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13 Cards in this Set

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Dx DM?
must repeat one of the 3 tests to make the Dx:
1. Sx of DM + 1 random glucose>200
2. fasting glucose>126
3. 2 hour plasma glucose during OGTT>200
Dx Intermediate glucose tolerance

-at risk for what?
1. Impaired glucose tolerance (IGT)
-2 hr plasma glucose during OGTT >140 but <200

2. Impaired Fasting Glucose (IFG):
-fasting glucose >100 but <126
-2 hr plasma glucose during OGTT <140

-combined glucose Intolerance=
IGT+ IFG

-at high risk for macrovascular complications (MI, stroke)
-low risk for microvscular (eye, kidney, nerve)
-30% develop DM 2 after 10 yrs
macrovascular complications
MI, stroke
microvascular complications
eye, kidney, nerve
et of Type 2 DM
1. impaired insulin secretion
-Early: incr insulin concentration
-Late: progressive beta cell failure==>insulinopenia, hyperglycemia

2. Hepatic Insulin Resistance
*incr hepatic glucose prod despite fasting hyperinsulinemia

3. Muscle Insulin Resistance
*decr response to insulin (measured by insulin clamp technique)
genetics of DM 1
-DM 1 is polygenic
**Most imp gene assoc w/DM 1 is on short arm of chrom 6 within HLA region
-2nd most imp gene is located near insulin gene
-3rd most imp gene=the only non-HLA gene identified:
"IDDM2" on chrom 11p5.5

*95% DM 1 have DR3, DR4 or both
(however, 40% of general pop also have these)
*DR2 markedly decreases risk of DM 1, even in those who carry the DQ 3.2 susceptibility gene

*DQ3.2 susceptibility gene
-found in HLA class II region
-linked to DR4 HLA type
-DQ3.2 (not DR4) confers susceptibility to DM 1
what confers susceptibility to DM 1?
DQ 3.2 (not DR4)
what viruses can trigger DM1?
Coxsackie
Rubella
Mumps
what immunologic abnl is MC in DM 1?
islet cell antibodies
earliest fxn'al abnormalitity in development of DM?
loss of first phase of insulin secretion
predictors of DM 1?
a. DR3 and 4, DQ3.2
b. islet cell antibodies
c. loss of 1st phase of insulin secretion
d. Ia positive T lymphocytes
daily insulin dose in T1DM vs T2DM?
T1DM: 0.5 units/kg
T2DM: 0.7-1.3 units/kg
initiation of insulin Tx
-bassal insulin replacement is 50% of total insulin dosee

i. Breakfast (2/3):
-NPH (2/3)
-REG (1/3)

ii. Dinner (1/3)
-NPH (2/3)
-REG (1/3)

iii. Lantus (once daily) plus regular (rapid acting) insulin with meals