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Posterior Segment > The Skinny On Diabetes > Flashcards

The Skinny On Diabetes Flashcards

1
Q

What’s the top 5 things of the list

A
  1. HbA1C under 7%
  2. Control BP
  3. Control Cholesterol
  4. Rule out SA
  5. Rule out Anemia
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2
Q

Hypertensive patients with diabetes need their BP to be what?

A

125/80 or better

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3
Q

At what concentration of cholesterol will we see retinal deposits?

A

> 240mg/dl

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4
Q

What 4 things does a CPAP do?

A
  1. Reduce nocturnal HTN
  2. Increase Oxygen
  3. Decrease FBS
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5
Q

Hemaglobin should be above what to rule out anemia?

A

Hb must be above 11

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6
Q

At what level of Hb should Procrit be considered?

A

If below 9

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7
Q

At what concentration of proteinuria are we afraid of adverse effects?

A

300mg or more (albuminuria)

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8
Q

What category of drug should a patient be on if proteinuria is dx?

A

ACE inhibitor or ARB

- renoprotective

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9
Q

Smoking causes what 3 things?

A
  1. Increases proteinuria
  2. BV wall damage
  3. Vasoconstriction
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10
Q

Insufficient sleep causes what?

A
  1. Increase blood insulin + inflammation
  2. Decreased leptin + increased ghrelin
  3. Increased cortisol release
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11
Q

Hyperhomocystein can be found in diabetics taking metformin due to a loss of what vitamin?

A

Vitamin B12

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12
Q

What is the reward center of the brain?

A

Nucleus Accumbens

- dopamine is released

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13
Q

What is the emotional center of the brain?

A

Amygdala

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14
Q

What stage of DM gives you CSME?

A

Both proliferative and NP

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15
Q

What type of cholesterol is fluffy and doesn’t stick?

A

Pattern A

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16
Q

What type of cholesterol is sticky?

A

Pattern B

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17
Q

What drug allows erythropoietin be injected? What’s it for? At what Hb level do we use it?

A

Procrit - used to treat lower than normal RBCs

Use if Hb is below 9

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18
Q

What is the definition of Anemia?

A

Hb below 11

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19
Q

What is a CPAP used for?

A

Used for sleep apnea

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20
Q

What protein is released by liver to help keep blood in the vessels?

A

Albumin

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21
Q

What is the name of the hormone that blocks leptin? What does it do? Where is it secreted from?

A

PYY- acts as appetite suppressant

- secreted by small intestine

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22
Q

What type of fat comes from estrogen?

A

Subcutaneous fat - cardio protective

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23
Q

What type of fat comes from a sedative lifestyle?

A

Visceral fat - smooth fat, causes heart attacks

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24
Q

What is the BMI for obese and overweight ppl? What about anorexia?

A

Obese - 30
Overweight - 25
Anorexia - less than 17

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25
Q

If patient has proteinuria, what medication should they be on? Why?

A

ACE inhibitors - protects capillaries

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26
Q

Ghrelin secreted by the stomach tells you what?

A

Hungry

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27
Q

Leptin secreted by fat tells you what?

A

Tells you that you’re full

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28
Q

WIT: caused by abnormal autoimmune reaction, leads to destruction of pancreatic cells causing decreased insulin production

A

T1DM

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29
Q

Type 2 DM accounts for what percentage of patients w/ dm in the US?

A

90%

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30
Q

Type 2 diabetics are resistant to what?

A

resistant to insulin action

31
Q

DM is the ___ leading cause of death in US

A

7th

32
Q

When someone has DM, theres a __ to __ fold increase in risk of CV disease.

A

2 to 4 fold increase

33
Q

How many people have diabetes?

A

> 29 million

34
Q

How many ppl have type 1 DM?

A

1.5 million

35
Q

How many people have T2DM? What % diagnosed and undiagnosed?

A

23 million
70% diagnosed
30% undiagnosed

36
Q

How many people have pre-DM? What percentage is over 20 yo?

A

86 million

37% over 20

37
Q

What ethnicity has the highest prevalence of diabetic retinopathy over 50?

A

Hispanics

38
Q

What ethnicity has the highest prevalence of DR from 40-49 yo?

A

Blacks

39
Q

DM is the leading cause of blindness in Americans between what age?

A

20-74 years old

40
Q

What 3 ethnicities are high risk for DM?

A

African Americans
Hispanics
Native Americans

41
Q

DM is a small vessel disease that leads to the dysfunction of the capillary vessels, causing ?

A

Retinopathy
Nephropathy
Neuropathy

42
Q

DM is a large vessel disease leading to atherosclerosis, increasing the risk for ?

A
  • Strokes
  • Cerebral Artery Disease
  • Coronary Artery Disease
  • Peripheral Vascular Disease
43
Q

Hyperglycemia causes the release of? What does this cause in the body?

A

Mitochondrial ROS

Inflammation

44
Q

What 4 pathways occur due to the release of mitochondrial ROS?

A
  1. P. Kinase
  2. Glycation
  3. Polyol
  4. Hexosamine
45
Q

All 4 pathways lead to what?

A

Diabetic micro and macroangiopathy disease

46
Q

What study(s) concluded that hyperglycemia is the initiating cause of diabetic tissue damage seen clinically?

A

DCCT - diabetic control and complication trial

UKPDS - UK prospective diabetic study

47
Q

What are the systemic biomarkers for inflammation?

A

CRP
ICAM-1
VCAM-1

48
Q

What’s upregulated for a cotton wool spot? What else causes a CWS?

A
  1. ICAM-1 and VCAM-1 (signals that recruit WBCs)

2. Accumulation of platelets

49
Q

Hyperglycemia causes a decrease in what omega-3 ?

A

DHA

50
Q

HTN exacerbates DM induced retinal inflammation by increasing the expression of what molecules?

A
  1. VEG-F

2. ICAM-1

51
Q

What cell cycle does the inner retina rely on?

A

Glycolysis

52
Q

What cell cycles does the outer retina rely on?

A

Oxidative phosphorylation

53
Q

How many ganglion cells are lost before retinal thinning is noted?

A

~200K

54
Q

What is the most common cause of central vision loss and decreased vision in working-aged Americans?

A

Diabetic Macular Edema

- loss of inner BRB

55
Q

After 15 years of known DM, risk of CSME is what percent in T1DM?

A

20 %

56
Q

After 15 years of known DM, risk of CSME is what percent in T2DM taking insulin?

A

25%

57
Q

After 15 years of known DM, risk of CSME is what percent in T2DM not taking insulin?

A

14%

58
Q

After 20+ years of DM, risk of CSME in mild NPDR = ?

A

3%

59
Q

After 20+ years of DM, risk of CSME in mod to sev. NPDR = ?

A

38%

60
Q

After 20+ years of DM, risk of CSME in severe NPDR = ?

A

71%

61
Q

What was the first study to introduce the term CSME?

A

ETDRS - Early Treatment Diabetic Retinopathy Study

62
Q

What are the 3 definitions of CSME?

A
  1. Thickening of retina within 500 um of center of macula
  2. Hard exudates w/in 500 um of center of macula w/ thickening
  3. 1 zone of retinal thickening greater than 1 DD in size
63
Q

What study said aspirin therapy is good for diabetic patients to reduce inflammation? How much? what age?

A

ETDRS - Early treatement diabetic retinopathy study

81-325mg/day

30 and over

64
Q

Aquaporin-4 promotes increased leakage, edema and cell disorganization. What drug should be used to stop this?

A

Steroids = reduce aquaporin-4

65
Q

If we have swelling the macula w/o meeting definitions of CSME, what is this called?

A

Diabetic maculopathy

66
Q

DR = presence of a few microanuerysms, RTC 1 year

A

Mild NPDR

67
Q

DR = MAs, hemes, venous beading, CWS, RTC 6-9 mths.

A

Moderate NPDR

68
Q

Explain the 4-2-1 rule found in severe NPDR. (we only need 1 of these things to be classified as severe)

A
  • 4 quads of 20 hemes
  • 2 quads of venous beading
  • 1 quad of IRMA (intraretinal microvasculature abnormalities)
69
Q

What type of vision loss do we have in NPDR?

A

Moderate = doubling of the visual angle usually caused by CSME

70
Q

Proliferative DR is characterized by what 3 things?

A
  1. Neo
  2. Tractional RD
  3. Vitrous Hemorrhage
71
Q

What are the 3 high risk findings related to severe vision loss?

A
  1. NVD > 1/3 DD
  2. Vitrous or preretinal heme
  3. NVE > half disc area
72
Q

What classifies an Advanced PDR?

A
  1. extensive vitrous heme & can’t grade DR
  2. RD involving mac
  3. Phthisis bulbi
73
Q

What type of vision loss is found in PDR?

A

less than 5/200 or 20/800 vision

Posterior Segment (8 decks)

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