Studied by 7 people
What are the 4 different was to dx DM?
fasting plasma glucose 126+
sx of DM + random glucose 200+
plasma glucose level 200+ after an oral dose of 75g of glucose
Hb A1C 6.5+%
DM is due to a deficiency of insulin action. What causes this?
dec insulin secretion by Beta cells
insulin resistance at target tissues
inc in counterregulatory hormones that oppose insulin
A1C provides an estimation of blood glucose concentration over the past ____
120 days (3 months)
What microvascular diseases can DM cause?
Retinopathy, Nephropathy, Neuropathy
What macrovascular disease can DM cause?
CAD, PVD, CVA; major cause of death in DMT2
DM is the leading cause of what?
blindness in working age adults
ESRD
nontraumatic LE amputations
What can help prevent DM?
healthy diet, regular exercise, maintaining healthy weight, avoid tobacco use
What is DM Type 1?
Insulin-dependent diabetes
What cause DMT1?
autoimmune destruction of pancreatic B cells
What age group does DMT1 typically affect?
bimodal peak of incidence: 5-7 yrs & again at puberty
What S/sx are associated w/ DMT1?
polyuria, polydipsia, wt loss, markedly inc serum glucose levels, polyphagia, inc ketone bodies, DKA
What is the tx for DMT1?
lifelong insulin therapy
What is the pathophysiology behind DMT1?
selective destruction of B cells by T lymph or AI destruction occurs gradually → Sx of insulin deficiency appear
What are found in 50% of newly dx T1 diabetics?
islet cell antibodies (ICA) and insulin autoantibodies (IAA)
What lab findings would you see in a pt w/ DMT1?
hyperglycemia
ketonuria
low/undetectable serum insulin and C peptide
Auto-antibodies against components of the islet B cells
How are ketones made?
dec glucose uptake by tissues → lipolysis & ketosis → free ketones
What are signs of DKA?
inc ketones, polyuria, edema, glucose avg >500, coma (due to hyperosmolality)
Which form of DM is more common?
Type 2
What age group is most affect by DMT2?
adults, inc prevalence w/ age
DMT2 is more prevalent in what race?
Native Americans, Mexican Americans, African Americans
What is the hallmark of DMT2?
insulin resistance
What is DMT2 associated with?
obesity
What do normal adipocytes secrete?
“healthy” adipokines → inc insulin sensitivity
What do hypertrophied adipocytes seen in obese pts secrete?
other adipokines (TNF, IL-6) → contribute to insulin resistance; adiponectin release dec → insulin resistance
How soon is DMT2 dx after onset?
often 5-7 yrs later
The increase in the prevalance and epidemic of DMT2 is associated with what?
heavily associated w/ obesity
It is estimated that ___ children born after 2000 will develop diabetes in their lifetime.
1/3
What lab findings would you see in a pt w/ DMT2?
hyperglycemia, HLD, high serum insulin/C peptide, defective insulin secretion, insulin resistance, inc glucagon levels, high glucagon-insulin ratio
What S/sx are associated w/ DMT2?
Glucosuria, polyuria, nocturia, polydipsia, polyphagia, wt loss, dehydration, obesity
What is the etio of DMT2?
insulin resistance → inc in insulin secretion → pancreas burns out → ineffective insulin secretion; also due to B cell defect
What is the primary source of mediators of insulin resistance?
adipose tissue, particularly central (abd) obesity
What is the tx of DMT2?
lifestyle modification, medication therapy, insulin is NOT required but may be used to achieve optimal glucose control
What is the role of medications in DMT2?
enhance insulin secretion, dec insulin resistance in hepatic or peripheral tissue, interfere w/ intestinal absorption of carbs
What are complications of DMT2?
Hyperosmolar Coma (HHNK/HHNS), DKA, hypoglycemia
What are signs of a Hyperosmolar coma?
ketosis absent, glucose 800-2400, inc osmolarity, dehydration
What triggers DKA in DMT2?
inc stress that inc levels of counter regulatory hormones (MI, infections, trauma)
What can cause hypoglycemia in DMT2?
meds, exercise, fasting
What is seen in Latent Autoimmune DM?
autoantibodies, some insulin resistance; adult onset
Pts w/ LADA often become insulin dependent w/in how many yrs?
6 yrs
As age of mother goes up, the incidence of Gestational diabetes ____
increases
What are complications of Gestational Diabetes?
high birth wt & fetal complications (inc risk for DM, cancer, schizophrenia, cardiac disease, obesity)
Gestational diabetes typically occurs during the ___ half of pregnancy.
2nd
What is the tx for Gestational diabetes?
typically resolves w/ delivery
About ___ of women w/ gestational diabetes develop DMT2 later in life.
50%
Note 
Flashcard (156)