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CMS 200 > Wk3 Diabetes Mellitus > Flashcards

Wk3 Diabetes Mellitus Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What is the pathophysiology of diabetes?

A

Destruction of pancreatic islet beta cells, secondary to an autoimmune reaction.

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2
Q

Who will be affected by type 1 diabetes mostly?

A

Children and young adults

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3
Q

What is the global incidence of T1DM?

A

3% per year

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4
Q

T1DM susceptibility is due to…?

A

one-third genetic factors (HLA locus) & two-thirds environmental factors

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5
Q

True or False: nearly all patients with diabetic food ulcer have neuropathy?

A

True

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6
Q

If diabetic food ulcers is left untreated, what will it progress into?

A

Soft tissue infection, gangrene and limb loss (amputation)

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7
Q

Where’s the common place for diabetic food ulcer?

A

At pressure points:

Venous ulcers= above malleolus
Arterial ulcers=Toes/metatarsal heads/shins

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8
Q

If the patient has peripheral arterial disease, what is the prognosis for diabetic ulcers ?

A

Peripheral arterial disease is a strong predictor of nonhealing ulcers

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9
Q

By the time diabetic foot ulcer is discovered, what does it present with?

A

Osteomyelitis (inflammation of bone, usually due to infection)

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10
Q

How often should you examine the feet of low-risk diabetic foot ulcer patient?

A

At least annually

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11
Q

How often should you examine the feet of high-risk diabetic foot ulcer patient?

A

Every visit

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12
Q

Diabetic ketoacidosis primarily affect which population?

A

Type 1 diabetes

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13
Q

What are the three key features of diabetic ketoacidosis?

A

Hyperglycemia
Ketosis
Acidosis

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14
Q

What do patient with diabetic ketoacidosis usually present with?

A
  • Polyuria
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)
  • Weakness
  • Kussmaul’s respirations
  • Acetone breath
  • nausea/vomiting
  • coffee-ground emesis from hemorrhagic gastritis
  • abdominal pain
  • Dehydration (dry mucous membranes)
  • tachycardia
  • hypotension
  • altered consciousness (alert/confused/comatose)
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15
Q

For patient with diabetic ketoacidosis due to an infection ,what the body temperature usually look like?

A

Normal/low

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16
Q

Is diabetic ketoacidosis a serious condition?

A

LIFE-THREATENING

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17
Q

What is the frequency to monitor patient with diabetic ketoacidosis?

A
  1. blood glucose evaluated every 1-2 hours until patient is stable
  2. blood urea nitrogen
  3. serum creatinine
  4. sodium
  5. potassium
  6. bicarbonate levels monitored every 2-6 hours depending on the severity of DKA
  7. for patient with significant electrolyte disturbances, monitor cardiac function
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18
Q

What caution should be made when managing children/adolescents with diabetic ketoacidosis?

A

Greater care must be taken in administering electrolytes, fluids, insulin. Increased concern of high fluid rates such as cerebral edema.

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19
Q

Can diabetic ketoacidosis occur in children with obesity and type 2 diabetes ?

A

Yes although less common

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20
Q

Which population is mostly affected hyperosmolar hyperglycemic state?

A

Older adult with type 2 diabetes

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21
Q

What are the precipitating factors for hyperosmolar hyperglycemia state?

A
  • infections
  • medications
  • non-compliance with diabetic medications
  • undiagnosed diabetes
  • substance abuse
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22
Q

What are the symptoms of hyperosmolar hyperglycemic state?

A

Similar to diabetic ketoacidosis:

  • excessive thirst
  • hyperglycemia
  • dry mouth
  • polyuria
  • tachypnea (rapid breathing)
  • tachycardia
  • weakness
  • visual disturbance
  • leg cramps
  • lethargy (lack of energy)
  • confusion
  • hemiparesis (one-side muscle weakness)
  • seizures
  • coma
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23
Q

Is hyperosmolar hyperglycemic state a serious condition?

A

EMERGENT CONCERN

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24
Q

What are some of the complications of diabetes?

A

Microvascular
Macrovascular
Neuropathic conditions

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25
Q

What can uncontrolled diabetes lead to ?

A

Blindness
Limb amputation
kidney failure
Vascular/Heart disease

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26
Q

The patient is displaying symptoms of polyuria, polydipsia, fatigue, blurry vision, weight loos, poor wound healing, numbness, tingling. What diagnosis can be considered?

A

Consider the diagnosis of diabetes

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27
Q

If the patient is between the age of 40 to 70 (now has been updated to include 35-39yoa ) and is overweight/obese, what should we screen? What is the frequency?

A

Screen for abnormal blood glucose and type 2 diabetes.

Repeat testing every 3 years if results are within normal limits

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28
Q

What test should be done for individuals with clinical history (sign and symptoms, risk factors) that indicate diabetes?

A

Diagnostic testing

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29
Q

How often should these population be screened for type 2 diabetes:

  1. over 45yoa
  2. under 45yoa with major risk factors

If test results are normal, how often should we repeat?

A

Every year

At least every 3 years

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30
Q

Is prediabetes common in older adults?

A

Yes, very common (less likely to progress to diabetes)

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31
Q

Under which condition is ceasing diabetes screening recommended?

A

Ceasing diabetes screening after 70yoa will avoid overdiagnosis and unnecessary treatment

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32
Q

Does treating borderline glucose values improve quality of life, mortality or any other patient-oriented outcomes?

A

No

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33
Q

How do you see prediabetes blood glucose level?

A

Consider it as one of several risk factors for developing type 2 diabetes

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34
Q

What is the leading cause of death in type 2 diabetes?

A

Myocardial infarction

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35
Q

To prevent complication of type 2 diabetes, what is more significant than glycemic control?

A

Blood pressure

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36
Q

At time of diagnosis of type 2 diabetes, what monitoring is recommended?

A

Serum lipid monitoring since patients are also prone to cardiovascular disease

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37
Q

Due to a combination of hyperglycemia, hyperlipidemia, hypertension, platelet adhesiveness, coagulation factors, oxidative stress and inflammation, the risk of which condition is increased?

A

Increased risk of heart disease

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38
Q

For patient with diabetes, what is the ADA recommendation for blood pressure?

A

Systolic BP under 140 mmHg and diastolic BP under 90mmHg

For younger patient: 130/80

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39
Q

What other organ systems would be affected by diabetes?

A
  • Cardiovascular
  • Skin & mucous membrane
  • Bone & joint
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40
Q

What reactions are the most common complications that occur in patients with diabetes treated with insulin?

A

Hypoglycemic reactions

Sympathetic: tachycardia, palpitations, sweating, tremors.

Parasympathetic: nausea/hunger/nervous system symptoms

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41
Q

What CNS-related condition is due to hypoglycemia?

A

Neuroglycopenia

  • insufficient glycose for normal CNS function
  • Irritability/confusion/blurred vision/tiredness/headache/difficulty speaking/loss of consciousness/seizure
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42
Q

What is the prevalence of diabetes in US and Canada?

A

10-14%

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43
Q

What are some environment factors for T1DM?

A

breastfeeding in the first 6 months as being protective.

Improvement in public health and reduced infections —>dysregulated immune system & development of autoimmune disorders

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44
Q

What is idiopathic type 1 diabetes?

A

Patients without evidence of pancreatic bata cell autoimmunity (5%)

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45
Q

What are the sign and symptoms of T1DM?

A
  • Polyuria
  • Polydipsia
  • Blurred vision
  • weight loss
  • Parasthesias
    -Altered level of consciousness
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46
Q

Is screening for T1DM recommended?

A

No. Typically patients present with an acute onset of symptoms

47
Q

T2DM is predominantly diagnosed in which population?

A

Adults

48
Q

Risk factors for T2DM?

A
  • obesity
  • first-degree relative with T2DM
  • Cardiovascular disease
  • hypertension
  • low HDL (<35)
  • high TG (>250)
  • acanthosis nigricans
  • PCOS
  • gestational diabetes
  • delivery baby over 9lb
49
Q

Does gene play a role in T2DM development?

A

yes

50
Q

Which environmental factor is the most significant factor causing insulin resistance?

A

obesity

51
Q

Does subcutaneous abdominal fat has a strong or weak correlation with insulin resistance?

A

Weak

52
Q

what is metabolic obesity?

A

increased visceral fat in patients with T2DM without overt obesity

53
Q

what are some environment factors that can contribute to T2DM?

A

Adipokines secreted by adipocytes which impair insulin signaling

TNF-alpha, IL-6…

54
Q

How is T2DM recognized ?

A

Only after glycosuria or hyperglycemia is discovered on routine lab testing

55
Q

At the time of diagnosis of T2DM, what complication may patient be already having?

A

Neuropathic or cardiovascular complications

56
Q

Is screening recommending for T2DM?

A

yes

57
Q

What are the obstetrical complications for T2DM?

A

Delivery baby >9lbs
Polyhydramnios
Preeclampsia
Unexplained fetal losses

57
Q

Which asymptomatic adults should be screened for T2DM?

A

BMI>25 and 1+ of the following:
- HbA1C >5.7%
- impaired glucose intolerance
- impaired fasting glucose

58
Q

What is the sign &symptoms differences between T1DM and T2DM?

A

T1DM:

  • polyphagia with weight loss
  • nocturnal enuresis (bed wetting )
59
Q

What are the 2 risk factors for developing gestational diabetes?

A

Advancing age and greater pre-pregnancy BMI

59
Q

What does metabolic syndrome identify?

A

It identifies individuals at higher risk for developing diabetes and cardiovascular disease

60
Q

How is gestational diabetes screened?

A

Screening done between 24-28 week’s gestation with a non-fasting 50g glucose challenge test.

if BG >140 (7.8), perform a 3hr fasting 100g glucose challenge test —> Diagnostic

61
Q

what is one step testing for gestational diabetes?

A

a single fasting 75g oral glucose tolerance test

62
Q

what is two step testing for gestational diabetes?

A

non-fasting 50g oral glucose tolerance test, if result is 130-140 (7.2-7.8), do a 3hr fasting 100 glucose tolerance test

63
Q

How is one step testing & two step testing for gestational diabetes compared to each other?

A

Diagnosis of gestational diabetes is more common in one step screening but two-step produces equivalent benefits and fewer harms

64
Q

Your pregnant patient come in present with obesity, advanced maternal age, history of gestational diabetes, fHx of diabetes and belong to a high-risk ethnic group, what do you suggest?

A

gestational diabetes screening in the first trimester

65
Q

When should asymptomatic pregnant patient screen for gestational diabetes?

A

At or after 24 weeks’ gestation

66
Q

When should screening be done post partum for women who had gestational diabetes?

A

6-12 weeks postpartum with a fasting glucose measurement or a 74 2hr glycose tolerance test

67
Q

How often should women with history of gestational diabetes be screened?

A

every 3 year for overt diabetes

68
Q

What is the major acute complication of T2DM in youth?

A
  • Diabetic ketoacidosis
  • Hyperglycemic hyperosmolarity
69
Q

Long-term morbidity of T2DM in youth is due to..?

A

Macrovascular (atherosclerosis)

Microvascular (retinopathy, nephropathy, neuropathy)

70
Q

Is screening T2DM recommended in youth?

A

Insufficient evidence

71
Q

Your patient is under 18 and is overweight, fHx of T2DM, high-risk ethnic group, acanthosis nigricans, hypertension, hyperlipidemia, PCOS. Is screening for T2DM recommended?

A

Yes

72
Q

How often should you screen for at-risk patient?

T2DM/youth

A

every 2 years starting at age 10

or

onset of puberty if under age 10

73
Q

what is MODY?

A

non-insulin dependent form of diabetes

74
Q

When is MODY diagnosed typically?

A

<25yoa

75
Q

x% of all patients with diabetes have MODY type.

A

1-5%

76
Q

This patient is not obese, and were diagnosed with diabetes at a young age (<30yoa). He has a strong fHx of diabetes. Which condition should be suspected?

A

MODY

77
Q

What type disease is MODY?

A

autosomal dominant disease

78
Q

Which type of MODY is most common?

A

MODY3

79
Q

What is the difference between MODY 1.2.3?

A

MODY 1 & MODY 3
- progressive hyperglycemia
- vascular complication

MODY 2
- mild stable fasting hyperglycemia
- low risk of diabetes-related complications
-no treatment required except during pregnancy

80
Q

Is routine screening of T2DM recommended in older adults?

A

No while screening is dependent on whether treatment would improve overall quality of life or life expectancy.

81
Q

Under which condition is screening T2DM recommended for older patients?

A

to prevent complications that may lead to functional impairment

82
Q

what is secondary causes of diabetes?

A

Any disorder that damages the pancreas

83
Q

Which value of fasting plasma glucose indicates increased risk of diabetes (aka pre-diabetes)?

A

5.6-6.9

84
Q

Which value of fasting plasma glucose is diagnostic?

A

> 7 on more than one occasion after at least 8h fasting

85
Q

what is pros and cons of Fasting Plasma Glucose?

A

Pros: may identify 1/3 more undiagnosed cases than A1c

cons: need fasting

86
Q

Patient’s fasting plasma glucose is under 7 but diabetes is still suspected, what’s next?

A

perform oral glucose tolerance test

87
Q

What value of oral glucose tolerance test indicates diagnostic?

A

126 (7) or 2hr value of 200 (11.1)

88
Q

what is pros and cons of oral glucose tolerance test?

A

pros: identify 1/3 more undiagnosed cases than A1c

cons: require fasting. maybe false-positive

89
Q

What is the diagnostic test for T1DM and T2DM?

A

HbA1c

90
Q

How often should you repeat HbA1c?

A

at 3-4 month intervals

91
Q

How do you interpret HbA1c value?

A

5.7-6.4% = pre-diabetes
6.5%= diagnostic

92
Q

What’s the important of HbA1c?

A

reducing the average HbA1c by 0.2% could lower overall mortality by 10%

increasing 1% of HbA1c—> morality/CVD

93
Q

What is the pros and cons of HbA1c

A

Pros:
- no fasting needed
- lower variability
- provide estimate glucose control for the preceding 2-3 months

cons:
- substantial individual variability
- affected by Hb variants
- falsely lowered by conditions that decrease RBC age

94
Q

What is the normal glucose tolerance for plasma glucose 2 hours after glucose load?

A

<140 (7.8)

95
Q

What is the DM value for plasma glucose 2 hours after glucose load?

A

> 200 (11.1)

96
Q

what is recommendation to maintain LDL cholesterol?

A

<100 (2.6)

lowering to 70 infer additional benefits for T2DM

97
Q

What is the characteristic of diabetic dyslipidemia?

A

High TG
Low HDL
presence of smaller-density LDL

98
Q

what is the most common complication of diabetes, which is also a major cause of death in T1DM?

A

Diabetic nephropathy (kidney disease)

contribute to 1/3 of all end-stage renal disease

99
Q

Is end-stage-renal disease more prevalent in T2DM or T1DM?

A

T2DM

100
Q

What is the signs & symptoms of diabetic nephropathy?

A
  • albuminuria
  • urea & creatinine accumulation in the blood
  • declined kidney function
101
Q

what is the most common type of diabetic neuropathy?

A

Distal symmetric polyneuropathy

102
Q

sign & symptoms of distal symmetric polyneuropathy

A
  • loss of function in a ‘stocking-glove’ pattern
  • sensory changes
  • clawing of the toes
    -altered biomechanics of the foot
  • calluses
    -ulcerations
103
Q

what is isolated peripheral neuropathy?

A

due to vascular ischemia/traumatic damage, involving mononeuropathy or mononeuropathy multiplex

104
Q

where does isolated peripheral neuropathy commonly affected?

A

cranial and femoral nerves, causing motor abnormalities

105
Q

Which type of diabetic neuropathy occurs primarily in patients with long-standing diabetes and affected many visceral functions?

A

autonomic neuropathy

  • cardiovascular
  • GI
  • genitourinary
106
Q

which condition that nearly all patients with diabetes will eventually have?

A

diabetic retinopathy, microangiopathy of the retina

107
Q

what is the risk factor for developing diabetic retinopathy?

A

-long standing diabetes
- abnormal blood glucose levels
- inadequate arterial blood pressure control

108
Q

how often should patient do diabetic retinopathy screening?

A

every year

109
Q

what type of diabetic retinopathy happens in early stage?

A

non-proliferative retinopathy

110
Q

what type of diabetic retinopathy happens in final and most severe stage?

A

proliferative retinopathy
(higher prevalence in T1DM)

111
Q

what signs & symptoms happens in diabetic retinopathy?

A
  • cataracts: glycosylation of lens protein
  • glaucoma: increased ocular pressure damaging the optic nerve (6%)
  • dry eye
  • macular edema

CMS 200 (6 decks)

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