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Overview of DM

Clinical Medicine II

Whas DM type 1 Absolute insulin deficiency
What is type 2 DM relative insulin Deficiency, insulin resistance
What is Diabetes lack of cellular access to glucose→↓ cellular glucose utilization, accumulation of glucose in plasma
What happens at the liver in DM unmitigated hepatic glucose production, can be not eating and glucose still rises
Why do we need insulin need it to uptake glucose in the cells (except the brain), results in micro and macro
What is the fxn of the pancreas primary endocrine gland of glucose homeostasis, B-cells produce insulin, alpha: glucagon, delta: somatostatin
What happens in the liver during the fed state extracts glucose from blood, glycogen synthesis, FA and TG synthesis
Liver fxn during fasted state ↑ hepatic glucose production, glycogenolysis, gluconeagensis
What is the main glucose producer liver
Does the liver, skeletal muscle, adipose tissue and brain need insulin for glucose uptake? only the skeletal muscleand adipose tissue
What happens in skeletal muscle for fed state and fasted state fed: extracts glucose for glycogen sythensis and ATP production, Fasted: provides AAs and lactate to liver for gluconeaogensis
Fxns of adipose tissue in fed and fasted state fed: extracts glucose for energy storage as TG, fasted, released FA for oxidation and energy, LT fast: ketones
Are fatty acids a source of glucose NO!
Why are ketones produced in LT fast d/t B-oxidation, Aceytyl co-A produces ketones
4 inhibitory fxns of insulin gluyconeolysis, gluconeogenesis, HGP, lipolysis
4 fxns of glucagon in the liver stimulates HGP, glycogenolysis, gluconeogenesis, FA release from adipose
Stimulates glucose production from glycogen (liver & muscle) and FA release from tissue epinehhrine
Functions of cortisol AA release from muscle, glucose production from glycogen in liver/muscle, FA release from adipose
Fxns of GH Circadian rhythms, nocturnal rise in GH→insulin resistance, AM hyperglycemia
Know the chart of insulin def pg 2
Nl fasting plasma glucose 70-100mg/dL
What is necessary for brain fxn 40 mg/dL
What level of blood glucose will cause glucose in the urine >180mg/dL
When are most type 1 DM diagnosed 5-15, around puberty previously called “juvenile diabetes”
What causes type 1 DM genetic, environmental, autoimmune dysfx-more prone to have another autoimmune dz
How does type 1 DM show up later in life in it is a complete insulin deficiency there is a gradual destruction f the b-cell in the pancreas
What % of the b-cells need to be gone prior to clinical dz 90% loss prior to symptomatic
What are some environmental exposures/triggers infections/viruses, chemicals, infant feeding practices (bovine proteins?) obesity?, starts the autoimmune cascade
What is the honeymoon phase in type I DM giving some insulin induces insulin production in the pancreas for some time, but will eventually d/c and need full time insulin replacement
What % of the U.S. POPULATION has type2 DM 7%!
What ethnicities see ↑ in DM type 2 NA, AA, Hispanics,Polynesian, asians
What causes type 2 GENETIC!: obesity!!, RF’s
BMI > what will usually result in DM >35 72% will have DM!
What are 6 genetic factors in type 2 DM Obesity, FH, metabolic syndrome, Race, GDM, SGA
RF’s for DM overweight, inactivity, insulin resistance, pre-dm, concomitant factors: HTN and hyperlipidemia (TG) low HDL, AGE: pancreatic burnout theory
What is IDDM insulin dependent DM aka type 1 DM
DKA diabetic ketoacidosis
Patho of type 2 DM relative insulin deficiency (resistance), receptor and post-receptor defects, perpetuated by hyperinsulinemia, with a progressive secretory defect
Symptoms of type 1 DM polydipsia, polyuria, polyphagia, wt loss
Symptoms of type 2 DM often asymptomatic, present w/ comorbidities (HTN, CVD, stroke, dyslipidemia)
Insulin in Type 1 and2 1: usually absent, severely diminished 2: low, nl, high
Test to distinguish b/w type 1 and type 2 C-peptide, 1: decreased 2: normal or increased
Why do we give insulin to patients with insulin resistance it takes more insulin to get the same response to a non-insulin resistant patient.
What are other disease that can cause problems with the pancreas pancreatitis, cystic fibrosis
What are some disease that DM can be secondary to Cushing’s disease, acromegaly, hyperandrogenism, PCOS
Classification of DM monogenetic diabetic syndrome, neonatal DM, Maturity onset diabetes of the young, genetic b-cell dysfx for insulin receptor defect, medication induced
What are signs of prediabetes abnl oral glucose tolerance test, 20% progress to type 2
Why does GDM occur HCG and progesterone, estrogen, lactogen ↑ insulin degradation and resistance
How often do we see GDM 7% of all pregnancies! (↑blacks and Hispanics: obesity)
What ↑ risk of perinatal morbidity and morbidity macrosomia and post-natal hypoglycemia
What are nl, pre and DM FPG nl: 70-100, pre: 100-125, DM>126
Random PG levels nl <140, Pre: 140-199, DM >200 w/ sxs
What is Hgb A1C Average level of hyperglycemia over 2-3m
Hgb surrounded by high glucose levels causes ↑ A1C
Impaired fasting glucose out of the nl range
Pre diabetes levels of A1C 5.7-6.4 (no classified nl level (usually under 5 but not gold std))
What is the diagnostic criteria for metabolic syndrome Waste >40, >35, TG’s: < 150 HDL: <40M <50F, BP: >130/85,
What are screening guidelines for type 2 DM Begin 45 yo, every 3 yrs, (more frequent w/ ↑ risk), FPG, OGTT, Hgb A1C
WHO do we screen asymptomatic patients who are overweight (BMI > 25). Who have >1 RFs
RF’s DM BMI>25, inactivity, 1 relative w/ DM, delivery >9lb baby, PCOS, HTN, HDL, H/O CVD, Acanthosis nigracans
What is acanthosis nigracans in NA/AA’s darkening areas of the skin usually around the neck
What is the screening for type I DM there isn’t any, abrupt onset, and too rare for screening (research for potential intervention BEFORE b-cell destruction)
How do we detect type 1 DM immune assays to detect abs
Diagnostic criteria for gestational DM: OGTT at 24-28 weeks (everyone), Fasting: >92, 1hr: >180, 2 hrs>153
What is the post-partum assessment for DM for women check 6-12 weeks postpartum (test other than A1C), then check q3years if hx of GDM
CP of type 1 DM polyuria, dipsia, phagia, wt loss, blured vision, DKA, Dehydration, ketonuria, glucosuria, ketone breath, C-peptide absence
CP of type 2 DM +/- nl D sxs, vaginal yeast, candida, ↑infx, vision sxs, neuopathy, retinopathy,
Lab findings of DM A1C, FLP, LFTs, microalbuminurea, and micro (creatinine), SCr, estimated GFR, TSH
What should we screen for with t1 and t2dm celiac dz
What other endocrine dysfx is often associated/ dm polycystic ovarian syndrome PCOS
Microvascular complications of DM eye, kidney, nerve
Macrovascular complications of DM cardiac, CVD, PAD
Skin manifistationsof DM acanthosis nigicans,insulin injection sites
What is important when giving pt ed for DM it’s a self-managed dz!! Patient orientated tx
Self-montioring guidelines for type 1 3 or more injections/day or continuous pump therapy, should have pre and post pradinal insulin dosing,
What are indications for continuous glucose monitoring patients unaware of hypoglycemia
Why is there such a chance for hypoglycemia in the diabetic patient their nl bodies response to insulin decreases, so the insulin continuous to decrease the blood glucose
Hgb A1C testing recommendations 2/year if meeting tx goals, 4x yr if not meeting goals
Goal for A1C <7 % will ↓ micro and macrovascular complications
What is the primary target for glycemic control A1C
What populations need special considerations when managing DM children, pregnant women, elderly
Targetgoals for DM A1C, BP, BG, lipids A1C <7, pre prandial BG 70-130, post prandial or peak <180, BP: 130/80, LDL<100, TG<150, HDL>40M >50F
MNT for Type 1 glycemic control by coordinating CHO intake, exercise, and insulin therapy, also: prevent HTN,CAD
Why do we keep BG highter in those younger more vulnerable to hypoglycemia `
What is the hallmark of DM management CHO counting and control
Does a diabetic need to be on a low CHO diet? no, just need to distribute it throughout the day
What is a diabetic diet normal healthy eating with a reduction in saturated fats
What do we do with a 5 yo type 1 DM going to a birthday party and going to eat cake and ice cream adjust his insulin dose, but ensure he is actually going to eat this
What classifies early stage renal disease 30-299mg/24 hrs microalbuminuria
What is tx for early Early stage renal dz avoid excess protein (.8-1.0gm/kg) (not a RDA restriction)
Management for T2DM weight management of >25BMI, calorie reduction, Low CHO, mediterranean, exercise, pharm
Wt management in T1DM watch excess wt gain in tightly controlled T1DM
What are 3 other nutritional considerations fiber, ↓ calorie/non-nutritive sweetners,alcohol ↓
Alcohol recommendations for diabetics on for women, 2 for men 1:15g/carb
How can alcohol contribute to hypoglycemia the liver works on metabolizing alcohol, stops producing glucose
Bariatric surgery indications type2DM w/ BMI >35, comorbid condition, difficult to control w/ LSM and pharm
Is gastric bypass rcommended w/ BMI 30-35 no
Why does physical activity help glucose ↑ muscle, ↑ glucose consumer, ↑insulin sensitivity, wt management, ↓ risk CVD
PA recommendations moderate 150m/week, vigerous 90m/wk, resistance 3x/wk
Pharm for t1 and t2dm 1: insulin, 2: metformin, insulin
What are we trying to do w/ drug therapy cell glucose intake, ↑insulin secretion, ↓HGP,
Immunization recommendations (STOP SMOKING), annual flu >6m old, pneumococcal for al DB>2yr, HBV
When do we revaccinate for pneumococcal >65, >5yr ago, have nephrotic syndrome, CRF, immunocompromised
Tx for preDM ↓kcal, ↑fiber whole grains-helps w/ insulin control,
Tx for gestational dm manage w/ diet, wt loss CI in preggo, pharm: insulin only, non-insulin pharm CI
Created by: becker15
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