S17C219 - Type 2 Diabetes Flashcards
1
Q
T2DM pathophys: Insulin resistance
A
-occurs at major sites such as liver, muscle, adipose tissue
2
Q
T2DM pathophys: impaired insulin secretion
A
- impaired in part due to high free fatty acid levels
- also glutotoxic effects
3
Q
T2DM pathophys: impaired regulatn of hepatic glucose production
A
- liver becomes resistant to insulin and therefore overproduces and underuses glucose
- kidney’s also involved in gluconeogenesis
4
Q
T2DM complications: vascular
A
Microvascular
-retinopathy, neuropathy, nephropathy
Macrovascular
-CAD, CVA, PVD
5
Q
T2DM complications: non-vascular
A
- ifxns
- dermatologic changes
- UT involvement
- sexual dysfunction
- GI involvement (gastroparesis, diarrhea)
- cataract/glaucoma
6
Q
T2DM: manifestation
A
- fatigue, weakness, polyuria, polyphagia, polydipsia, blurred vision
- assoc with obesity, age >30, HTN, CAD/CVA, dyslipidemia, PCOS
7
Q
T2DM: neuropathy - DDx
A
- must first r/o:
- chronic inflammatory demyelinating polyneuropathy
- B12 deficiency
- hypothyroid
- uremia
8
Q
T2DM: neuropathy Sx
A
- electrical/stabbing sensations
- paresthesias
- hyperesthesia
- deep aching pain
- stocking glove pattern
- loss of vibration, pressure, pain, temp
9
Q
T2DM complication: Diabetic mononeuropathies
A
- difficult to differentiate from a TIA
- sudden onset, assoc with pain
- isolated cranial nerve or large peripheral nerve (median/peroneal)
10
Q
Diabetic complications: infxns
A
- staph aureus and mycobacterium tuberculosis are more common in diabetics with PNA
- candida spp more comming UTI in diabetics
- malignant otitis externa: unilateral otalgia, decr hearing, purulent ear d/c, fever, tender inflamed ext auditory canal, granular-appearing tissue (pseudomonas, staph, fungi, gm-)
- emphysematous cholecystitis and pyelonephritis (medical emergencies, u/s should be done on any diabetic with unexplained fever)
- rhinocerebral mucormycosis
11
Q
T2DM: foot ulcers
A
- pathogen: aerobic gm+ cocci (staph), gm- rods if recent Abx or chronic wound
- venous ulcers: above malleoli with irregular borders
- arterial ulcers: toes/shins with pale punhed out borders
- diabetic ulcers: occur at areas of increased pressure or friction (sole of foot)
- if able to probe to bone this is sign for osteomyelitis
- xr diabetc ulcers to r/o OM, subcu gas, FB, charcot joint
12
Q
T2DM: Ophthalmologic complications
A
- diabetic retinopathy, maculopathy, CRVA/BRVO, tractional retinal detachments
- optic nerve dz: NAION, glaucoma, papillitis
- 3/4/5 CN palsies
- cataract
- decr corneal sensation
- vitreous hemorrhage
- recurrent styes, blepharoconjuctivitis, xanthelasma
-retinopathy: proliferative, nonproliferative
13
Q
T2DM: derm complications
A
- protracted healing, ulcers
- acanthosis nigricans, necrobiosis lipoidica, scleredema
- infx: erythrasma, necrotizing fasciitis, mucormycosis
- lipoatrophy, lipohypertrophy
14
Q
Classes of Antidiabetics
A
-insulin
Oral Antihyperglycemics
- Biguanides (metformin) sensitize cells to insulin in liver, decreases gluconeogenesis
- Thiazolidinediones (glitazones) sensitize cell to insulin in tissues
- Insulin secretagogues (sulfonylureas - glyburide) promotes secretion of insulin
- alpha-glucosidase inhibitors (acarbose) slow the absorption of carbohydrates
15
Q
Antidiabetic complications/side effects
A
- metformin: lactic acidosis, nausea, diarrhea
- glitazones: worsening of liver disease, CHF, bone loss, wt gain
- sulfonylureas: hypoglycemia, GI
