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25 Cards in this Set
- Front
- Back
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WHO definition of diabetes
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“A state of chronic hyperglycemia which may arise from many environmental and genetic
factors often acting jointly”. |
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Diabetes in Greek means?
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to pass through
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MC's associated with DM? (4 according to Dew)
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1. MC cause of end stage renal disease
2. MC cause of blindness in adults 20-74 age 3. MCC polyneuropathy 4. MCC death cardiovascular complications |
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Which global region has highest % of population of diabetes?
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pima indians
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Age specific and gender most prevelant in US?
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black women
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Type 1 diabetes
a. genes related b. presense of a protein? c. miscellaneous |
a. HLA- DR3, DR4, B8, B15
b. 64K c. History of certain viral infections (mumps, CMV, Coxsackie) and emotional and physical stress |
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Risk factors for DMII?
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• Family history
• Gestational diabetes • Obesity • Physical inactivity • Metabolic Syndrome |
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Metabolic syndrome dx?
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at least 3 of these
dislipidemia, HTN, insulin resistance/glucose intolerance, prothrombotic state (increased fibrinogen/plasminogen in blood), proinflammatory state (increased C-reactive protein in blood) |
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With metabolic syndrome what is it associated with in...
a. women? b. skin probs? c. development of what brain thing? |
a. polycystic ovary syndrome
b. acanthosis nigricans c. increased risk for Alzheimer's disease |
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Primary prevention for diabetes?
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1. Maintain body weight at not greater than 20% of ideal body weight
2. Proper caloric intake based on level of activity 3. Consume diets with fats making up less than 30% of total calories, and diets high in fibers and low in sugars 4. Perform aerobic exercises for at least 20 minutes, 3 to 4 times a week |
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According to Dew what are the values diagnosis of DM and IGT (impaired glucose tolerance)?
-What type of prevention is this? |
Screening = 2ndary prevention
DM- Fasting plasma glucose ≥ 126 mg/dLon 2 occasions - OR symptoms plus random plasma glucose ≥ 200 mg/dL - OR 2 hour plasma glucose ≥ 200 mg/dL during OGTT (75 grams) IGT- Fasting plasma glucose > 110 mg/dL but <126 mg/dL AND 2 hour plasma glucose ≥ 140 mg/dL but < 200 mg/dL during OGTT |
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What populations would show the highest predictive value for screening DM in the US?
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native americans... in general higher the risk the population... the higher the positive predictive value
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Why is glucose urine test not sensitive? (i.e. many false positives for DM)
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Glucose in urine is not a sensitive test-- some people may have a low renal threshold for glucose (< 180 mg/dL)
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Recommendations for screening of DM?
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only in symptomatic but those select persons at high risk should be screened
- immune markers screening is not recommended in general population |
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ADA recommendation for all individuals?
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if careful hx and random glucose over 160
should- screening all individuals with a careful history and measuring fasting glucose on those with identified risk factors |
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According to ADA fasting plasma glucose greater than 115mg/dL or random glucose greater than 160mg/dL means?
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A fasting plasma glucose
greater than 115 mg/dL or a random glucose greater than 160 mg/dL, should be considered a positive screen requiring confirmation with OGTT. |
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What is a sensitive indicator for diabetic nephropathy?
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urine for microalbumin
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Tertiary prevention includes?
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Appropriate Health Care, BP, Lipids, Hem A1c level, skin foot exam, annual eye exam, patient education, home monitering, diet, exercise, compliance, foot care
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what is the definition of tertiary prevention?
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Tertiary prevention generally consists of the prevention of disease progression and attendant suffering after it is clinically obvious and a diagnosis established.
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Tx of DMII goals
a. FPG (fasting plasma glucose) b. peak post prandial c. BP d. cholesterol |
a. 90-130
b. <180 c. <130/80 d. <70 with LDL less that 100 |
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General guidline for diabetic diet?
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1. Less than 10% of total calories from saturated fat
2. Less than 25% to 30% of total calories from all fat 3. Less than 300 mg/day of cholesterol 4. Protein limited to < 0.8 g/kg of body weight 5. The majority of food to be selected from those high in fiber or complex carbohydrates |
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For non-acute diagnosed Diabetes when do you add meds and what meds?
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1. after trying lifestyle modification and blood sugar not controlled after 6 months start with single oral hypoglycemic agent
2. add 2nd oral agent if needed 3. switch to insulin if oral agent not effective anymore (while monitering BP and lipids) 4. annual eye checkup |
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2 most important metabolic controls to prevent complications of DM?
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from UKPDS study-
glucose control by metformin best HTN control second more important to prevent complications |
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Which study studied intensive glucose vs. regular control in DMII in patients and how the CV outcomes were related to them?
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ACCORD study (action to control cardiovascular risk in diabetes)
- too rapid drop in glucose could increased adverse events, |
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What is most common finiding in PIMA Indians with DMII?
What was shown as strong risk factor for development of diabetes in this population? What gene was found to contribute to insulin resistance and why? |
80% overweight
Hyperinsulinemia is strong risk factor for development of Diabetes - FABP2 may contribute to insulin resistance--> makes intestinal fatty acid binding protein that increases the absorption of fatty acids from the fat in meals which could contribute to insulin resistance |
