Type I and Gestational Diabetes

Question 1

Type 1 Diabetes

Answer 1

5-10% of diagnosed diabetes
Autoimmune disease that destroys the pancreatic beta cells causing absolute insulin deficiency
Bottom line: NO INSULIN BEING PRODUCED.
Oral agents INEFFECTIVE. Insulin therapy required

Question 2

Type 2 Diabetes

Answer 2

90 to 95% diagnosed cases of diabetes
Due to Both:
Decreased insulin release (not on an autoimmune basis)
Disease of the insulin receptors (lack of insulin receptors) so that the glucose can’t get into the cells so glucose levels rise
INSULIN RESISTANCE

Question 3

Diabetes Mellitus Type 1 Presentation

Answer 3

Classic new onset of chronic polydipsia, polyuria, and weight loss with hyperglycemia and ketonemia (or ketonuria)

Most common: Hyperglycemia without acidosis
2nd most common: Diabetic ketoacidosis (hyperglycemia and ketoacidosis)

Question 4

Triad of hyperglycemia

Answer 4

Polyuria
Polydipsia
Polyphagia

Question 5

Diabetes Diagnosis Labs

Answer 5

Fasting blood sugar (FBS) >126 on two separate occasions
Random blood sugar >200
Oral Glucose Tolerance Test (OGTT) >200
Glycosylated hemoglobin (HgA1C) >6.5%

Question 6

Insulin and C-peptide levels

Answer 6

High fasting insulin and C-peptide levels suggest T2DM.

Low levels or in the normal range relative to the concomitant plasma glucose concentration in T1DM.

Question 7

Diabetes Management GLYCEMIC CONTROL

Answer 7

Adults- goal Hem A1C < 7

Children & Adolescents- goal Hem A1C < 7.5

Question 8

Comprehensive Annual Exam Laboratory evaluation:

Answer 8

HgbA1c (q 3 months)
Fasting lipid profile
Liver Function Tests (LFT’s)
TSH
Celiac disease screening (tTG Q 2-3 years)
Kidney profile (CMP or Chem7)

Question 9

Gestational Diabetes

Answer 9

Insulin receptors do not function properly
Hormonal changes make cells less responsive to insulin
Hormones from placenta block the action of the mother’s insulin = insulin resistance.
Estrogen, cortisol, human placental lactogen
(vital hormones in pregnancy preservation)
*** 2nd & 3rd trimester – mom needs three times as much insulin as normal. Growing placenta continues with insulin resistance,
leading to hyperglycemia in mom.

Question 10

Gestational Diabetes Initial test

Answer 10

Glucose challenge test
This test does not have to be fasting
50 grams of glucose orally (glucola)
Wait one hour and have blood glucose level drawn
A value equal to or above 130mg/dL should be used as the threshold level.

Blood glucose above 130 requires a 2nd test for diagnosis.
Only about 1/3 of women who test positive on the glucose screen actually have GD.

Question 11

Treatment of GD

Answer 11

Insulin is FIRST-LINE rather than oral anti-hyperglycemic agents during pregnancy.

glyburideis a reasonable alternative but insulin is go to