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33 Cards in this Set
- Front
- Back
What two clinical aspects do all DM presentations share?
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1) Abnormalities in CHO, protein, and fat metabolism as a result of a relative or absolute insulin deficiency
2) End-organ complications involving the eyes, kidneys, nerves and BVs. |
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Using an oral glucose tolerance test, in what three categories are people placed?
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1) Diabetes: > (200 mg/dL)
2) Impaired Glucose Tolerance: 200 > x > 140 3) Impaired Fasting Glucose: 125 > x > 100 |
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Pre-diabetics are at risk for what medical complications?
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Pre-diabetics are at risk for heart disease, stroke, and developing T2DM
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Define "INCIDENCE" and "PREVALENCE"
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INCIDENCE - the rate at which new cases appear
PREVALENCE - proportion of a population afflicted |
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Is hypoglycemia an early- or late-stage development of T1DM?
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Hypoglycemia is a late-stage development of T1DM.
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What is a major genetic marker/determinant of T1DM?
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HLA Short-arm Chromosome 6
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What new therapy was recently shown to preserve insulin secretion in newly-diagnosed patients?
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A monoclonal antibody directed against CD3 was shown to preserve insulin secretion in newly-diagnosed patients.
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On the molecular level, what are the most common causes of insulin resistance?
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Receptor Level - changes in the number, affinity, or transduction of insulin receptors.
Post-Receptor Level - loss of signal transduction by receptor. |
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What insulin-related pathologies are required for the development of T2DM?
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Both insulin resistance and a relative insulin deficiency are required for the development of T2DM
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What are the functional characteristics of insulin secretion in T2DM?
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The beta cell lesions in T2DM is specific to glucose. Other agents, such as amino acids, may promote insulin release.
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What subset of T2DM is developed early in life?
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MODY - Maturity Onset Diabetes of Youth
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What are the hallmarks of DKA?
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1) Insulin deficiency
2) Glucagon excess 3) Volume depletion |
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Can DKA occur in T2DM?
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Yes, but more common is a Nonketotic Hyperosmolar Coma.
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How is severe hypoglycemia defined?
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Severe hypoglycemia is defined as an episode requiring assistance from another person for treatment.
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What two physiologic alarm mechanisms for hypoglycemia are gradually lost in DM?
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1) After 5 years of T1DM, glucagon levels do not respond to hypoglycemia
2) After 10 years, the EPI response is blunted as well |
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What are the four classes of diabetes complications?
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1) Microvascular
2) Macrovascular 3) Neuropathic 4) Miscellaneous |
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Describe the microvascular pathology of diabetic retinopathy.
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Non-perfusion of retinal capillaries leads to weakness and hemorrhage. Blindness results from vitreal hemorrhage, retinal detachment, or edema.
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What histopathologic finding accompanies diabetic nephropathy?
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Thickening of the basement membrane, leading to glomerular hypertension and proteinuria.
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What pharmacotherapy is renal-sparing in DM?
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ACE or ARB and good glucose control may manage diabetic nephropathy.
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Why is diabetic neuropathy such a problem?
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Insensate feet are vulnerable to infection, ulceration, and gangrene, requiring surgical debridement or amputation.
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Has the relationship between MACROvascular complications and hyperglycemia been established?
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Not statistically, although a correlation has been seen.
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What medication attempts to reverse the damaging, excessive intracellular production of sorbitol in hyperglycemics?
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Aldose reductase inhibitors.
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What molecular inhibitor is under investigation for the prevention of diabetic retinopathy?
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Protein Kinase C inhibitors
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How do sulfonylurea receptors function?
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Sulfonylureas are responsible for drug binding and subsequent closure of an ATP-dependent K-Channel, promoting insulin secretion in beta islet cells.
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Sulfonylurea drugs...
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are economical, may cause hypoglycemia and weight gain, and are not effective long-term.
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Metformin is...
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Metformin (a biguanide) is as effective as sulfonylureas, does not cause hypoglycemia or weight gain. MF frequently causes GI upset. Lactic acidosis is the most serous side-effect.
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How does metformin work?
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Metformin reduces hepatic glucose production primarily through suppression of gluconeogenesis.
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Who may not take metformin?
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Metformin is contraindicated in people with liver or kidney malfunction.
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How do thazolinediones (TZDs) work?
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TZDs increase insulin sensitivity in target tissues, especially muscle, possibly through PPARs
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What are the major thazolinediones (TZD) side-effects?
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Edema, weight gain are common. Increased risk of CHF.
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How do the incretin drugs function?
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Incretins mimic gut hormones (Glucagon-like peptides, GLPs) released in response to a meal. They potentiate beta-islet cell insulin secretion.
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Do T1DMs make any amylin?
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No. Type 1 diabetics make no amylin.
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What functions have been attributed to amylin?
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Amylin has been shown to have several functions, including retardation of gastric emptying, post-prandial glucagon suppression, and suppression of appetite.
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