Week 12 - DM: Hyperglycemia

Question 1

What is the etiology of hyperglycemia for Indigenous populations? (4)

Answer 1

1. Colonial structure and imposed lifestyle
   - Diet: processed foods carbs (sugar, flour, salt)
   - Sedentary convivence-based lifestyle (tv, vehicle transportation)
   - Changes in activity/movement -> traditional indigenous lifestyle was active, joy of movement, but colonial lifestyle had introduction of exercise to lose weight
   - access to food: exceedingly high cost, destruction of land (fishing, hunting, gathering)

Question 2

Why may colonial abuse cause hyperglycemia? (3)

Answer 2

• increase in stress, leading to increase in cortisol
• residential school trauma (physical, emotional, spiritual, community)
• cultural genocide (ex. healing, understanding of health, ceremony, etc)

Question 3

How can genetics cause hyperglycemia (indigenous)? (4)

Answer 3

HNF-1αG319S variant
- Thrifty gene hypothesis
- impairs insulin secretion when exposed to dietary carbohydrate stress, but protective in traditional off-the-land food rich in protein and fat
- Today, diabetes in First Nations is 25x higher than all other Manitoba youth, w/ rapid progression to insulin

Question 4

Does hyperglycemia cause increased osmosis and increased serum osmolality?

Answer 4

yes

Question 5

What are the clinical manifestations of high blood sugar?

Answer 5

• Glucosuria (glucose in the urine)
• Polyuria (grequent urination)
• Polydipsia (excessive thirst)

each leads to the next

Question 6

What are the clinical manifestations of DM? (6)

Answer 6

Patient may present with chronic complications of hyperglycemia
- fatigue
- recurrent infections
- prolonged wound healing
- visual acuity changes
- painful peripheral neuropathy in te feet

Question 7

What are the 4 methods of diagnosing DM? Note that 2 positive tests are needed to confirm diagnosis. (5)

Answer 7

1. HemoglobinA1C > 6.5%
2. Fasting blood glucose > 7 mmol/L
   - fast for 8 hours, water intake is okay
3. Random plasma blood glucose > 11.1 plus classic symptom of DM
4. 2 hour - oral glucose tolerance test (screening for pregnancy)

Question 8

What is a hemoglobinA1C test? (3)

Answer 8

• determines the glycemic control over time
• shows the amount of glucose that has been attached to haemoglobin molecules over the lifespan of the blood cell (120 days)
• Overall glucose average over the last 90-120 days

Question 9

What occurs in the oral glucose tolerance test? (3)

Answer 9

• patient drinks 75 g of glucose
• blood/capillary blood glucose is measured at 30, 60, and 120 min
• Normal = <11.1 mmol/L at 30 and 60 min, <7.8 mmol/L at 120 min

So we’re basically spiking the blood sugar and then checking how good the body is at regulating it

Question 10

Secondary prevention for T2DM is screening. Here is the flow chart for it.

Answer 10

Question 11

Why can hyperglycemia occur? (8)

Answer 11

• undiagnosed DM
• untreated/under-treated diabetes
• inactivity
• stress
• acute illness
• infection
• surgery
• medications (corticosteroids)

Question 12

What are the acute clinical manifestations of hyperglycemia? (10)

Answer 12

• Glucosuria
• Polyuria
• Polydipsia
• Polyphagia (hunger)
• Increase in appetite followed by lack of appetite
• weakness, fatigue
• blurred vision
• headache
• N+V
• Abdominal cramps

Question 13

What can hyperglycemia progress to? (2)

Answer 13

HHS - hyperosmolar hyperglycemic state
DKA - Diabetic ketoacidosis

Question 14

What are 2 signs of insulin resistance?

Answer 14

• acanthosis nigricans (dark spot in back of neck, groins, armpits)
• skin tags