Pathophys Exam 2

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Author:
Rx2013
ID:
40575
Filename:
Pathophys Exam 2
Updated:
2010-10-07 20:57:03
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Diabetes Mellitus
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Description:
Pathophysiology of Diabetes Mellitus
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  1. Epidemiology of DM
    • 20.8 million diagnoses
    • type 1 = 1 million
    • type 2 = 19.8 million
  2. Epidemiology of prediabetes
    54 million
  3. Populations with a predisposition for diabetes
    • american indian/alaska natives 15.1%
    • african americans 13.3 %
    • hispanic americans 9.5%
  4. Etiology of type 1 diabetes
    • autoimmune disorder
    • destruction of pancreatic beta cells
    • absolute deficiency of insulin
  5. Etiology of type 2 diabetes
    • genetic
    • older age
    • insulin resistance
    • eventual impairment of beta cells
    • increased glucose production by the liver
  6. Risk factors for type 1 DM
    • family history
    • beta cell autoimmunity
    • infection
    • environmental exposure
    • chemical exposure
    • dietary exposure
  7. Risk factors for prediabetes and type 2 DM
    • family history
    • overweight
    • hypertension
    • history of GD
    • polycystic ovary syndrome
    • cardiovascular disease
    • Sedentary lifestyle
    • increased triglycerides and low HDL
    • delivery of infant >9lbs
    • psyciatric illness
  8. Risk factors for gestational diabetes
    • family history
    • history of stillbirth
    • abnormalities of previous pregnancy
    • previous heavy infant
    • obese
    • age
    • > 5 pregnancies
  9. Signs and sypmtoms of Type 1 DM
    • polyuria
    • intracellular dehydration = increased thirst
    • cellular starvation
    • weight loss
    • blurred vision
    • paresthesias
  10. Signs and symptoms of type 2 diabetes
    • polyuria
    • intracellular dehydration = increased thirst
    • blurred vision
    • paresthesias
  11. Prefered diagnostic test for DM
    Fasting blood glucose (8hrs)
  12. Oral glucose tolerance test
    • used in pregnancies
    • measures ability of body to store glucose by removing it from blood
    • 75g glucose load
  13. HbA1C
    • hemoglobin binds to glucose when glucose levels are high
    • A1c shows index of BG over 6-12 weeks
  14. Normal FPG levels
    < 100 mg/dl
  15. Normal Glucose tolerance test level
    <140 mg/dl
  16. Prediabetes HbA1c
    5.7 - 6.4%
  17. Diagnostic criteria for DM
    • HbA1c > 6.5%
    • FPG > 126 mg/dl
    • 2 hr glucose tolerance test > 200 mg/dl
    • casual plasma glucose >200 mg/dl plus symptoms
  18. Diagnostic criteria for gestational diabetes
    • same as DM
    • retest between weeks 24-28
  19. When to test for DM
    • > 45 years of age
    • 1st degree relative with DM
    • signs and symptoms and risk factors of DM
    • previous positive test for DM
  20. monitoring DM
    • home blood glucose tests
    • A1c repeated ~ 3 months
  21. Goals of DM therapy
    • stabilize blood glucose levels
    • optimize risk factors
    • prevent complications
    • reduce morbidity and mortality
  22. Non-pharmacologic treatment of DM
    • Medical nutrition therapy
    • optimize BG and lipid levels
    • Exercise
  23. optimal BG and lipid levels
    • not less than 130g of carbs/day
    • <7% daily calories from saturated fat
    • <200 mg cholesterol daily
    • minimize trans fat
  24. Exercise goals for DM
    • 30 min a day 5x a week
    • weight management
    • improve insulin sensitivity
    • could result in hypoglycemia
  25. Oral agent treatment options for type II diabetes
    • stimulate insulin secretion from pancrease
    • decrease glucagon secretion
    • increaes sensitivity to insulin
    • inhibit hepatic glucose produciton
    • delay absorption of glucose from the GI tract
  26. Injectable treatment option
    insulin
  27. other treatment options
    • decrease glucagon secretions
    • decrease appetite by delaying gastric emptying
  28. Targets of treatments for DM in the pancrease
    • impaired insulin secretion
    • excessive glucagon secretion
  29. Targets for treating DM in the intestines
    carbohydrate absorption
  30. targets for treating DM in the liver
    increased basal hepatic glucose produciton
  31. targets for treating DM in the muscle and fat cells
    decreased insuli stimulated glucose uptake
  32. Accute complications of DM
    • Diabetic ketoacidosis
    • hyperosmolar hyperglycemia state
    • hypoglycemia
  33. chronic complications of DM
    • impaired immune system
    • microvasculature problems
    • macrovascular problems
  34. Microvascular complications of DM
    • Kidney
    • Eye
    • Nerves
  35. Macrovascular complications of DM
    • Peripheral vascular disease
    • MI
    • Stroke

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