Pathophysiology of Type 2 Diabetes

Question 1

African Americans, Hispanics, and Native Americans are ______ more likely to get diabetes

Answer 1

2-4 times

Question 2

what are Current recommendations for pre-diabetics

Answer 2

1) yearly screening for diabetes,
2) formal intervention with diet and exercise (use of dieticians, exercise physiologists, certified diabetes educators [CDE])
3) only FDA approved pharmacological intervention is metformin

Question 3

Women who have very low risk for diabetes “may not need to be screened” per the clinical guidelines, but common practice is to screen all pregnant women at _______

Answer 3

24-28 weeks.

Question 4

For all patients, diabetes testing should begin at age ______,If results are normal, testing should be repeated at a minimum of ______ intervals

Answer 4

45 years,

3-year

Question 5

Testing should be considered in all adults who are overweight (BMI>25 kg/m2 or>23 kg/m2 in Asian Americans) and have additional risk factors such as:

Answer 5

•physical inactivity
•first-degree relative with diabetes
•high-risk race/ethnicity 
•hypertension 
etc...

Question 6

Insulin resistance is defined as: _______

Answer 6

Inadequate biological effects of insulin to stimulate glucose uptake in the skeletal muscle glucose and to suppress endogenous glucose production by the liver.

Question 7

The concordance rate for type 2 DM in identical twins is ______ compared to _____ in type 1 DM.

Answer 7

90-100%,

<50%

Question 8

true or false?

There is no association with any particular HLA types and Type 2 DM

Answer 8

TRUE

Question 9

______ is diminished in nearly all patients with type 2 DM for more than 10-15 years.

Answer 9

Insulin secretion

Question 10

insulin resistance in the liver leads to _______ while resistance in peripheral tissues (muscle, adipose tissue) leads to ________

Answer 10

fasting hyperglycemia,

postprandial hyperglycemia

Question 11

The NCEP III panel developed the following clinical definition of the Metabolic Syndrome. It is present if three or more of the following risk factors are present:

Answer 11

1) Waist circumference >40 inches in men and >35 inches in women
2) Triglycerides >150 mg/ld.
3) HDL-cholesterol <40 mg/ld. (men) or < 50 mg/ld. (women)
4) Blood pressure >130/85 mm Hg
5) Fasting plasma glucose >100 mg/ld.

Question 12

what are the Clinical Manifestations of insulin resistance syndrome?

Answer 12

Central (abdominal) obesity, glucose intolerance, hypertension, atherosclerosis, polycystic ovary syndrome (PCOS)

Question 13

what are the Biochemical Manifestations of insulin resistance syndrome?

Answer 13

1) Altered carbohydrate metabolism: insulin resistance, hyperinsulinemia and carbohydrate intolerance
2) Dyslipidemia: high triglycerides, low HDL-cholesterol, small, dense LDL particles
3) Procoagulant state: impaired fibrinolysis, increased plasminogen activator inhibitor, type 1 (PAI-1)

Question 14

what is MATURITY ONSET DIABETES OF THE YOUTH (MODY)

Answer 14

familial diabetes presenting in youth that is neither

Type 1 nor Type 2 diabetes mellitus

Question 15

MATURITY ONSET DIABETES OF THE YOUTH (MODY) in some families is due to ____, This can be treated with _______

Answer 15

a glucokinase deficiency (MODY 2).

sulfonylureas

Question 16

what is the The typical presentation of maturity onset diabetes of the youth (MODY)

Answer 16

IT is an autosomal dominant pattern of inheritance with the presentation in thin persons <25 years of age

Question 17

Blood glucose of ______ is considered necessary for diagnosis of DKA

Answer 17

> 200 mg/dl

Question 18

Serum ________ is positive in ketoacidosis

Answer 18

b-hydroxybutyrate

Question 19

what is the Treatment of Diabetic Ketoacidosis

Answer 19

Insulin replacement will inhibit both gluconeogenesis and ketogenesis while promoting utilization of glucose and ketoacids.

Fluid replacement will help restore blood volume and improve kidney perfusion. In doing so the kidney is better able to clear glucose and restore bicarbonate. Restoration of normovolemia will also decrease the stimuli to counter regulatory proteins.

Question 20

_______ is the most common acute complication of diabetes

Answer 20

Hypoglycemia

Question 21

Symptoms of hypoglycemia usually begin when the plasma blood glucose falls to ______

Answer 21

50 or 60 mg/dl

Question 22

hypoglycemia Symptoms can be divided into two categories: _____ and ______

Answer 22

Adrenergic: due to excessive secretion of epinephrine.
Neuroglycopenic: due to dysfunction of the central nervous system (CNS) because of hypoglycemia.

Question 23

what are the symptoms of adrenerigic hypoglycemia

Answer 23

Sweating
Tremor
Tachycardia

Question 24

What are the symptoms of Neuroglycopenic hypohlecemia

Answer 24

Confusion
Convulsions
Loss of consciousness

Question 25

_______ stimulates glycogenolysis from the liver

Answer 25

Epinephrine

Question 26

what is hypoglycemic unawareness?

Answer 26

Hypoglycemic unawareness occurs when the patient no longer has the adrenergic warning signs of diabetes and may go into an altered mental state with no warning symptoms at all. This is more common in patients who have frequent hypoglycemia

Question 27

The treatment of hypoglycemic unawareness is ________

Answer 27

scrupulous avoidance of hypoglycemia for 3 or more weeks