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Endocrine > Lec 15 Diabetes > Flashcards

Lec 15 Diabetes Flashcards

1
Q

What are 3 diagnostic criteria for diabetes?

A
  • fasting plasma glucose > 126 mg/dl
  • 2hr post-load plasma glucose > 200 mg/dl
  • HbA1c > 6.5%
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2
Q

What is the HbA1c cutoff for pre-diabetes? diabetes?

A 
pre-diabetes = 5.7-6.4%
diabetes = >6.5%
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3
Q

What are the diabetes and pre-diabetes cutoffs for 2hr post-load plasma glucose?

A 
pre-diabetes = 140-199 mg/dl
diabetes = > 200 mg/dl
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4
Q

What is the fasting plasma glucose cutoff for pre-diabetes? diabetes?

A 
pre-diabetes = 100-125 mg/dl
diabetes = > 126 mg/dl
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5
Q

What is the primary aim of DM2 therapy?

A

weight reduction

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6
Q

What is best technique for dietary weight loss?

A

reduce calories 500-1000 kcal –> lose 1 to 2 pound a week

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7
Q

What is insulin secretion level of pts at time of DM2 diagnosis?

A

variable; often high but have high insulin resistance

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8
Q

What are 5 risk factors for diabetes that you cannot change?

A
  • 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
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9
Q

What are 2 risk factors for diabetes that you can change?

A
  • inactive lifestyle

- overweight

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10
Q

What are some complications associated with obesity and metabolic syndrome?

A
  • type 2 DM
  • hypertension
  • hyperlipidemia
  • cardiovascular disease
  • hepatobiliary disease
  • osteoarthritis
  • sleep apnea and asthma
  • stroke
  • PCOS
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11
Q

What is the etiology of type 2 diabetes?

A
  • 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
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12
Q

What is the effect of prolonged hyperglycemia in someone with diabetes?

A
  • sorbitol accumulation
  • formation advanced glycation end products [AGE]
  • activation of protein kinase C
  • oxidative stress
  • increased angiogenic factors [VEGF]
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13
Q

What are microvascular complications of diabetes?

A
  • retinopathy
  • neuropathy
  • nephropathy
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14
Q

What are 3 macrovascular complications of diabetes?

A
  • cerebral vascular disease
  • coronary heart disease
  • peripheral vascular disease
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15
Q

What is relationship cardiovascular disease and diabetes?

A

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]
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16
Q

WHat is leading cause of death in adults with dibaetes?

A

CVD

17
Q

What are risk factors for cardiovascular disease other than diabetes?

A
  • hyperglycemia
  • dyslipidemia
  • hypertension
  • tobacco use
  • microalbuminuria
  • overweight
  • genetic/family history
18
Q

What are signs of peripheral vascular disease?

A

claudication = leg pain with walking

19
Q

How do you prevent peripheral artery disease in pt with diabetes?

A
  • exercise
  • glycemic control
  • smoking cessation
  • lipid control
  • BP control
20
Q

What fibers are effected in diabetic neuropathy?

A

loss of proprioception = large fiber
loss of vibration = large fiber
loss of sensation = small fiber

symmetric in a glove/stocking distribution

21
Q

What is the most common microvascular complication of DM?

A

diabetic retinopathy

22
Q

What is effect of DM retinopathy?

A

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

23
Q

What is course of diabetic nephropathy?

A

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

24
Q

How do you screen for diabetic nephropathy

A

urine microalbumin test = increased protein excretion is earliest sign of diabetic kidney disease

25
Q

What are contributing factors to diabetic nephropathy?

A
  • hyperglycemia
  • hypertension
  • smoking
  • longer duration of diabetes [onset before 20 yo]

Endocrine (21 decks)

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