T2D + Fat peepo

Question 1

4% of pregnant women have gestational diabetes during which trimester?

Answer 1

2+3

• if a woman is only at risk for GDM, then she should be retested at 24-28 weeks

Question 2

What is the key element in the pathogenesis of T2D?

Answer 2

B-cell dysfxn

decreased insulin sensitivity is the 2nd

Question 3

Glucose toxicity

Answer 3

prolonged hyperglycemia producing a state of impaired insulin secretion
-use aggressive diabetes control early on to prevent this and long term complications

Question 4

Insulin resistance in the liver leads to ____, while insulin resistance in the peripheral tissues(m, adipose) leads to____.

Answer 4

liver: fasting hyperglycemia
- Glut2 - no matter when, if you have insulin R, then you have hyperG

peripheral tissue: postprandial hyperglycemia
-GLut4: insulin should increase after you eat, butif you have insulin R, then right after you eat, you can get hyperG

Question 5

MODY (maturity onset diabetes of the youth)

Answer 5

neither T1 or T2D

Negative antibody screen and strong family Hx
- thin persons

Question 6

What ratio of insulin:glucagon promotes ketogenesis in the liver?

Answer 6

Low insulin/glucagon ratio

Increased CAT (aka CPT) enzyme and decreased malonyl CoA activity permitting FA entry into mito

Question 7

Most common cause of DKA

Answer 7

Infxn often accompanied by misguided omission of insulin (or noncompliance of insulin)

Question 8

Goals in the tx of DKA

Answer 8

1. improve circulatory vol and tissue perfusion
2. decrease serum glucose
3. clear the serum and urine of ketoacids
4. decrease CRH
5. correct electrolyte imbalance
6. avoid cerebral edema in kids

Question 9

MOST COMMON acute complication of diabetes

Answer 9

hypoglycemia

- more ER visits than DKA

Question 10

plasma blood glucose of hypoglycemia

Answer 10

50-60ish mg./dl

nl is 70-115

Question 11

Symptoms of hypoglycemia

Answer 11

1. adrenergic due to excessive secretion of epi
   - want more glucose - secrete epi and glucagon –> get adrenergic sx
2. neuroglycopenic due to dysfxn of CNS bc of hypoglycemia

Question 12

Adrenergic vs neuroglycopenic sx

Answer 12

adrenergic:
- sweating
- tremor
- tachycardia

Neuroglycopenic

• confusion
• convulsions
• loss of consciousness

Question 13

in the first 3-5 yrs after the onset of T1D, recovery from hypoglycemia is mainly achieved by the release of?

Answer 13

Glucagon and epinephrine

• After glucagon response is lost, epi becomes the primary defense against hypoglycemia acutely

Question 14

Hypoglycemic unawareness

Answer 14

pt no longer has the adrenergic warning signs of diabetes and may go into altered mental state with no warning.
- common in pts with frequent hypoglycemia

Question 15

How do you tx hypoglycemic unawareness?

Answer 15

scrupulous avoidance of hypoglycemia for 3/m weeks