diabetes

Cards (77)

  • Diabetes Mellitus is the most common endocrine disorder
  • Hyperglycemia
    Elevated blood glucose
  • Diabetes Mellitus
    A group of metabolic diseases characterized by inappropriate chronic hyperglycemia with disturbances of carbohydrates, fats and protein metabolism resulting from defect in insulin secretion, insulin action or both
  • Causes of Diabetes Mellitus
    • Failure of the body to secrete insulin
    • Failure of the body's receptors to recognize insulin
  • Diabetes Mellitus is incurable, except for Gestational Diabetes
  • Classifications of Diabetes Mellitus
    • Type 1
    • Type 2
    • Specific Type due to other causes
    • Gestational Diabetes
  • Type 1 Diabetes

    • Destruction of pancreatic beta cells responsible for insulin production
    • Associated with autoimmune disease
    • Usually develops in children and young adults
    • Requires insulin supplementation
  • Type 2 Diabetes

    • More common type
    • Lifestyle disorder that worsens with age
    • Occurs in adults older than 40 years
    • Caused by relative insulin deficiency and body's inability to effectively use insulin
  • Gestational Diabetes
    • Experienced by pregnant patients
    • Hyperglycemia first detected during pregnancy, usually 2nd or 3rd trimester
    • Associated with adverse outcomes for mother and fetus
  • Specific Type due to Other Causes
    • Diabetes is a result of a pre-existing condition
    • Examples: pancreatitis, use of immunosuppressants or corticosteroids
  • Differentiation between Type 1 and Type 2 Diabetes Mellitus
    • Onset
    • Clinical Features
    • Ketosis
    • C-peptide
    • Antibodies
    • Therapy
    • Associated Auto-Immune Diseases
  • GLUT2 Transporter

    Allows glucose in the blood to enter beta cells
  • Insulin Secretion
    1. Glucose undergoes glycolysis to form glycogen and ATP
    2. ATP binds to and closes ATP-sensitive K-channels
    3. K buildup causes Ca-channels to open
    4. Ca stimulates insulin exocytosis or secretion from the vesicle
  • GABA
    Stimulates insulin exocytosis or secretion
  • Hormones affecting sugar levels
    • Insulin
    • Counterregulatory hormones
    • Incretin hormones
    • Amylin
  • Insulin
    Regulates carbohydrate, protein, and lipid metabolism by promoting glucose uptake into the cell
  • Counterregulatory Hormones
    Produced during low glucose levels to increase the amount of glucose in the body, antagonize insulin effects
  • Incretin
    Released or secreted after meal or nutrient intake to stimulate release of insulin, inhibit inappropriate glucose secretion, increase beta cell growth and reproduction, suppress appetite
  • Amylin
    Co-secreted with insulin, lowers postprandial blood glucose by prolonging gastric emptying time, reduces postprandial glucagon secretion, suppresses appetite
  • Pathophysiology of Type 1 Diabetes
    • Genetics
    • Environment
    • Autoimmunity
  • Pathophysiology of Type 2 Diabetes
    • Genetics
    • Beta cell dysfunction
    • Peripheral site defect
  • Risk Factors for Type 2 or Pre-Diabetes
    • Maternal history of DM or GDM
    • Family history of T2 DM
    • Race/ethnicity
    • Signs of insulin resistance
  • Clinical Manifestations
    • Glucosuria
    • Polyuria
    • Polydipsia
    • Polyphagia
    • Weight loss
  • Criteria for Diagnosis of Diabetes
    • FPG ≥ 126 mg/dL
    • 2-h PG ≥ 200 mg/dL during OGTT
    • A1C ≥ 6.5%
    • Random plasma glucose ≥ 200 mg/dL with classic symptoms
  • Blood Glucose Level Thresholds
    • Fasting Blood Glucose Level ≥ 126 mg/dL
    • Random Blood Glucose Level ≥ 200 mg/dL
    • Oral Glucose Tolerance Test ≥ 200 mg/dL
    • Hemoglobin A1c ≥ 6.5%
  • Criteria for Testing Asymptomatic Individuals

    • Physical activity
    • 1st degree relative with diabetes
    • High-risk ethnicity
    • Women who delivered a baby weighing ≥ 9 lbs or diagnosed with GDM
    • Hypertension140/90 mmHg or on therapy
  • Glucose tolerance test

    A test to determine if a patient has diabetes
  • A1C
    3 month average of the glucose level, a good way to determine if the patient really has diabetes
  • A1C
    1. Checks if all throughout the 3 months, there is an increase in the blood glucose level
    2. Reassess the patient whether you can add or subtract a medication
  • NGSP
    National Glycohemoglobin Standardization Program
    1. h PG
    2. h Plasma glucose
  • In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate test samples
  • Blood Glucose Level
    • Fasting Blood Glucose Level ≥ 126 mg/dL
    • Random Blood Glucose Level ≥ 200 mg/dL
    • Oral Glucose Tolerance Test ≥ 200 mg/dL
    • Hemoglobin A1c ≥ 6.5%
  • Conditions for testing asymptomatic individuals

    • Physical activity
    • 1st degree relative with diabetes
    • High-risk ethnicity (African Americans, Latino, Native Americans, Asian Americans, Pacific Islander)
    • Women who delivered a baby weighing ≥ 9 lbs or diagnosed with GDM
    • Hypertension ≥ 140/90 mmHg or on therapy for HTN
    • HDL level < 35 mg/dL and/or triglyceride level > 250 mg/dL
    • Women with polycystic ovaries syndrome
    • Previous testing indicative of pre-diabetes
    • Clinical condition with insulin resistance
    • History of CVD
  • Atherosclerosis
    • It could lead to Stroke, Heart Attack, Artery Disease
    • Glucose conjugates with lipids causing the release of inflammatory molecules
    • Increased Lipid levels + Inflammatory molecules = development of atherosclerosis
  • Retinopathy
    • It could lead to Cataract and Glaucoma
    • Increased concentration of Glucose in the blood could also affect the small blood vessels found in the eyes thereby causing Retinopathy, Cataracts, and Glaucoma
  • Neuropathy
    • It could lead to Diabetic Foot
    • There is damage in the nerve cells, ↑ damage = no sensation at all
    • High concentration of glucose in their blood becomes an environment or medium for bacterial growth, leading to infection and diabetic foot
    • Worst case scenario for diabetic foot is amputation
  • Nephropathy
    • There is a destruction in the nephrons of the patient
    • Glucose is not supposed to be excreted in the kidney, it destroys the nephrons
    • Defective in terms of filtration because of the damage caused by the increase in the glucose level in the kidney
  • Treatment Goals
    • Prevent Complications
    • Optimize Quality of Life
  • Decision Cycle for Person-Centered Glycemic Management in Type 2 Diabetes
    1. Access key patient characteristics
    2. Consider specific factors which impact choice of treatment
    3. Utilize shared decision-making to create a management plan
    4. Agree on management plan
    5. Implement management plan
    6. Provide ongoing monitoring and support
    7. Review and agree on management plan