Term
A1C >/= 6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay
FPG (fasting plasma glucose) >/= 126 mg/dL. Fasting is defined as no caloric intake for at least 8 hours.
2 hour plasma glucose >/= 200 mg/dL during an oral glucose tolerance test. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose >/= 200 mg/dL.
*criteria 1-3 should be confirmed by repeat testing |
|
Definition
| criteria for the diagnosis of diabetes |
|
|
Term
fasting plasma glucose of 100-125 mg/dL = impaired fasting glucose (IFG)
2 hour plasma glucose on the 75 g oral glucose tolerance test of 140-199 mg/dL = impaired glucose tolerance (IGT)
A1C of 5.7-6.4% |
|
Definition
| categories of increased risk for diabetes |
|
|
Term
1) Testing should be considered for all adults who are overweight (BMI >/= 25 kg/m^2) and have additional risk factors:
physical inactivity
first degree relative with diabetes
member of a high risk ethnic population (AA, latino, Native American, Asian American, Pacific Islander)
women who delivered a baby weighing > 9 lbs or were diagnosed with gestational diabetes
hypertension (>/= 140/90 mmHg or on therapy for hypertension)
HDL < 35 mg/dL and/or a TG level > 250 mg/dL
women with polycystic ovarian disease
A1C >/=5.7%, impaired fasting glucose, or impaired glucose tolerance on previous testing
other clinical conditions associated with insulin resistance (severe obesity)
history of CVD
2) in the absence of the above criteria, testing for diabetes should begin at age 45
3) if the results are normal, testing should be repeated at least at 3 year intervals, with consideration for more frequent testing depending on initial results and risk status |
|
Definition
| criteria for testing for diabetes in asymptomatic adult individuals |
|
|
Term
criteria: overweight (BMI > 85th percentile for age and sex, weight for height > 85th percentile, or weight > 120% of ideal for height
plus any 2 of the following risk factors:
family history of type 2 diabetes in 1st or 2nd degree relatives
race/ethnicity (Native American, AA, Latino, Asian American, Pacific Islander)
Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome, or small for gestational age birth weight)
maternal history of diabetes of gestational diabetes during the child's gestation
age of initiation: age 10 years or at onset of puberty, if puberty occurs at a younger age
frequency: every 3 years |
|
Definition
| testing for type 2 diabetes in asymptomatic children |
|
|
Term
A1C < 7%
blood pressure < 130/80
LDL cholesterol < 100 mg/dL |
|
Definition
| summary of recommendations for glycemic, blood pressure, and lipid control for adults with diabetes |
|
|
Term
|
Definition
|
|
Term
|
Definition
| production of glucose from carbohydrates or proteins |
|
|
Term
Type 1 diabetes
(Tyep 2 diabetes would be similar to non-diabetic graph, but moved up higher) |
|
Definition
[image]
what type of diabetes is portrayed in this graph? |
|
|
Term
glucose metabolism: major metabolic effect of insulin - stimulates glucose uptake into muscle and adipose cells, inhibits hepatic glucose production; consequences of insulin deficiency - hyperglycemia -> osmotic diuresis and dehydration
lipoprotein metabolism
ketone metabolism: major metabolic effects of insulin - inhibits ketogenesis (the process by which ketone bodies are produced as a result of fatty acid breakdown)
protein metabolism: major metabolic effects of insulin - stimulates amino acid uptake and protein synthesis, inhibits protein degradation, regulates gene transcription; consequences of insulin deficiency - muscle wasting |
|
Definition
| direct effects of insulin |
|
|
Term
|
Definition
secreted by pancreatic beta-cells
an anoretic hormone
works on the brain to stimulate the feeling of satiety
this results in decreased GI motility, slowed carbohydrate absorption, and decreased appetite
secreted at meal times along with insulin |
|
|
Term
GLP-1
in patients with T2DM there is less GLP-1 response |
|
Definition
"incretin" hormone secreted by jejunal and ileal L cells in response to a meal
stimulates insulin secretion before the pancreas is able to sense glucose in the blood
decreases glucagon secretion
slows gastric emptying
reduced fuel intake (increases satiety)
improves insulin sensitivity
increases beta-cell mass and improves beta-cell function (animal studies) |
|
|
Term
persistent hyperglycemia
hyperglycemia results from excessive hepatic glucose production as well as impaired glucose clearance caused by defects in insulin secretion, insulin action, or both
chronic hyperglycemia is associated with long term tissue damage involving various organs in the body, most notably the eyes, kidneys, nerves, heart, and blood vessels. |
|
Definition
| ( ) is the hallmark of all forms of diabetes |
|
|
Term
effects of hyperglycemia: glycation of proteins (hemoglobin, collagen), accumulation of sorbitol and fructose (in nerves, lens), activation of protein kinase C on vascular cells (inflammatory protein)
tissue changes: altered protein function and turnover, cytokine activation, osmotic and oxidative stress, reduced motor and sensory nerve conduction velocity, increased glomerular filtration rate and renal plasma flow |
|
Definition
| effects of hyperglycemia and the tissue changes associated with hyperglycemia |
|
|
Term
retinopathy
nephropathy
neuropathy
glycemic control will reduce incidence of these |
|
Definition
| microvascular complications of diabetes |
|
|
Term
cardiovascular disorders
glycemic control will not reduce the incidence of this.
someone with diabetes is at the same risk of an MI as someone who already had an MI |
|
Definition
| macrovascular complications of diabetes |
|
|
Term
retinopathy - can result in blindness
nephropathy - can lead to renal failure
peripheral neuropathy - can lead to foot ulcers and amputations
autonomic neuropathy - often causes cardiovascular, gastrointestinal, and genitourinary problems as well as sexual dysfunction
cardiovascular disease - MI, peripheral vascular and cerebrovascular disease
infections
cataracts
connective tissue disorders |
|
Definition
| medical complications of hyperglycemia |
|
|
Term
glycation pathway: glycated proteins -> altered function and turnover OR advanced glycation end products -> receptor-mediated cytokine effects
sorbitol pathway: sorbitol and fructose -> osmotic and oxidative effects |
|
Definition
| 2 mechanisms of tissue injury by hyperglycemia |
|
|
Term
[image]
aldose reductase reduces aldehydes generated by reactive oxygen species (ROS) to inactive alcohols, and glucose to sorbitol
sorbitol is produced when there is high glucose concentrations; a way of reducing glucose in the blood; sorbitol is not as soluble as glucose and will crystallize; sorbitol accumulation intracellularly causes nerve damage |
|
Definition
| actions of aldose reductase |
|
|
Term
|
Definition
impaired insulin secretion; absolute insulin deficiency
typically autoimmune (~90%)
beta-cells destroyed by multiple antibodies
can occur at any age (but more in kids)
fast progression (the older the slower b/c of thymus)
urine ketones
ketoacidosis - weight loss, N/V, lethargy |
|
|
Term
|
Definition
normal physiological response to carbohydrate shortages cause the liver to increase production of ketone bodies from acetyl-CoA generated from fatty acid oxidation
allows the heart and skeletal muscles primarily to use ketone bodies for energy, thereby preserving the limited glucose for use by the brain |
|
|
Term
| the ability of the failing beta-cells to become hyper-productive and compensate for failing insulin response |
|
Definition
|
|
Term
|
Definition
insidious
obesity (almost always) or weight gain
related to other IRS signs - hyperlipidemia, acanthosis nigricans
older (increased obesity in youth, so not always older patients)
ethnic links - Native Americans, Asian Americans, African Americans
family history
no ketones
insulin receptors become less receptive
component of metabolic syndrome |
|
|
Term
|
Definition
hyperpigmented, velvety patches of skin in axillary regions and neck (typically)
only associated with T2DM, not T1DM |
|
|
Term
insulin resistance: decreased glucose uptake, unrestrained lipolysis, excessive hepatic glucose output
insulin deficiency - decreased insulin secretion |
|
Definition
| dual metabolic abnormalities in type 2 diabetes |
|
|
Term
[image]
primarily liver and muscles |
|
Definition
| relative organ contribution to decreased glucose uptake |
|
|
Term
[image]
primarily increased gluconeogenesis |
|
Definition
| hepatic insulin resistance (T2DM) |
|
|
Term
inherited: rare mutations - insulin receptor, glucose transporter, signally proteins; common forms - largely unidentified
acquired: inactivity, obesity, stress medications, glucose toxicity, lipotoxicity |
|
Definition
| insulin resistance: inherited and acquired influences |
|
|
Term
idiopathic type 1 diabetes
AKA Flatbush diabetes
AKA type 1B diabetes |
|
Definition
African American and Asian men ages 18-25
fluctuating insulin secretion
no antibodies
many honeymoons |
|
|
Term
| LADA - latent autoimmune diabetes of adulthood |
|
Definition
like type 1 diabetes but diagnosed after age 25
~20% of those diagnosed with T2DM may actually have this
slower onset than T1DM
positive antibodies
low or no C-peptide
no family history |
|
|
Term
MODY - maturity onset diabetes of the young
if either parent has MODY every child will have MODY (100% chance) |
|
Definition
a collection of many (at least 6) inherited diseases affecting insulin secretion
dominant inheritance characteristics
normal insulin sensitivity
impaired insulin secretion (but still some)
diagnosis confirmed by genetic testing
will still have insulin with meals, but do not need basal insulin |
|
|
Term
|
Definition
results from a failure of the pancreas as a whole
may be secondary to alcohol abuse, trauma, repeat pancreatitis
exocrine pancreas generally fails (missing lipase = fatty diarrhea) before endocrine pancreas
will need pancreatic enzyme replacement as well as insulin |
|
|
Term
|
Definition
any glucose intolerance first diagnosed during pregnancy
some definitions require a return to normal following end of pregnancy
closely related to T2DM
treat only with insulin - some data to support the use of SUs and metformin |
|
|
Term
100-g oral glucose tolerance test
if 2 numbers are above the glucose threshold (fasting, 1h, 2h, 3h) then diagnosed with gestational diabetes |
|
Definition
| how is gestational diabetes diagnosed? |
|
|
Term
6 - 135
7 - 170
8 - 205
9 - 240
10 - 275
11 - 310
12 - 345
for every 1% point of increase in A1C add 35 mg/dL of glucose
remember 7 - 170 and go up or down 35 from there |
|
Definition
| A1C and the corresponding mean plasma glucose |
|
|
Term
falsely elevated: iron deficiency anemia, splenectomy (iron deficiency anemia and splenectomy make RBC's last longer and will cause A1C to be higher b/c they have more time to bind to glycogen), untreated hypothyroidism
falsely decreased - RBC's last a shorter amount of time, hemolytic anemia, bleeding disorder (heavy menses, GI bleed), sickle cell anemia (or other hemoglobin variant condition), transfusion, hyperthyroidism |
|
Definition
| causes of false A1C readings |
|
|
Term
glycated hemoglobin <- EXAM QUESTION
patients with sickle cell have more hemoglobin S, A1C only tests if hemoglobin A is glycated |
|
Definition
| should A1C of glycated hemoglobin be used to test a patient with sickle cell anemia for diabetes? |
|
|
