Guide to Diabetes - Ch1

Question 1

How many people in US have Diabetes? How many have Prediabetes?

Answer 1

29 million in US have diabetes. 86 million have Prediabetes.

Question 2

What is prediabetes?

Answer 2

1. Increased glucose levels
2. Impaired gluocose tolerance
3. Doesn’t meet Dx criteria for Diabetes

There is a higher risk of progressing to full Diabetes

Question 3

What is the Diagnostic criteria for Diabetes?

Answer 3

Fasting blood glucose of 100- 125 mg/dL
2 Hr Oral Blood glucose test of 140 - 199 mg/dL
A1C blood test of 5.7 - 6.4%

Question 4

What is the A1C blood test?

Answer 4

It is a test to measure Blood glucose level from the last 2- 3 months

Question 5

What do Education classes for Pre Diabetes focus on?

Answer 5

1. Pathophysiology of Pre DM and progression to full Diabetes
2. Healthy eatings
3. Regular physical activity and exercise
4. Stress management

Thee factors can affect and reduce conversion rate to full Diabetes.

See also National Diabetes Prevention Program

Question 6

What are the 4 types of Diabetes?

Answer 6

1. T!DM
2. T1DM
3. GDM
4. Other

Question 7

What is Type 1 Diabetes?

Answer 7

T1DM aka Juvenile onset, or Insulin dependent.
Results from B Cell destruction.
Creates an absolute Insulin deficiency.

Question 8

What is Type 2 Diabetes?

Answer 8

T2DM aka MAture/ adult onset
Results from progressive insulin secretory deficit, reduced insulin function, increased insulin resistance.
Non insulin dependent form of Diabetes.

Question 9

What is GDM?

Answer 9

Stands for Gestational Diabetes, usually diagnosed during pregnancy.

Question 10

What other forms of DM are there?

Answer 10

Medication induced (ie steroids)
Chemically induced
Genetic defects in B Cell function
Dz in exocrine Pancrease
<5% , monogenic DM syndromes (neonatal or maturity onset)

Question 11

How does the ADA Dx Diabetes?

Answer 11

The American Diabetes Association has multiple ways to Dz.

1. Fasting PLasma glucose >= 126 mg/dL
2. Casual plasma glucose >= 200 mg/dL
3. OGTT w 2He plasma glucose >= 200 mg/dL using glucose load of 75g.

Question 12

What is the basic function of Insulin?

Answer 12

It activates transport of glucose form bloodstream to the cells.

Question 13

What could happen without Insulin?

Answer 13

hyperglycemia, ketoacidosis, coma and death

Question 14

What percentage of Diabetics have Type 1?

Answer 14

about 5- 10%.

Question 15

What is the cause of Type 1 DM?

Answer 15

A lack of insulin due to autoimmune destruction of insulin producing B cells in the pancreas.

Question 16

What is the Tx for T1DM?

Answer 16

insulin, meal planning and exercise

Question 17

What percentage of Diabetics have Type 2?

Answer 17

about 90 - 95%

Question 18

Who has T1DM?

Answer 18

Children, adolescents or adults. May be acute onset, but can also develop over years.

Question 19

Who has T2DM?

Answer 19

Historically, pts over 40 yo. But over the last decade, seeing an increase in adolescent Dx r/t Obesity.

Question 20

What is the condition for T2DM?

Answer 20

Insulin resistance and impaired insulin production can cause hyperglycemia.
Pts often have Hypertension, hyperlipidemia, and central or truncal obesity.

Question 21

What is the Tx for T2DM?

Answer 21

Meal planning, exercise, and if Blood sugar is not controlled, Oral DM medication or Insulin.

Question 22

Whats the key difference between T1DM and T2DM?

Answer 22

T1DM is insulin dependent. T2DM is Insulin requiring (body still makes insulin, it just doesn’t work as well)

Question 23

What happens in GDM?

Answer 23

Gestational DM is associated with pregnancy induced insulin resistance.
Continued hyperglycemia during pregnancy can lead to
- Macrosomia (big baby)
- hypoglycemia of newborn.

Question 24

How do you Tx GDM?

Answer 24

Strict blood glucose control during pregnancy can lead to health newborn being born.
Tx includes meal planning, blood glucose monitoring, moderate exercise, and sometims insulin or Oral hypoglecemic agents.

Question 25

What goes into Diabetes Managment?

Answer 25

In a nutshell, Management of blood glucose level to treat hyperglycemia.
Each pt has personalized Blood glucose range, the Tx helps keep the blood in that range.
ADA recommends minimal of Biannual A1C test. (goal <= %7.
If comorbidities or limited life expectancy, less stringent range is ok, like <= %8.

Question 26

What kind of complications can Blood Glucose management prevent?

Answer 26

Long term complications of Cardiovascular, kidney, eye disease, neuropathy

Question 27

Summarize the DCCT - Diabetes Control and Complications Trial.

Answer 27

1993, National Inst of Health did the largest most comprehensive study on DM tx.
Comparing Intensive vs Conventional DM tx, Intensive Tx had greater success in preventing complications vs Conventional Tx.

Question 28

What goes into Intensive Tx for T1DM according to the DCCT Study?

Answer 28

3-4 Insulin injxn / day or an Insulin pump
3-4 Blood glucose monitoring / day
Healthy meal and exercise plan
Monthly evaluation by Diabetes Tx team

Question 29

What goes into Conventional Tx for T1DM according to DCCT study?

Answer 29

1-2 Injection/ day
1/day Blood glucose monitoring
Standard meal planning and exercise.

Question 30

What were the results of the DCCT?

Answer 30

In the Intensive vs Conventional Tx group:
Blood Glucose:
155 mg/dL vs 231 mg/dL

Dev Retinopathy:
23 pts vs 91 pts

Dev Neuropathy:
3% pts vs 10% pts

Shows strong correlation of Blood Glucose Control and Prevention of Complications

Question 31

Summarize the UK Prospective Diabetes Study

Answer 31

Showed similar results as DCCT, but for T2DM and A1C test.

Question 32

What are the Key risk factors for DM?

Answer 32

Age > 40
Overweight
Family Hx of DM
S/S of hyperglycemia

Question 33

What are the S/S of Hyperglycemia

Answer 33

Fatigue, thirst, hunger, frequent urination, blurry vision, reduced wound healing, numb or reduced sensation in extremities.