Imported: Endo_Test 2: Ryan_Diabetes Mellitus

Front 1

acute complication of DM? chronic complications?

Back 1

acute: severe hyperglycemia

chronic: characterized by damage, dysfunction, and eventual failure of various organs, especially the eyes, kidneys, nerves, heart, and brain.

Front 2

what populations of people are at high risk for diabetes?

Back 2

Hispanics (especially females)

old

low socioeconomic status

Front 3

describe macro and microvascular complications of diabetes

Back 3

macrovascular complications (stroke, ischemic heart disease, peripheral vascular disease)

microvascular complications (retinopathy, nephropathy and neuropathy).

Front 4

classic buzzwords for boards for acute symptoms of hyperglycemia (diabetes)

Back 4

polyuria,
polydipsia,
polyphagia,
weight loss
blurred vision.

Front 5

why do you get increased susceptibility to infections with diabetes?

Back 5

grow in the sugar water in your urinary tract

Front 6

why do you have impaired growth in diabetes?

Back 6

just enough sugar to maintain weight, not to gain it

Front 7

Acute marked hyperglycemia may lead to what 2 problems?

Back 7

diabetic ketoacidosis (DKA) in type 1


nonketotic syndrome (HHNS) in type 2 diabetes.

Front 8

pre-diabetes

Back 8

body can produce just enough insulin to overwhelm receptors to get glucose into the cell

Front 9

About 50% of newly diagnosed type 2 diabetes will already have developed a...

Back 9

a vascular complication

Front 10

you have diabetes if you have the classic symptoms plus plasma glucose of what? Hba1c of? morning fasting plasma glucose?

Back 10

plasma glucose >200

Hba1c > 6.5

FPG>126

Front 11

What is glucose intolerance

Back 11

denoted by Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT), is not a clinical entity on its own but rather an independent risk factor for progression to clinical diabetes and development of macrovascular complications.

Front 12

Individuals with glucose intolerance are at increased risk for...

Back 12

cardiovascular disease and death indicating a continuing risk along glucose levels.

However, persons with glucose intolerance do not exhibit an increased prevalence of microvascular, or diabetes-specific complications.

Front 13

People with glucose intolerance need to initiate what kind of tx?

Back 13

nonpharmacologic lifestyle interventions to prevent progression to clinical diabetes:

calorie restriction
increased physical activity leading to weight loss

Front 14

what is Type 1 diabetes? most common cause?

Back 14

pancreatic beta islet cell destruction leading to absolute insulin deficiency
autoimmune (most common)
idiopathic (rare)

Front 15

what is type 1b diabetes?

Back 15

presents like type 1 (with DKA), then behaves like type 2

(pancreas recovers and have relative insulin insufficiency)

Front 16

what is type 2 diabetes?

Back 16

varying degrees of insulin resistance and insulin deficiency

Front 17

What is gestational diabetes? cause?

Back 17

Characterized by progressive insulin resistance that begins near midpregnancy and progresses through the third trimester.

Two main contributors to insulin resistance include increased maternal adiposity and the insulin desensitizing effects of hormones produced by the placenta

Front 18

what is Maturity onset diabetes of the young (MODY)? genetics? onset?

Back 18

Currently 6 monogenetic defects of beta cell function defined with defects in islet cell glucokinase or in various transcriptions factors such as HNF-1alpha, HNF-4alpha, IPF-1.
---The end result is impaired insulin release and hyperglycemia.

Autosomal dominant pattern.

Onset of hyperglycemia generally before age 25

(refers to any of several hereditary forms of diabetes caused by mutations in an autosomal dominant gene disrupting insulin production)

Front 19

Secondary Diabetes is most commonly due to what?

Back 19

Drugs (e.g. corticosteroids/alcohol/ antipsychotics)

Front 20

guy comes in with COPD and is treated with steroids, what problem do you have to worry about?

Back 20

secondary diabetes

Front 21

classic clinical exam finding of mutation of the insulin receptor?

Back 21

acanthosis nigricans (thickening and discoloration of skin

note: some forms of polycystic ovarian syndrome can be found too

Front 22

Many drugs may impair insulin resistance or insulin secretion leading to diabetes in predisposed individuals, what is a major one?

Back 22

Glucocorticoid

Front 23

what is the most common virus implicated in the development of diabetes?

Back 23

Congenital rubella (blueberry muffin lesions, German measles)

note: Coxsackievirus B, adenovirus, mumps and cytomegalovirus have all been implicated in inducing certain cases of the disease

Front 24

what is the pathogenesis of DM-1? what does this predispose a pt to?

Back 24

Cell-mediated autoimmune destruction of pancreatic beta islet cells, which leads to absolute insulin deficiency

predisposes individuals to diabetic ketoacidosis (DKA).

Front 25

what do all DM-1 pts require for survival?

Back 25

all patients with DM-1 require insulin for survival.

Front 26

glutamic acid decarboxylase antibodies (GAD-65),
islet cell antibodies (ICA512/IA-2) and
insulin antibodies (IAA).

are all markers for?

Back 26

DM-1

Front 27

What auto-antibodies have the highest sensitivity/specificity for DM-1?

**

Back 27

GAD-65

Front 28

Type 1 diabetes can be associated with what?

Back 28

other autoimmune processes

Graves' disease,
Addison's disease
autoimmune polyendocrine syndromes.

Front 29

pt presents with DKA, polyuria, polydipsia, polyphagia, blurry vision and unexplained weight loss...what do they have?

**

Back 29

TYPE 1 diabetes

Front 30

what is diabetic dyslipidemia? associated with what type of diabetes?

Back 30

characterized by low HDL and high TG rich particles (such as VLDL, chylomicrons) which ultimately lead to LDL

DM-1

Front 31

DM-2 is characterized by ....

Back 31

varying degrees of insulin resistance and insulin deficiency

Front 32

what 2 defects are necessary for DM-2 to develop?

Back 32

insulin resistance and insulin deficiency relative to the resistance

Front 33

Although insulin resistance may be thought as the central defect in the pathogenesis of DM-2, and most patients with the disease have insulin resistance, it is............that defines clinical diabetes

Back 33

it is the health of the beta islet cell that determines the development of hyperglycemia which defines clinical diabetes.

Front 34

type 2 is primarily a disease of what population

Back 34

adults

Front 35

which pts typically have the polydipsia, polyuria, and polyphagia, type 1/2/both?

Back 35

Type I

Front 36

Nephropathy
Retinopathy
Neuropathy

associated with what type of diabetes?

Back 36

Type II

Front 37

erectile dysfunction is associated with what diabetes?

Back 37

Type II

Front 38

Patients with diabetes, are at least twice as likely as someone who does not have diabetes to have...2

Back 38

heart disease or stroke

note: tend to have them at a younger age than others

Front 39

diabetes has a risk equivalent of what?

Back 39

Middle-aged people with type 2 diabetes, have the same chance of having a heart attack as someone without diabetes who has already had one heart attack

Front 40

why do type 2 diabetics tend to have "silent MIs"

Back 40

Because of autonomic neuropathy, there is an increased incident of “silent MIs”

Front 41

there are 4 major problems that occur with type 2 diabetes that are microvascular complications...what are they?

Back 41

retinopathy with potential loss of vision

nephropathy leading to kidney failure

peripheral neuropathy leading to pain, foot ulcers, and limb amputation

autonomic neuropathy causing gastrointestinal, genitourinary, cardiovascular symptoms and sexual dysfunction

Front 42

3 macrovascular compilations of DM-2? most common cause of death?

Back 42

coronary heart disease which is the major cause of death for patients with diabetes

peripheral vascular disease -diabetic ulcers

cerebrovascular disease- TIAs or stroke

Front 43

_____is the leading cause of blindness, chronic kidney disease and non-traumatic limb amputation in the US.

Back 43

Diabetes

**Think Vascular Damage**

Front 44

Know that people with diabetes are 2-4x more likely to develop cardiovascular complications and stroke

Back 44

Also, know that diabetes during pregnancy is a leading cause of congenital malformations, perinatal mortality and premature mortality

Front 45

Many patients with DM remain asymptomatic for long periods, so that the first presentation
of the disease is usually a __________

Back 45

chronic complication

Front 46

OPP findings for DM?

Back 46

tissue changes at T11-L2 on the
right side.

Front 47

______ patients may also exhibit diabetic dyslipidemia, characterized by low HDL and high TG rich particles (such as VLDL, chylomicrons).

Back 47

DM-1

Front 48

In type 1 diabetics:

TG's will be _____

HDL will be ______

Back 48

TGs = high

HDL = low