Week 4 Diabetes Review and Clinical Presentation Lecture Flashcards
today, 1 in __ adults have diabetes
11
is diabetes a problem?
LOLZ. yes. it is a growing problem with increasing prevalence worldwide, and increasing cost (1 in 9 health dollars spent on diabetes). serious, common, costly
what three factors are largely contributing to the soaring diabetes prevalence worldwide?
- poor diet
- sedentary lifestyle
- longer life
what explains why children from low-income homes are more likely to be obese?
unhealthy food is cheaper than healthy food
we see that Asian countries do not have a high BMI, yet they have a high prevalence of diabetes. what does this suggest?
these individuals may experience metabolic complications before having an obese BMI. Suggesting a lower BMI in which to test for diabetes in these populations.
what are some adverse health affects that diabetes is the leading cause for? 4
- 6th leading cause of death in the US
- leading cause of new blindness in adults
- leading cause of renal failure
- leading cause of non-traumatic lower limb amputations
most of the medical cost of diabetes goes into which aspect of diabetes care?
treating the complications, NOT preventing the disease
Diabetes is a disease in which the body doesnt (3)
- doesnt produce insulin at all
- doesnt produce sufficient insulin
- doesnt properly use (sense) insulin
contrast type I and II diabetes; age of onset, gradual or sudden, body type
Type I: younger, sudden, usually thin
Type II: older, gradual, usually obese
what are some causes (4) of insulin resistance?
obesity (increase in FFAs and adipokines (leptin, TNF-alpha, decreased adiponectin)
stress: counter regulatory hormones (adrenaline/NE, cortisol)
Pregnancy: placental hormones
Infection
what are two clinical presentations of insulin resistance? whats the difference?
glucose intolerance and type II DM: glucose intolerance is a pre-diabetic condition
Generally, at the time of Type II DM diagnosis what is the condition of B cells? what does this suggest?
B cell fxn is 50% of normal. suggests that B cells were declining in fxn many years before diagnosis, a progressive disorder
what are the symptoms of hyperglycemia? 6
thirst (polydipsia), frequent urination (polyuria), blurry vision, weight loss, fatigue, hunger
when should diabetes screening be conducted?2
- every 3 years for individual over 45
- in those with a BMI>25 (overweight)
what are the compication ABCs of diabetes?
A: HbA1C
B: Blood pressure (high)
C: LDL cholesterol (high)
In general what is the role of TZD
diabetes medication that decreases insulin resistance of skeletal muscle
in general what is the role of Metformin
inhibits gluconeogenesis in the liver
what is the general role of Acarbose and miglitol
decrease glucose absorption from the gut
what is general role of sulfonylureas
enhance insulin secretion
when is insulin needed (4)
type I (for life), acute illness, pregnancy, type 2 when intolerance or contra-indications to other therapies
what are two type of insulin? what are their roles?
Basal insulin: long acting
bolus insulin: short acting, after meals
what are the current methods of blood glucose testing 2
fingerstick, continuous glucose monitoring
what are the 3 general macrovascular complications seen in patients with diabetes 3
metabolic injury to large blood vessels that supply heart (myocardial infarct), brain (stroke), or extremities (amputations)
what are the 3 general microvascular complications associated with diabetes?
complications in the small blood vessels (capillaries): retinopathy (blindness), nephropathy (kidney failure), neurpathy (amputation)
what is the best way to prevent DM in pre-diabetics?
lifestyle change!
