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13 Cards in this Set
- Front
- Back
Dx DM?
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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 |
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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 |
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macrovascular complications
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MI, stroke
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microvascular complications
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eye, kidney, nerve
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et of Type 2 DM
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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) |
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genetics of DM 1
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-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 |
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what confers susceptibility to DM 1?
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DQ 3.2 (not DR4)
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what viruses can trigger DM1?
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Coxsackie
Rubella Mumps |
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what immunologic abnl is MC in DM 1?
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islet cell antibodies
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earliest fxn'al abnormalitity in development of DM?
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loss of first phase of insulin secretion
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predictors of DM 1?
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a. DR3 and 4, DQ3.2
b. islet cell antibodies c. loss of 1st phase of insulin secretion d. Ia positive T lymphocytes |
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daily insulin dose in T1DM vs T2DM?
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T1DM: 0.5 units/kg
T2DM: 0.7-1.3 units/kg |
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initiation of insulin Tx
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-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 |