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74 Cards in this Set
- Front
- Back
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What is the random blood glucose criteria for DM?
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two glucose readings above 200mg/dl
AND classic signs/symptoms |
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What is the fasting blood glucose criteria for DM?
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two readings above 126mg/dl
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What is the glucose tolerance test reading for DM?
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above 200mg/dl 2 hours after standard CHO load
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What is the normal A1c level?
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5%
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What is the prediabetes A1c level?
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5.7-6.4%
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What is the diabetes A1c level?
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greater than 6.5%
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What is type 1 DM?
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an absolute deficiency of insulin due to B cell destruction
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what is type 2 DM?
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insulin resistance with realtive insulin deficiency
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What pancreatic disorders can cause type 2 DM?
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pancreatitis, cystic fibrosis
hemochromatosis |
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What endocrine disorders can cause type 2 DM?
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cushing syndrome
acromegaly glucagonoma somatostatinoma |
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What kind of infections can cause type 2 DM?
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Coxsackie B
CMV |
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What type of drugs can cause type 2 DM?
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glucocorticoids
protease inhibitors thiazieds Beta agonists |
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what maintains the fasting glucose levels?
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the liver
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What does a C-peptide assay look for?
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this measures endogenous insulin production
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What is the cause of type 1 DM?
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autoimmune process that only presents after 90% of B cells are destroyed
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Is there a genetic concordance with type 1 DM?
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yes there is
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What geneotypes are associated with Type 1 DM?
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HLA-DR3, DR4
CTLA 4 (involved in t cell regulation) |
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What is Insulitis?
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this is autoimmune destruction of B cells by T ymphocytes
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What is insulin resistance?
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decreased response to insulin in peripheral tissues
post prandial hyperglycemia** |
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What are the two main causes of type 2 DM?
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insulin resistance
B cell dysfunction (inadequate insulin secretion) |
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What are the risk factors for type 2 DM?
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central fat
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How do NEFA's cause insulin resistance?
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obese people have high TAG's these TAGs become NEFAs-> which have toxic intermediates which attenuate insulin signaling
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What factors are increased in Obesity related type 2 DM?
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NEFA's
adipokines inflammation PPARG |
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What cytokines are increased in type 2 DM?
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TNF
IL-6 |
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What are the skin findings in insulin resistance?
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acanthosis nigricans and polyps of skin
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How does excess insulin promote HTN?
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retains sodium
produces NE smooth muscle proliferation in arterioles |
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What is MODY?
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maturity Onset Diabetes of the Young
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What are the genetics of MODY?
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autosomal dominant, with high penetrance
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What enzyme is defective in MODY?
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glucokinase deficiency is the root cause
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In DM, what complications do AGE's lead to?
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atherogenesis, microangiopathy
neuropathy, retinopathy |
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What does RAGE-AGE lead to in vessels?
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smooth muscle proliferation, synthesis of ECM
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What does AGE do in large vessels?
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decreases elasticity via crosslinking
activates endothelium |
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How does AGE cause microangiopathy?
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AGE traps LDL and albumin in the BM of small vessels
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What does intracellular hyplerglycemia lead to?
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this activates PKC
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What does PKC activation lead to in DM?
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increased VEGF and diabetic retinopathy
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What pathway is involved in glucose neruotoxicity?
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aldose reductase, sorbitol-> fructose
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What is the morphology of Type 1 DM pancreas?
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reduced size/number of islets
leukocyte infiltration of islets (insulitis) |
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What is the morphology of Type 2 DM?
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deduction in islet cell mass
amyloid replacement of islets |
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What is the most common cause of death in DM?
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macrovascular disease- accelerated atherosclerosis
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What are the diseases caused by macrovascular disease?
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MI
CVAs Renal artery steonosis Hyaline arteriolosclerosis Gangrene of legs |
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How does late stage diabetes affect small vessels?
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this leads to thickening of the basement membranes
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What are the renal lesions associated with Diabetes?
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Nephrotic syndrome- nodular glomerulosclerosis*
Hyaline ateriolosclerosis pyelonephritis |
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What is the most common cause of end stage renal disease ?
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diabetic nephropathy
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What is the earliest marker for diabetic pehropathy?
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microalbuminuira - more than 30mg/day but less than 300mg/day
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What causes diabetic retinopathy?
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neovascularization due to VEGF, due to PKC activation, due to high intracellular glucose
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What causes Diabetic cataracts?
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polyol-sorbital pathway
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How does diabetic neruopathy present ?
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symmetrical peripheral neuropathy-
sensory and motor foot ulcers charcot joints |
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What are the most common diabetic GI complaints?
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constipation
diarrhea abd pain N/V dysphagia heart burn |
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What is Gastroparesis?
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delayed stomach emptying in absence of mechanical obstruction
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What are the symptoms of Gastroparesis?
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early satiety
postparandial fullness nausea heart burn |
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What are the common infections due to DM?
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skin infection
TB Fungals- necrotizing mucor of sinuses Pneumonia Pyelonephritis |
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What is the typical first time presentation of type 1 DM?
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abrupt onset insulin deficiency (usualy before 18)
manifested with an infection of some kind |
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What are the initial symptoms of type 1 dm?
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polyuria/polydipsia
polyphagia with weight loss ketoacidosis |
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How do you get polyphagia in type 1 Dm?
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fat metabolism is increased-> ketone bodies
protein metabolism release amino acids negative enegry balance= polyphagie |
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How do you get polyuria in type 1 Dm?
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blood sugar above renal threshold of 160mg/dl
osmotic diuresis |
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How do you get ketoacidosis in type 1 Dm?
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Epi released with insulin deficiency (blocking insulin, and stimulating glucagon release)
ketones are rapidly formed dehydration leads to increased hydorgen ion concentration |
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What is the typical presentation of type 2 DM person?
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obese, over 40, discovered by accidental lab work.
may have polyuria, polydipsia |
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How people with type 2 DM get DKA?
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no not usually, they get hyperosmolar nonketotic comas
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What causes Hyperosmlar nonketotic coma?
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severe dehydration in face of hyperglycemia
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What is the only treatment for type 1 DM?
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insulin
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What do sulfonylurea drugs do?
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stimulate release of insulin
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What does metformin do?
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decreases hepatic glucose production
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What do thiazolidinediones do?
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decrease insulin resistnace
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What does Sitagliptin and Exenatide do?
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these GLP-1 like things enhance insulin release
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What does A1c look for?
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glycosylated hemoglobin
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Who is most at risk to get gestation diabetes?
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excessive maternal weight gain
Hx large babies Hx fetal loss UA + for glucose |
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How are the criteria for gesttional diabetes different?
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they are lower.
only 165 @ 2 h |
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What are the fetal complications of gestational diabetes?
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Cardiac/Neruotube congential malformation
Neonatal hypoglycemia fat stupid kid. large baby pre-eclampsia |
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What is the morphology of pancreatic endocrine tumors?
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carcinoid tumors
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What is the msot common islet cell tumor?
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insulinoma
small, benign within the pancreas |
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What is the whipple triad of Hyperinsulinism?
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Hypoglycemia
CNS symptoms relieved by glucose |
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What are he lab findings in hyperinsulinism?
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low fasting blood sugar
high insulin and C peptide levels |
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What are the symptoms of alpha cell tumor (Glucagonoma)
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mild DM
migratory necrotizing skin erythema** |
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What are the sings of a VIPoma?
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watery diarrhea
hypokalemia achlorhydria |
