Lecture 1 (Background)

Question 1

Definition of Diabetes Mellitus

Answer 1

A metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, insulin action, or both

Question 2

What are the three main hormones from the pancreas and their cells?

Answer 2

somatostatin - delta
glucagon - alpha
insulin - beta

Question 3

What is the balance with glucagon and insulin?

Answer 3

insulin is secreted when the BG is too high and tells the cells to open and take in the glucose from the blood
Glucagon is secreted when there is too low of BG and it tells the liver to produce more glucose from stores

Question 4

List the different types of DB

Answer 4

prediabetes - IGT (impaired glucose tolerance)
- IFG (impaired fasting glucose)

Type 1
Type 2

gestational diabetes

Question 5

Main cause of T1DM

Answer 5

lack of insulin secretion
autoimmune beta cell destruction
usually diagnosed young

Question 6

Explain prediabetes

Answer 6

An intermediate state between normal glucose levels and diabetes
Includes IFG (impaired fasting glucose) and IGT (impaired glucose tolerance)
Is a strong predictor of T2DM & CVD

Question 7

What is the FPG for IFG?

Answer 7

6.1-6.9

Question 8

What is 2h PG for IGT?

Answer 8

7.8-11.0

Question 9

What is A1C for prediabetes?

Answer 9

6.0-6.4

Question 10

What is the general cause of T2DM?

Answer 10

impaired insulin secretion and insulin resistance
mainly genetic and environmental factors

Question 11

What are some factors for T2DM?

Answer 11

Genetics: certain genes have been shown to determine risk for T2DM
Enviro: excessive caloric intake, sedentary lifestyle
Aging

Question 12

List as many risk factors as you can for T2DM

Answer 12

Age ≥40 years
First-degree relative with type 2 diabetes
Member of high-risk population (e.g., African, Arab, Asian, Hispanic, Indigenous or South Asian descent, low socioeconomic status)
Overweight / obesity
History of prediabetes
History of GDM
History of delivery of a macrosomic infant
Presence of end organ damage associated with diabetes:
Microvascular (retinopathy, neuropathy, nephropathy)
CV (coronary, cerebrovascular, peripheral)
Associated diseases: Acanthosis nigricans, PCOS, obstructive sleep apnea, HIV infection, psychiatric illnesses (schizophrenia, bipolar), gout, non-alcoholic steatohepatitis, cystic fibrosis, history of pancreatitis
Vascular risk factors (low HDL, high TG, hypertension, overweight/obesity, smoking)
Medications

Question 13

What is insulin resistance?

Answer 13

there is a decrease in sensitivity to the actions of insulin by the target tissues (muscle, liver, and adipocytes)

Question 14

List some clinical symptoms of T1DM

Answer 14

Usually presents as acute symptoms of short duration
Polyuria
Polyphagia
Polydipsia
Weight loss

Fatigue
Blurred vision
Infections
DKA after several days of the sx above

Question 15

List some clinical sx of T2DM

Answer 15

Is commonly discovered incidentally, as patients may be asymptomatic

May have nonspecific symptoms (i.e. fatigue) or:
polyuria
polydipsia
nocturia

May already have established diabetic complications at diagnosis

Question 16

List some risk factors for children and T2DM

Answer 16

T2DM in a first- or second-degree relative
Member of a high risk ethnic or racial group
Obesity
IGT
PCOS
Exposure to diabetes in utero
Acanthosis nigricans
Hypertension and dyslipidemia
Nonalcoholic fatty liver disease (NAFLD)
Use of atypical antipsychotic medications

Question 17

Define gestational diabetes mellitus (GDM)

Answer 17

a condition that develops during pregnancy primarily due to insulin resistance

Question 18

What does GDM increase the risk of?

Answer 18

the risk of fetal hyperinsulinemia,
heavier birth weight,
higher rates of cesarian deliveries,
and neonatal hypoglycemia

Question 19

List some risk factors of GDM

Answer 19

Previous GDM
Member of high-risk population
Previous delivery of macrosomic infant
Age ≥ 35yo
Obesity
PCOS
Acanthosis nigricans
Corticosteroid use

Question 20

Can you prevent T1DM?

Answer 20

there is some research of ideas but nothing has been confirmed

Question 21

What can prevent T2DM?

Answer 21

mainly lifestyle modifications
but also some drugs can stop it from processing into something

Question 22

When should you be screening for T2DM in adults?

Answer 22

screen q3y for >40 or people with high risk
more frequent for the more risk factors

Question 23

What is the risk assessment tool for DB?

Answer 23

CANRISK
helps to see what level of risk people have to become prediabetic or have T2DM

Question 24

What are the diagnosis for DM for FPG, A1C, and 2hPG?

Answer 24

> 7mmol/L
6.5%
11.1 mmol/L

Question 25

What is the advantages of FPG?

Answer 25

established standard
fast and easy

Question 26

What is the disadvantages of FPG?

Answer 26

inconvenient
less sensitive than OGTT

Question 27

What is the advantages of A1C?

Answer 27

convenient
better predictor of CVD
No day to day variability

Question 28

What is the disadvantages of A1C?

Answer 28

cost
not valid for all medical conditions
altered by ethnicity and aging
not to be used for children, GDM, suspected T1DM

Question 29

What is the advantages of 2hrPG?

Answer 29

established standard

Question 30

What is the disadvantages of 2hrPG?

Answer 30

inconvenient
taste
cost