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64 Cards in this Set
- Front
- Back
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Define Diabetes Mellitus:
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Chronic metabolic disorder with characteristic complications associated with hyperglycemia
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Diagnostic criteria for Diabetes Mellitus:
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-2 fasting blood sugars >/= 126
-2 causal glucose levels >200 |
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4 main classes of diabetes mellitus:
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-Type I
-Type II -Other specific types -Gestational |
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What is Type I DM caused by?
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Beta cell destruction with lack of insulin
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What is Type II DM caused by?
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Insulin Resistance with Insulin Deficiency
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4 'other' sepcific types of DM:
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-Genetic B-cell function defects
-Exocrine pancreas diseases -Endocrinopathies -Drugs/chemicals |
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What is Gestational Diabetes?
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Insulin Resistance with B-cell dysfunction
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Does each class of DM present in the same typical way?
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No; there is a wide range of presentation of DM!
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Which class of DM REQUIRES exogenous insulin to SUSTAIN LIFE?
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Type I DM
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How does type I DM typically present?
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With acute onset of symptoms
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What is the peak incidence of onset of type I DM?
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11 yrs old - young
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Does Type I DM only occur in young?
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no it can occur at any age!
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What are 2 features that are pretty distinctive of type I DM?
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-Tend to be thin
-Tend to produce ketones |
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How does type II DM typically present?
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Insidiously in onset!
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What is the typical age of onset of Type II DM?
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40
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Does Type II DM always occur in older ages?
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No - it can obviously present at any age.
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What is the typical array of symptoms at onset of type II DM?
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Metabolic syndrome
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4 components of Metabolic syndrome:
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-Diabetes mellitus 2
-Dyslipidemia -Hypertension -Truncal obesity |
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What is the clinical course of Type II DM like?
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Progressively worsens
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What is the pathophysiologic cause of DM type I?
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Autoimmune destruction of the pancreatic islet B-cells
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What are the 5 stages in the development of Type I DM?
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1. Genetic susceptibility
2. Overt immunologic abnormality 3. Decreasing insulin release 4. Overt diabetes 5. Life-threatening diabetes |
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At what stage does pancreatic islet B-cell mass begin to decrease during the the development of Type I DM?
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When immunologic abnormalities become overt.
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At what stage do symptoms begin to appear during the development of Type I DM?
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When insulin release becomes so decreased that diabetes is overt and glucose is not normal.
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What is still detectable in spite of overt diabetes?
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C-peptide
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What is indicated by a complete lack of detectable C-peptide?
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Complete destruction of the Beta cells
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What is autoimmune attack of the beta cells also called?
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Insulitis
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What morphologic picture will be seen on histology in Early Insulitis?
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Lymphocytic infiltration with some remaining islet cells.
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What are the 2 prominent defects in DM type TWO?
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1. Insulin resistance
2. Insulin secretion is defective |
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What does Insulin normally do?
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-Impair liver gluconeogenesis during fasting state
-Stimulates fat/muscle uptake of glucose during fed state |
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So what does Insulin resistance result in?
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Overproduction of liver glucose, and hyperglycemic blood sugar levels
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What gets worse early in DM2; insulin resistance or secretion?
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Insulin resistance
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What are 7 short-term complications in Diabetes mellitus?
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FIPEPIT
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What is FIPEPIT?
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-Fatigue
-Immune dysfunction -Poor wound healing -Electrolyte abnormalities -Prolonged hospital stays -Increased inpatient morbidity/mortality -Txmt related hypoglycemia |
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Are the complications of type I and type II diabetes different?
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No, they both are reflections of the prolonged hyperglycemia.
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What are 2 subclasses of Long-term complications of diabetes mellitus?
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-Microvascular
-Macrovascular |
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What are 3 MICROvascular longterm complications of DM?
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-Retinopathy
-Nephropathy -Neuropathy |
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What are 2 MACROvascular longterm complications of DM?
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-Coronary artery disease
-Peripheral vascular disease |
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What are 2 retinal findings that indicate Retinopathy in DM?
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-Dot/blot Hemorrhages
-Microaneurysms |
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At what stage is the Diabetic retinopathy if you're seeing hemorrhages and microaneurysms only?
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BACKGROUND
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What will untreated Background Diabetic retinopathy progress into? Finding?
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Proliferative diabetic retinopathy with NEOVASCULARIZATION
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What will Proliferative Diab retinopathy progress into?
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Hard exudates and elevation of the retina
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What are 5 stages in Diabetic NEPHROPATHY?
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1 - Hyperfunction/hypertrophy
2 - Silent stage 3 - Incipient stage 4 - Overt diab nephropathy 5 - Uremia |
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What is the prominent characteristic of Stage 1 Hyperfunction/hypertrophy?
(GFR/Albumin excr/BP) |
GLOMERULAR HYPERFILTRATION
-Increased GFR in both type I/II -May be increased Alb excretion -BP will likely be normal, though may be high in type II |
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At what stage of diabetes does stage I nephropathy concur with?
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Time of diagnosis
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When is the silent stage of diabetic nephropathy seen?
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In the first 5 years
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What does the Silent stage of diabetic nephropathy consist of?
-Characteristics -GFR -Albumin excretion/BP |
-Thickened BM/expanded mesangium
-NORMAL GFR! -in type II Alb will be excreted, but less than 30mg/dl -BP will probly still be normal |
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What is the stage of diabetic nephropathy that coincides with the 6th-15th year of diabetes called again?
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Incipient stage
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What is the prominent feature of incipient diabetic nephropathy, and what happens to GFR, albumin excretion, and BP in this stage?
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MICROALBUMINuria
-GFR begins to fall -Alb excretion goes up to 30-300 -BP starts to be increased |
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What is the stage of diabetic nephropathy that coincides with the 15th-25th year of diabetes called again?
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Overt diabetic nephropathy..
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What is the prominent feature of overt diabetic nephropathy, and what happens to GFR, albumin excretion, and BP in this stage?
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MACROalbuminuria
-GFR is below normal for sure -Alb excretion is >380mg/dl -Hypertension for sure |
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What is the last stage of diabetic nephropathy?
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End stage renal disease
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What is this last stage of diabetic nephropathy called?
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Uremic stage
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What happens to GFR, albumin excretion, and BP in this uremic stage?
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GFR is now 0-10
Alb excretion now DECREASES BP is hypertensive |
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What 2 longterm complications of diabetes show the most dramatic increased relative risk as HbA1c levels increase?
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1. Diabetic Retinopathy
2. Diabetic Nephritis |
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For what complications is their risk of developing less dependent on HbA1c?
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-Neuropathy
-Microalbuminemia |
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What are the 3 main ways to PREVENT complications of Diab mellitus?
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-Strive for near-normal glycemia
-Treat other risk factors -Periodically assess for the presence of complications to slow them or prevent further progression |
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What are 3 major risk factors for diabetes complications?
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Lipid levels
Hypertension Smoking |
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What are 2 complications you would periodically check for?
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-Peripheral ulcers
-Microalbuminuria |
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What would you treat microalbuminuria with?
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ACE inhibitors
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What are the treatment goals for glucose levels
-preprandially -2hr postprandial |
Pre: 90-130 mg/dl
2hrPost: <180 mg/dl |
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What do you want to AVOID when treating diabetes mellitus?
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Hypoglycemia
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What do you want the HbA1c to be in diabetes patients?
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<7%
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What do you want the LDL, Triglycerides, and BP to be in DM?
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LDL <100
Tri <150 BP < 130/80 |
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What are 2 preventative treatments for diabetes mellitus?
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-Aspirin
-Exercise 150 min/week |
