Type 2 Diabetes Flashcards
Diabetes Diagnostic Criteria
Fasting glucose >126 on two occasions
Random or postprandial glucose >200
HgA1c>6.5%
Prediabetes Diagnostic Criteria
Fasting glucose between 100 and 126
Random/postprandial glucose: 140-200
A1c: 5.7-6.5%
What does HgA1c Reflect?
Glucose levels over past 2-3 months
Prevalence of diabetes
9.3% Americans: 28M with T2DM, 1.25 with T1DM, 8M undiagnosed
What are major pathophysiological defects in T2DM?
Liver, Pancreas, Periphery
Liver: Increased glucose output
Islet cell: Increased glucagon/Decreased insulin (beta cell mass)
Insulin resistance: reduced peripheral glucose uptake
Factors in B-cell Failure
First stage: Oversecretion of insulin Glucotoxicity/chronic hyperglycemia
Lipotoxicity (increased FFA release)
Second stage: metal cell dysfunction/exhaustion
What is 1st phase insulin secretion?
What happens during T2DM
Spike in insulin secretion in response to glucose stimulus
During T2DM it’s shut down
What happens to glucagon in T2DM?
Inappropriately high glucagon secretion by a-cells in islet increases hepatic glucose output
Contributes to hyperglycemia, disease progression
Incretins stimulate secretion of _____ in response to food ingestion
Insulin
Incretin effect is _____ in T2Dm
diminished
Risk factors for T2DM (9)
Obesity (visceral fat), age, race/ethnicity, metabolic factors (HTN, hyperlipidemia), meds, lifestyle, gestational diabetes, genetics, intrauterine effects
T2DM Screening: Who to Test
Overweight+risk factor
Normal at age 45 every 3 years
Classic Symptoms (4)
Polyuria, polydipsia, polyphagia, unexplained weight loss
Nonspecific Signs (5)
Fatigue, blurry vision, dry mouth, dry/itchy skin, poor wound healing
Physical Exam Findings (5)
Hypertension
Obesity
Fundoscopic changes (retinopathy)
Foot: decreased sensation, ulceration, pulse
Skin findings: acanthosis nigricans, abscess, tags
