Lecture 12 - DM Flashcards
Diabetes Mellitus definition
a chronic disorder characterized by hyperglycemia resulting in acute metabolic alterations and propensity towards the development of specific ophthalmic, renal and neurologic complications as well as increased risk of atherosclerotic vascular disease
Diabetes is the number 1 cause of what 3 health conditions?
blindness
renal failure
amputation
What is the difference in incidence between type 1 and 2 diabetes?
type 1 is 0.2-0.5% while type 2 is >9%
What is the difference in age of onset between type 1 and type 2 diabetes?
type 1 starts typically <30 years of age
type 2 starts >40 years of age
Ketosis is more common with type 1 or type 2?
Type 1
rare with type 2
Type 1 or type 2 has islet autoantibodies present?
Type 1
How does insulin secretion differ between type 1 and type 2?
type 1 is absent or severely impaired
type 2 is progressively impaired
Which type of DM is commonly associated with insulin resistance?
Type 2
LADA
late onset type 1 diabetes
Latent autoimmune diabetes in adults
What is the typical pt for type 1 1/2 DM?
young, obese, AA man presenting with DKA, but without permanent insulin requirement after stabilization
DKA is a marker for type 1
but these pts don’t need insulin
basically these are type 2 DM pts that present with characteristics of type 1
MODY
maturity onset diabetes of the young
autosomal dominant syndromes due to single gene mutations affecting beta cell function
How does age relate to DM?
Prevalence of DM increases with age
What metabolic effects does diabetes have on the muscle and fat?
decrease glucose uptake
What metabolic effects does diabetes have on the liver?
increase hepatic glucose production
all leading to hyperglycemia
What is the definition of insulin resistance?
impaired cellular response to the physiological effects of insulin
for ex. decreased glucose uptake by muscle in response to insulin
Insulin resistance in the presence of functioning beta cells
insulin resistance in the presence of functioning beta cells results in hyper-insulinism and only mild glucose abnormalities
When does insulin resistance start in DM pts?
Roughly 10 years before they get dx
beta cell failure continues after dx
sxs of hyperglycemia in type 1
polydipsia
blurred vision
weight loss
What are some of the less obvious risk factors for type 2 DM?
PCOS
gestational DM
more obvious ones: HTN obesity family hx sedentary lifestyle
Type 2 DM can present less obviously, with what sxs?
UTI, cellulitis, vaginal yeast
What are the dx criteria for diabetes in nonpregnant adults?
fasting plasma glucose >/= 126 mg/dl (on 2 occasions)
or
HbA1c >6.5%
or
random plasma glucose >200 mg/dl together with sxs of hyperglycemia (polyuria, polydipsia, weight loss, blurred vision)
or
2 hour plasma glucose >200 75g OGTT
How an you distinguish between type 1 and 2 DM?
Type 1 has GAD antibody
this is a better test than C-peptide because it doesn’t change with change in glucose
If you have a DM pt who is having seizures, what must their blood glucose level be?
lower than 30
HgA1C can tell you about the glucose levels over the past ____months
2-3 months
