Diabetes Pathophys.csv

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Diabetes Pathophys.csv
2013-02-27 14:48:04

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  1. Beta; alpha; and delta cells and their secretion
    Beta: insulin. Alpha: glucagon. Delta: somatostatin.
  2. Insulin effect on body
    Storage: striated mm ( gluc and aa uptake + glycogen synthesis). adipose (gluc uptake and lipogenesis). liver (glycogen synth lipogenesis and decrease in gluconeogenesis.)
  3. Presenting sings of type 1 diabetes
    Commonly from acute hyperglycemia: polydipsia; polyuria; weight loss. Less frequently; polyphagia; blurred vision; and pruitis. DKA in 25% of cases.
  4. Presenting siigns of type 2 diabetes
    Insiduous; co-morbid CV disease lethargy; fatigue.
  5. Diagnostic criteria for diabetes and impaired fasting glucose and impaired glucose tolerance.
    Diabetes I: autoantibody test. Diabetes II: >126 fasting or >200 2hr-post prandial/random or A1C>6.5. IFG: 110-125. IGT 140-200.
  6. Define gestational DB; prognosis.
    Presence of glucose intolerance during pregnancy; usually returns to normal after pregnancy. Screening at 2nd trimester; 50gm 1hr post prandial challenge (>140). Mild predisposition to DM2.
  7. Pathogenesis of type 1 diabetes
    Environmental insult: trigger virus/compound. Genetic susceptibility (HLA-DR3/DR4). Autoimmunity: CD8/4 and macrophages destroy Beta-cells; distruciton-recovery cycle; eventual clinical manifestation; honeymoon phase.
  8. Pathogeneisis features of type 2 diabetes
    Insulin resistance (defective intracellular signlaing following insulin binding); B-cell dysfunction (early: hypersecretion of insulin; late: can't keep up; insulin secretion drops); dysregulated hepatic glucose production (HGP); abnormal intestinal glucose absorption; obesity.
  9. Largest subgroup of monogenetic diabetes; name and charaterized by:
    MODY-maturity onset diabetes of the young. AD inheritence; early onset <25; absence of obesity; absence of beta-cell Ab.
  10. Pathogenesis of permanent neonatal diabetes
    KCNJ11 or ABCC8 mutation; permenant activation of K channel; hyperpolarization; hypoinsulinemic diabetes.
  11. Deaf baby with hyperglycemia
    Maternally inherited diabetes and deafness
  12. Hyperpigmentation (acanthosis nigricans); PCOD; elevated androgen lvls
    Type A insulin resistance; insulin receptor mutations
  13. Hyperglycemia accompanied by loss of adipose tissue
    lipoatrophic diabetes
  14. Clasical clinical triat of diabetes; pathophys.
    Polyuria; hyperglycemia pulls in water. Polydipsia; osmotic diuresis leads to dehydration. Polyphagia; starvation mode can't take up glucose.
  15. T2DM effect on mm/fat; liver; beta cells.
    glucose intolerance in skeletal mm and fat. liver increase heptatic glucose output; beta cells dysfunctional from glucotoxisity.
  16. Importance of post prandial glucose levels
    elevated PPG can predit fasting hyperglycemia; perdic diabete before symptoms arise. PPG control in diabetes patients assoicated with lowered cardiovascular risk and mortality
  17. Goals of monitoring blood glucose
    SMBG performed fasting; preprandial; 2hrs postprandial; and bedtime glucose for tight contorl of glucose. HBA1c average blood glucose in 2-3 months; not diagnositc. preprandial fasting glucose (<100); post prandial glucose (<140); bedtime glucose 110. HbA1c<6.5
  18. Lipid levels for diabetes
    LDL<100 (<70 in established CV risk). HDL >45 in men; 55 in women. TG<150.
  19. Types of insulin dosing and how its administered.
    Standard therapy (1-2 injections). Intensive insulin therapy: multiple daily injections or insulin pumps. For intensive therapy-give 40-50% total daily dose; rest is given during the day as prandial insulin.
  20. Somogyi effect/dawn phenomenon
    Hypoglycemia at night causes rebount hyperglycemia in the morning. Usually from poor insulin injection technique. Increase evening dose or alter timing of insulin dosing.
  21. Clinical definition of DKA
    Hyper glycemia; keosis (ketonemia and moderate ketonuria) acidosis
  22. Etiology of DKA
    infection (respiratory/UTI); new onset diabetes; insulin administration; stress
  23. Symptoms of DKA
    nausea; vomiting; thirst; polydipsia; polyuria; abdominal pain; weakness; fatigue and anorexia. Tachycardia; orthostatic hypotension; poor skin turgor; warm/dry skin and mucus membranes; hyperventiliation or Kussmaul respiration; hypothermia; ketons on breath; weight loss; altered mental status; coma.
  24. Treatment of DKA
    Restore circulating volume; maintenance of CO and renal function. (Hyper glycemia pulls water away). Fluid replacement therapy as in DKA
  25. Hyperosmolar nonkeototic syndrome
    Occures exclusively in T2DM who are elderly and physically impaired. Marked hyperglycemia and dehydration in absence of acidosis; ketonemia. Fluid replacement theraphy as in DKA