA

A

Inadequate insulin administration
Infection (pneumonia, UTI, gastroenteritis, sepsis)
Infarction (cerebral, coronary, mesenteric, peripheral)
Drugs (cocaine)
Pregnancy

37
Q

Physical findings of DKA

A 
Tachycardia 
Dehydration/hypotension
Tachypnea/Kussmaul breathing 
Abdominal tenderness 
Lethargy, coma

Internal Medicine (10 decks)

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