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12 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Classification |
Type 1... IDDM Require insulin to survive Onset typically in youth Not related to obesity Type 2... NIDDM insulin levels are normal or high, but may diminish over years of having DM. insulin resistance(due to obesity) plays major role Goes undiagnosed for many years Impaired glucose tolerance Fasting glucose btn 110 and 125mg/dl Or 2 hr postprandial glucose btn 140 and 199mg/dL Inc risk of developing type 2 Dm and CV dx |
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Pathogen. Of type 1 DM |
Autoimmune dx... immune system mediates destruction of Bcells Develops in genetically susceptible indv who are exposed to env factors that's trigger the autoimmune response Overt IDDM occurs after 90% of Bcells are destroyed |
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Pathogen of type 2 (risk factors) |
Obesity (greatest RF) associated with inc plasma levels of FFAs which makes muscles more insulin resistant, reducing glucose uptake. Therefore obesity exacerbates insulin resistance. In liver, FFAs inc glucose production
Genetics Hx: fam hx, hx of gestational DM
Age... insulin production decreases with age |
OGHA |
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Diagnosis |
1. 2 FBS >125mg/dL/ 7 mmol/l (N 3.9-6.1mmol/L) 2. Single glucose lvl of 200mg/dL /11mmol/L (N 3.2 to 7.8 mmol/L) with symptoms 3. Inc glucose lvl on OGTT > 11.1mmol/L 4. HbA1c > 6.5%
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Lack of compensation in type 2 DM |
In normal indv pancreas release insulin in response to FFAs thus neutralising excess glucose In type 2, FFAs fail to stimulate insulin secretion thus compensation doesn't occur and hyperglycemia ensues Bcells become desensitized to glucose leading to decreased insulin secretion. |
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Symptoms |
Polyuria Polydipsia Polyphagia Fatigue Wt loss Blurred vision ... swelling of lens due to osmosis Fungal infections of mouth and vagina cmn, C albicans thrives under increased glucose cdns Numbness, tingling of hands and feet... neuropathy: Mononeuropathy: due to microscopic vasculitis leading to axonal ischaemia Polyneuropathy: etio multifactorial |
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When evaluating focus on |
Neurological dx: neuropathies Eyes: retinopathy Vascular dx : CAD, PVD Renal dx The feet Infectious dx |
Head, heart, kidney, feet, infection |
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Chronic complications classes |
Macrovascular Micro vascular |
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Macrovascular complications |
Accelerated atherosclerosis-> inc risk of stroke, MI, CHF reason why target BP (130/80) is lower than gen pln(140/90) and why target LDL is < 100mg/dL Cause unknown... glycatn of lipoproteins and Inc platelets adhesive ness/aggregation implicated. Fibrinolysis impaired in diabetics Manifestations of atherosclerosis: CAD 2-4× > risk, mc cause of death in diabetics, silent MI cmn PVD Cerebrovascular disease (strokes) |
Atherosclerosis!!! |
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Microvascular |
Nephropathy Retinopathy Neuropathy Diabetic foot Inc susceptibility to infections |
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Acute complications |
Diabetic ketoacidosis Hyperosmolar hyperglycemic nonketotic syndrome |
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Tx |
Type 2: diet and exercise Oral hypoglycemics ( metformin 1st choice. Blocks gluconeogenesis. CI in patients with renal failure.) Insulin Surgical... wt loss ie gastric bypass. Islet cell transplantation |
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