Other types of diabetes Flashcards
metabolic syndrome
-aka Syndrome X
-Coexisting hypertension
-Central obesity
-Dyslipidemia (high TG; low-HDL):
-With or without hyperglycemia but with increased insulin resistance
-Individuals with metabolic syndrome have an increased risk of atherosclerotic (CAD; stroke)
-Glucose intolerance (IGT or DM)
-Hypertension
-Decreased HDL
-Increase in plasminogen activator inhibitor 1 (PAI-1)
-Increase in markers of inflammation (e.g. C-reactive protein)
-Accelerated atherosclerosis
-small, dense, low-density lipoprotein (LDL), hyperuricemia, abdominal obesity, prothrombotic state with increased levels of plasminogen activator inhibitor type 1 (PAI-1), and proinflammatory state
genetic defects
-Genetic defects of - cell function characterized by mutations; Monogenetic DM
-Examples:
-MODY (maturity onset)
-Wolfram syndrome:
-Autosomal recessive
-Neurodegenerative disorder
-DIDMOAD
diseases of exocrine pancreas
-Pancreatitis, pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy
endocrinopathies
acromegaly, Cushing’s syndrome, glucagonoma, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronoma
other
-drug or chemical induced diabetes
-infections- congenital rubella, cytomegalovirus, coxsackie
-uncommon forms of immune mediated diabetes -> stiff man syndrome, anti-insulin receptor antibodies
-other genetic syndromes sometimes assoc:
Down’s syndrome, Klinefelter’s syndrome, Turner’s syndrome, Wolfram’s syndrome, Friedreich’s ataxia, Huntington’s chorea, Laurence-Moon-Biedl syndrome, myotonic dystrophy, porphyria, Prader-Willi syndrome
-gestational diabetes mellitus (GDM)
gestational diabetes mellitus
-Glucose intolerance
-Insulin resistance related to the metabolic changes of late pregnancy increases insulin requirements and may lead to IGT
-Post-partum most revert to normal GT
-Substantial risk of developing DM later in life
-glucosuria- can be normal physiological process during preg -> send for OGTT if +
-Screen all pregnant women for GDM
-Low risk - screened at 24 to 28 weeks’ gestation
-High risk - screened at 20 weeks’ gestation
-Screening tests:
-“One-step” 75-g OGTT or
-“Two-step” approach with a 50-g (non fasting) screen followed by a 100-g OGTT for those who screen positive
risk factors of GDM
-> 25 years of age
-Overweight or obese state
-Family history of diabetes mellitus (i.e., in a first-degree relative)
-History of abnormal glucose metabolism
-History of poor obstetric outcome
-History of delivery of an infant with a birth weight >9 pounds
-History of polycystic ovary syndrome
-Latino/Hispanic, non-Hispanic black, Asian American, Native American, or Pacific Islander ethnicity
-Fasting plasma glucose concentration >85 mg/dL or
-2-hour postprandial glucose concentration >140 mg/dL -> Indicates need to perform a 75-g oral glucose tolerance test
complications of GDM
-Fetal complications include:
-Congenital malformation
-Macrosomia
-Prematurity
-Respiratory distress syndrome
-Birth asphyxia
-Maternal complications:
-Hypertension
-Pre- eclampsia
-Spontaneous abortion
-Cesarean delivery
-Polyhydramnios
