Living with Diabetes

Question 1

What is diabetes?

Answer 1

Diabetes is defined as a blood glucose that is increased to a point that it could cause microvascular disease

Question 2

How can diabetes affect the Kidneys

Answer 2

proteinuria, progressing to end stage renal failure requiring dialysis.

Question 3

How can diabetes affect the Eyes?

Answer 3

macular edema, proliferative retinopathy, bleeding, potentially
progressing to blindness.

Question 4

How can diabetes affect the Nerves?

Answer 4

pain, numbness, propensity to injury, potentially leading to amputation.

Question 5

There are 4 ways to diagnose diabetes. The method and the specific levels of glucose that define diabetes are:

Answer 5

1) Fasting (no caloric intake for >8hrs) glucose: >126 mg/dl
2) 2-hr plasma glucose: >200 mg/dl during a 75 gram oral glucose tolerance test
3) Symptoms of diabetes with a random plasma glucose: >200 mg/dl
4) HbA1C (glycosylated hemoglobin): >6.5%

Question 6

pre-diabetics have an increased risk for ______

Answer 6

macrovascular disease (coronary artery disease, cerebrovascular disease),

Question 7

pre-diabetics have an increased risk for ______

Answer 7

macrovascular disease (coronary artery disease, cerebrovascular disease), but not microvasular disease

Question 8

How is oral glucose tolerance test (OGTT) performed?

Answer 8

75 grams of glucose ingested following a fast, blood drawn every 30 minutes for 2 hours

Question 9

what is an Impaired fasting glucose level

Answer 9

100-125 mg/dl

Question 10

what is an Impaired glucose tolerance (IGT) test

Answer 10

2-hr glucose 140-199 mg/dl during an OGTT

Question 11

An HbA1C: of ____ is indicative of “pre-diabetes” or “at risk for diabetes”

Answer 11

5.7-6.4%

Question 12

As glucose rises it can exceed the renal threshold for retaining glucose. It then causes an osmotic diuresis. What the person experiences is frequent urination (______) followed by increased thirst resulting in excessive drinking (_____)

Answer 12

polyuria,

polydipsia

Question 13

why does unexplained weight loss occur in diabetics?

Answer 13

Because the body is in a catabolic state, there is a breakdown of lean body mass (release of amino acids from muscle) to support gluconeogenesis. In addition, there is a breakdown of fat through high levels of lipolysis which is normally inhibited by insulin action.

Question 14

The increased blood glucose level can also affect the shape of the lens of the eye resulting in _____

Answer 14

blurry vision

Question 15

What are the 7 characteristics of Type 1 diabetes

Answer 15

1. Usually occurs in childhood.
2. Evidence of insulin deficiency: low C-peptide.
3. Genetic contribution <50% (family history of diabetes is usually negative).
4. Blood will show positive antibody tests to islet specific antigens at disease onset (positive GAD, insulin, Zn transporter or islet cell antibodies).
5. Affected individuals are usually of normal weight.
6. Predisposed to ketoacidosis.
7. Insulin sensitive (doesn’t take much insulin to lower glucose).

Question 16

Type 1 diabetes is due to ______ . The result is insulin deficiency, but presumed normal insulin sensitivity

Answer 16

autoimmune destruction of beta cells in the pancreas

Question 17

Type 2 diabetes is the most common form of diabetes affecting ______ of all people with diabetes

Answer 17

90%

Question 18

what are the 7 characteristics of Type 2 Diabetes

Answer 18

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 19

what are the 3 adverse outcomes for the baby and the mother in gestational diabetes?

Answer 19

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.

Question 20

What is Pancreatic diabetes

Answer 20

It is an unusual form of diabetes resulting from surgical removal of the pancreas or injury to the pancreas from pancreatitis

Question 21

What are 6 unique features of pancreatic diabetes

Answer 21

1. May have pancreatic malabsorption causing diarrhea and steatorrhea (fat in the stool), 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 consumption 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 22

what are some factors that predispose to high blood sugar?

Answer 22

stress,
increased carbohydrate intake
occasionally exercise

Question 23

what are factors that predispose to low blood sugars?

Answer 23

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