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53 Cards in this Set

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What type of disease is diabetes?
Proinflammatory procoagulant disease.
In order to be "frankly obsese", what body mass index does one have to have?
BMI>30
What is the formula for BMI?
BMI=kg/m2
What is a desirable BMI?
18.5-25
What is an overweight BMI?
25-30
What is the BMI of an obsese person?
30-40
What is the BMI of the morbidly obese?
>40
What is the optimal BMI?
21
A BMI of under 18.5 means what?
Patient is underweight.
How are the morbidly obese defined in terms of their weight?
Defined as anyone who weighs more than 100 lbs over their ideal body weight or twice their normal body weight.
-Abdominal obesity
-Hypertriglyceridemia
-Low HDL (good cholesterol)
-High blood pressure
-High fasting blood glucose
OF THESE CRITERIA, HOW MANY ARE NEED TO SUGGEST METABOLIC SYNDROME?
3
What 5 criteria suggest metabolic syndrome?
1.Abdominal obesity
2.Hypertriglyceridemia
3.Low HDL
4.High blood pressure
5.High fasting blood glucose
How big does a male's waist have to be for the male to qualify as having abdominal obesity?
>40 in
How big does a female's waist have to be for the female to quality as having abdominal obesity?
>35 in
How many triglycerides per dL are needed to qualify for hyperglyceridemia?
150 mg/dL
For a male to qualify as having low HDL, his HDL has to be lower than what number?
<40 mg/dL
For a female to qualify as having low HDL (good cholesterol), her HDL has to be lower than what number?
<50 mg/dL
For someone to qualify as having High BP, their blood pressure has to be higher than what number?
130/80
What blood glucose does a patient have to have in order to qualify as having high fasting blood glucose?
100 mg/dL
Does have a high fasting blood glucose make a person diabetic?
NO
What is an extremely important parameter, not picked up with a conventional dip stick, but with blood screening?
Microalbuminura
How much albumin does a patient need in their urine to qualify as having microalbuminuria?
30-300 mg/dL
How is diabetes described?
Diabetes is described as "artherosclerosis on fire" proinflammatory, prothrombotic/procoagulant disease.
What qualifications does a person need to meet in order to be diabetic?
1.Fasting plasma glucose level >125 mg/dL (Recall we just stated 100 mg/dL is just suggested to be "metabolic syndrome")
2.GTT both 1 and 2 hour values>200 mg/dL (post prandial blood sugar) after 75 gram glucose load
YOU DO NOT HAVE TO HAVE BOTH OF THESE, JUST ONE OR THE OTHER.
What is diabetes mellitus type 1 aka?
Juvenile or Insulin Dependent
What is the main cause of TIDM?
Disordered beta cells: characterized by insulin deficiency
When is TIDM diagnosed?
B/f the age of 20.
How is TIDM discovered?
Explosive onset-these people in retrospect may not have felt well and usually are acutely ill over 48-72 hrs and diagnosed.
What is the key difference between Type 1 and Type 2 diabetes?
Type ONE diabetes involves ketONES.
-TIDM is Ketosis prone.
-Basically Type I diabetics produce no insulin. There is unrestrained glycolysis, more than the liver can handle. This causes production of ketones.
If a patient with TIDM does not get insulin, what will happen?
They will go into ketonemia, which is an anion gap positive metabolic acidosis.
What are the complications that result from TIDM?
Develop microangiopathy=nephropathy, neuropathy, and retinopathy
What is "diabetic coma"?
Patient presents initially in ketosis. In other words, they didn't know they had diabetes and they are first diagnosed in metabolic acidosis.
-Particularly prone in the very young, i.e. a three year old. The three year old was probably wetting more diapers than he should have been.
What type of diabetes has islet cell antibodies?
TIDM
What is the etiology of TIDM?
Viral etiology, an acute viral infection of the pancreas.
In TIDM, what do autoimmune antibodies cause?
Autoimmune damage of the beta cell.
How come TIDM patients make very little insulin?
B/c 90-95% of beta cell mass is destroyed by the time of diagnosis.
What is TIIDM also known as?
Adult Onset or Non-Insulin Dependent
How can TIIDM be defined?
Resistance to effectiveness of insulin on peripheral tissue such as muscle, liver, and adipose tissue: characterized by elevated, normal, or diminished quantities of circulating insulin and accelerated rate of hepatic glucose production.
In TIIDM what are the beta cells trying to do?
Beta cells are trying to meet the demand caused by the relative insulin resistance by pouring out insulin. Eventually beta cells fall behind and the insulin levels start to drop. Beta cells will become nonfunctional.
TIIDM is broken down into what 2 types of diabetes?
Type A: non-obese (rare)
Type B: obese (more common)
How does the onset of TIDM differ from the onset of TIIDM?
TIDM: explosive onset
TIIDM: gradual onset
What is the relation between TIIDM and ketosis?
Ketosis RESISTANT. If they don't take their meds, blood sugar and hemoglobin A1C will rise, but will NOT develop ketosis. EXCEPTION: unless TIIDM are under stress they will develop ketosis and will need insulin replacement.
Are patietns with TIIDM insulin dependent?
NO, not necessarily insulin dependent--they seem to produce enough insulin.
If a diabetic patient is not hypertensive at time of diagnosis, what will happen later on down the road?
You can count on them becoming hypertensive.
Our job for diabetics is to maintain systolic below____ and diastolic below_____.
systolic below 130
diastolic below 80
Are patients with TIIDM overweight?
90% of TIIDM patients are overweight.
What are complications of TIIDM?
Macroangiopathy=coronary a., cerebrovascular a., and peripheral artery disease
What is the main problem in TIIDM?
Insulin resistance basically due to obesity and a sedentary lifetsytle.
What are the effects of insulin resistance?
1.Amplifies adrengergic resposne
2.Increase peripheral resistance. This is what causes high blood pressure
3.Increase renal Na and H2O reabsorption at the distal tubule of the kidney
4.MOST IMPORTANTLY: Adversely affects vascular endothelium
How does insulin resistance promote atherosclerotic processes?
1.Inflammation
2.Decrease size of low density lipoprotein (LDL) particles. MOST will have an elevated triglyceride and depressed HDL level, the good cholesterol, the scavenger cholesterol of LDL (bad cholesterol). The LDL they have is characterized by small dense particles. These are more atherogenic than the normal sized plaques. You want large buoyant particles for your LDL cholesterol.
3.Impaired fibrinolysis
4.Endothelial dysfunction which affects the production of NO.
What is the deadily quartet of metabolic syndrome?
1.Insulin resistance
2.Hyperlipidemia--primarily low HDL which is a major risk factor for coronary artery disease with elevated triglyceride which is also a risk factor for coronary artery disease
3.HTN
4.Obesity
MICROangiopathies are found in what type of diabetes?
TIDM
MACROangiopathies are found in what type of diabetes?
TIIDM