Living with Diabetes

Question 1

The specific levels of glucose that define diabetes

Answer 1

Fasting (no caloric intake for >8hrs) glucose: >126 mg/dl

2-hr plasma glucose >200 mg/dl during a 75 gram oral glucose tolerance test

Symptoms of diabetes with a random plasma glucose >200 mg/dl

A HbA1C>6.5%

Question 2

Glycosylated hemoglobin (HbA1C) is a test

Answer 2

represents the average blood sugar over the preceding three months

Question 3

Symptoms of diabetes

Answer 3

Polyuria: frequent urination, and nocturia: urination at night.

Polydipsia: the osmotic diuresis caused by hyperglycemia produces excessive thirst and drinking.

Blurry vision: osmotic shifts cause swelling of the lens of the eye.

Weight loss: increased gluconeogenesis produces loss of muscle mass, increased lipolysis causes loss of fat mass.

Question 4

What are the four types of diabetes?

Answer 4

1. Type I Diabetes
2. Type II Diabetes
3. Gestational Diabetes
4. Pancreatic Diabetes

Question 5

Type 1 Diabetes (Pathophysiology and common characteristics)

Answer 5

Autoimmune destruction of beta cells in the pancreas, resulting in insulin deficiency but presumed normal insulin sensitivity

Common characteristics:

1. Usually occurs in childhood.
2. Evidence of insulin deficiency: low C-peptide.
3. Genetic contribution

Question 6

Type 2 Diabetes

Answer 6

Most common form of diabetes (90%)

Insulin resistance- Insulin secretion is present, but is not sufficient to control the blood glucose (“relative” or even absolute reduction in insulin secretion)

Common features:

1. Usually occurs in adults although more recently adolescents have been found to be affected.
2. More common in specific ethnic groups: Hispanics, African Americans, Native Americans and Pacific Islanders.
3. Affected individuals are usually overweight or obese, and risk increases with progressive weight gain over time.
4. Strong genetic component. Patients usually have a positive family history for type 2 diabetes.
5. Usually do not have ketoacidosis.
6. Caused by both insulin resistance and insulin deficiency.
7. No evidence of beta cell autoimmunity.

Question 7

Gestational Diabetes (Pathophys, adverse outcomes)

Answer 7

Pregnancy, hormonal changes, and weight gain can cause insulin resistance

May resolve after delivery but increased risk for developing type 2-diabetes in the future.

Diagnosed based on levels of glucose that increase the risk of adverse outcomes for the baby and the mother. These include:

1. Big babies (macrosomia).
2. More complications for the mother at the time of delivery.
3. Child and mother are both at risk for type 2 diabetes later in life.

Specific diagnostic criteria are different than those for other forms of diabetes

Question 8

Pancreatic Diabetes (Pathophys and unique features)

Answer 8

Unusual form of diabetes resulting from surgical removal of the pancreas or injury to the pancreas from pancreatitis.

Glucose levels high due to insulin deficiency from beta cell destruction, and so it shares many features with type 1 diabetes.

Unique features:

1. May have pancreatic malabsorption causing diarrhea, steatorrhea, and fat soluble vitamin deficiency.
2. Affected individuals may be markedly underweight.
3. Affected individuals lack glucagon in addition to insulin because of generalized pancreatic injury. This predisposes to hypoglycemia.
4. May occur in an alcoholic (associated with pancreatitis) who may have liver disease which may predispose to hypoglycemia as alcohol use also impairs gluconeogenesis.
5. As a result of these features these individuals are prone to hypoglycemia.
6. May have surprisingly bad peripheral neuropathy because of the combined neurotoxicity of alcohol and diabetes.

Question 9

Factors that predispose to high blood sugars

Answer 9

stress, increased carbohydrate intake and occasionally exercise

Question 10

Factors that predispose to low blood sugars

Answer 10

excessive glucose lowering medication use, adrenal insufficiency, and in some situations exercise