Lec 15 Diabetes Flashcards
What are 3 diagnostic criteria for diabetes?
- fasting plasma glucose > 126 mg/dl
- 2hr post-load plasma glucose > 200 mg/dl
- HbA1c > 6.5%
What is the HbA1c cutoff for pre-diabetes? diabetes?
pre-diabetes = 5.7-6.4% diabetes = >6.5%
What are the diabetes and pre-diabetes cutoffs for 2hr post-load plasma glucose?
pre-diabetes = 140-199 mg/dl diabetes = > 200 mg/dl
What is the fasting plasma glucose cutoff for pre-diabetes? diabetes?
pre-diabetes = 100-125 mg/dl diabetes = > 126 mg/dl
What is the primary aim of DM2 therapy?
weight reduction
What is best technique for dietary weight loss?
reduce calories 500-1000 kcal –> lose 1 to 2 pound a week
What is insulin secretion level of pts at time of DM2 diagnosis?
variable; often high but have high insulin resistance
What are 5 risk factors for diabetes that you cannot change?
- increasing age
- family history
- race or ethnicity [more common in black, latino, native american, pacific islanders]
- gestational diabetes
- having baby weigh 9+ lbs at birth
What are 2 risk factors for diabetes that you can change?
- inactive lifestyle
- overweight
What are some complications associated with obesity and metabolic syndrome?
- type 2 DM
- hypertension
- hyperlipidemia
- cardiovascular disease
- hepatobiliary disease
- osteoarthritis
- sleep apnea and asthma
- stroke
- PCOS
What is the etiology of type 2 diabetes?
- impaired pancreatic insulin secretion + beta cell insensitivity to blood glucose concentrations
- continued hepatic glucose production even in face of hyperglycemia
- reduced glucose uptake into muscle and adipose tissue
What is the effect of prolonged hyperglycemia in someone with diabetes?
- sorbitol accumulation
- formation advanced glycation end products [AGE]
- activation of protein kinase C
- oxidative stress
- increased angiogenic factors [VEGF]
What are microvascular complications of diabetes?
- retinopathy
- neuropathy
- nephropathy
What are 3 macrovascular complications of diabetes?
- cerebral vascular disease
- coronary heart disease
- peripheral vascular disease
What is relationship cardiovascular disease and diabetes?
80% of adults with DM2 get CVD
- men 2x risk of CVD compared to non-diabetic man
- women 3x risk of CVD compared with non-diabetic woman
- high risk CVD begins at younger age in diabetes [men 41, women 48]
WHat is leading cause of death in adults with dibaetes?
CVD
What are risk factors for cardiovascular disease other than diabetes?
- hyperglycemia
- dyslipidemia
- hypertension
- tobacco use
- microalbuminuria
- overweight
- genetic/family history
What are signs of peripheral vascular disease?
claudication = leg pain with walking
How do you prevent peripheral artery disease in pt with diabetes?
- exercise
- glycemic control
- smoking cessation
- lipid control
- BP control
What fibers are effected in diabetic neuropathy?
loss of proprioception = large fiber
loss of vibration = large fiber
loss of sensation = small fiber
symmetric in a glove/stocking distribution
What is the most common microvascular complication of DM?
diabetic retinopathy
What is effect of DM retinopathy?
can lead to blindness
after 10 years of disease seen in 50% of DM1 and 10% of Dn2
proliferative retinopathy –> vitreous hemorrhage, tractional retinal detachment, diabetic macular edma + severe loss of vision
What is course of diabetic nephropathy?
renal dysfunction begins at glomeruli with mesangial expansion, thickening of glomerular basement membrane, and glomerular sclerosis
may be asymptomatic 5-10 years before symptoms start
How do you screen for diabetic nephropathy
urine microalbumin test = increased protein excretion is earliest sign of diabetic kidney disease
What are contributing factors to diabetic nephropathy?
- hyperglycemia
- hypertension
- smoking
- longer duration of diabetes [onset before 20 yo]
