Term
| ____________ million people have diabetes whereas 30% of people over 20 have _____________. |
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Definition
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Term
| What % of people who are diabetics "dont do it"--dont follow docs advice? |
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Definition
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Term
| The annual health care cost for a diabetic is ___ as much as a non diabetic. |
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Definition
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Term
| There is someone diagnosed with diabetes in the US every _______ seconds. |
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Definition
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Term
| A person with diabetes is ________ as likely of dieing from a CV disease and __________ more likely to die from cancer! |
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Definition
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Term
| Which country has the highest incidence of diabetes cases? |
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Definition
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Term
| Which country has the highest incidence for type 1 diabetes in children? |
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Definition
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Term
| T/F: Diabetes is the fastest growing chronic disease and is the 6th leading cause. 285 million people worldwide in 2010. |
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Definition
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Term
| Which ethnic group has the highest prevalence of diabetes? |
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Definition
| Native Americans > Black > Hispanic > Whites |
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Term
| 75 % of all deaths from diabetes are __________ related. |
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Definition
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Term
| Why is diabetes a major contributing cause of MI, Cerebrovascular disease, and PVD? |
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Definition
| Cuz of its vascular complications |
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Term
| T/F: Patients need more education. 2/3 dont consider CV diseases to be a risk for diabetes. |
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Definition
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Term
Diabetes Mellitus can be defined as a genetically determined disorder of _______________ of _____________. Which is manifest ultimately by _____________ and a loss of carbohydrate tolerance.
Not a single disease. |
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Definition
Metabolism of heterogeneous etiology.
Insulin deficiency |
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Term
Diabetes can be either (partial) = Type ______
or can be absolute = Type _______. |
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Definition
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Term
| What metabolic and vascular components occurs with Diabetes? |
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Definition
1. Hyperglycemia
2. Large vessel disease
3. Microvascular disease
4. Neuropathy |
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Term
| What symptoms do you see with hyperglycemia? |
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Definition
Eat alot, pee alot, drink alot
(polyuria, polyphagia, polydispia)
Also see glycosuria |
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Term
| What is an example of a large vessel disease that can occur with Diabetes? |
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Definition
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Term
| Microvascular diseases usually effect these vessels ____________. Most likely in the eye and kidney. |
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Definition
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Term
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Definition
| Sensory, motor and autonomic dysfunction |
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Term
| How do you diagnose Diabetes? |
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Definition
1. FPG (fasting plasma glucose in 8 hr) 2.
2 hr OGTT (oral glucose tolerance test)
3. Random blood sample of plasma glucose
4. A1C test
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Term
| To be diagnosed with Diabetes what FPG should you have? |
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Definition
| > 126 mg/dl on more than 1 occasion |
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Term
| To be diagnosed with Diabetes what OGTT should you have? |
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Definition
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Term
| If taking a random blood sample to determine plasma glucose, what should you have to be diagnosed with diabetes? |
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Definition
| >200 mg% combined with classic symptoms |
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Term
| A1C testing is for Type 2 diabetes and for pre-diabetes. What are the respective values to be diagnosed with? |
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Definition
Type 2 = A1C > 6.5%
Pre = A1C between 5.7% - 6.4% |
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Term
| What is the normal A1C for non diabetic? |
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Definition
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Term
| Instead of the A1C, a diabetic person can use __________ to have there A1C expressed in mg/dl (which is what they are familiar with) |
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Definition
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Term
| Each unit of A1C ~ ______ mg% blood glucose. |
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Definition
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Term
| What are some classical symptoms of diabetes? |
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Definition
1. Triad (Polydipsia, polyphagia, polyuria)
2. weight loss
3. Nocturia
4. Visual changes
5. Lethargy
6. Chronic skin infections
7. Neuropathic symptoms (numbness, pain) |
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Term
| What is done if one tests positive for diabetes? |
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Definition
| Do another test on a subsequent day |
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Term
| Why is a urine test recommended annually in Diabetic patients? |
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Definition
| Because urinary microalbuminuria is correlated with an increase in renal and CV risks. |
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Term
| Which has more glucose; plasma or whole blood? |
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Definition
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Term
| Impaired Glucose tolerance is aka __________. |
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Definition
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Term
| Type _____ accounts for 5-10% of all diabetes cases. |
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Definition
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Term
| T/F: Type 1 Diabetes is greater in Hispanic. |
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Definition
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Term
| With Type 1 Diabetes there is no ___________ and the onset is usually < __________. |
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Definition
Endogenous insulin (need insulin for rest of life)
40 yrs (dramatic onset) |
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Term
| What are the clinical manifestations for Type 1 Diabetes? |
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Definition
1. Thirst
2. Frequent pee
3. Weight loss
4. Fatigue
5. Ketones |
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Term
| Which type of Diabetes has a greater family history for its cause? |
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Definition
Type 2
(less common in Type 1) |
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Term
| Which cell of the pancreas is damaged in Type 1 Diabetes? |
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Definition
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Term
| T/F: Type 1 Diabetes has a slower onset and severe hyperglycemia can occur. |
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Definition
| False; it has a sudden onset (faster) |
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Term
| What was the concordance rate in twins who were Type 1 Diabetics? |
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Definition
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Term
| Type 1 Diabetes has an autoimmune component. Which HLA are linked to diabetes and are found in 95% of patients? |
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Definition
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Term
| Which HLA provides weak protection against Type 1 Diabetes? |
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Definition
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Term
| Which HLA are protective against Diabetes? |
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Definition
HLA-DR2
HLA-DR11
HLA-DR 15 |
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Term
| Individuals with heterozygote - DR3 and DR4 are ____________ at a greater risk. |
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Definition
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Term
| Circulating ________ are found at the time of diagnosis in virtually all Type 1 patients |
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Definition
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Term
| What is ICA? It is found in 70-85% of Type 1 patients and about 5% in Type 2. |
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Definition
| Islet cell autoantibodies |
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Term
| Type 1 Diabetics have a higher secretion of ____________ which is restored with insulin therapy. |
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Definition
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Term
| There is an increase in these coutner regulatory hormones in Type 1 Diabetes. |
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Definition
1. GH
2. Cortisol
3. Catecholamines |
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Term
| What happens to a Type 1 patient who does not get insulin? |
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Definition
| Accelerated lipolysis and eventually will get ketoacidosis |
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Term
| Type 2 Diabetes accounts for _______% of all diabetes cases. |
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Definition
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Term
| T/F: 30-50% of Type 2 patients are undiagnosed. |
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Definition
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Term
| Patients with Type 2 have the disease __________ yrs before they are diagnosed. |
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Definition
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Term
| What is the concordance rate for Type 2 Diabetes? |
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Definition
| 100% (shows strong genetic predisposition) |
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Term
| What is the typical age of onset for Type 2? |
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Definition
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Term
| Type 2 is strongly correlated with ______________, having 60-80% more than 15% over the ideal. |
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Definition
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Term
| What % of Americans are clinically obese? |
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Definition
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Term
| What are the clinical manifestations of Type 2 Diabetes? |
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Definition
1. Nonspecific, Asymptomatic
2. Insidious (creeps up on you)
3. Overweight
4. Fatigue, visual changes, sensory problems
5. Macrovascular complications |
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Term
| Type 2 Diabetes is characterized by _____________ and ____________. |
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Definition
1. Fasting hyperglycemia = Due to impaired B-cell function and reduced insulin secretion.
2. Marked impaired glucose tolerance = makes insulin resistance |
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Term
| Why are obesity and age major risk factors for Type 2? |
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Definition
1. TNF-a levels are increased in obesity
2. Glut 4 and Glut 2 levels are decreaesd |
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Term
| What defects in insulin secretion are there in Type 2? |
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Definition
1. Decreased Glut 2
2. First phase insulin release is suppressed
3. Beta cell desenitization |
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Term
| Why is there an increase in glucose production in Type 2? |
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Definition
1. Increase in glucagon synthesis
2. Increase in mobilization of FFA
3. Inhibition of glucose utilization
4. Less inhibition of glycogenolysis/gluconeogensis |
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Term
| Why do Type 2 Diabetes patients have insulin resistance? |
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Definition
1. Abnormal gluc transporters
2. Liver dysfunction (fail to respond to insulin)
3. Receptor downregulation
4. Deficiency of Glycogen synthesis |
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Term
| Generally speaking, why do you see hyperglycemia in Type 2 diabetes? |
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Definition
| More glucose production and less glucose utilization |
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Term
| In Type 2, if the islet cells do not function normally then they cannot overcome what? |
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Definition
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Term
| What happens to incretin in Type 2? |
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Definition
| About 50% of postprandial insulin-incretin (GLP) is diminished or absent |
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Term
| Gestational Diabetes accounts for 4% of pregnant women. There is a higher ethnic implication in ___________. |
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Definition
| Asian> Hispanic> Black> White |
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Term
| What are the new proposed criteria for diagnosing pregnant women to have GDM? |
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Definition
FPG = >92 mg%
or an OGTT (in 1 hr) = 180 mg%
or in 2 hr = >153 mg% |
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Term
| The new guideline for GDM says to test all pregnant women who have risk factors at their _____________. |
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Definition
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Term
| Because diagnosis at the first prenatal visit would not be of GDM but rather Type 2, you should use the _______ OGTT at the 24-28 wk of gestation. |
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Definition
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Term
| If pregnant and have an A1C> 10.3 then there is 4x increase in fetal lung development retardation. Why? |
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Definition
| Hyperinsulinemia and Hyperglycemia decrease the levels of surfactants which keep the lungs open. |
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Term
| What is macrosomia and why does it occur in GDM? |
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Definition
It is having a baby that weighs more than 9 lbs.
There is more fetal insulin so more growth.
(the offspring is greater risk for obesity and Type 2 in adulthood) |
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Term
| Why do you see infant hypoglycemia at birth? |
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Definition
| There were use to high insulin in utero. |
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Term
| GDM mothers have a ____% chance of developing Type 2 Diabetes in the next 5-10 yrs. |
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Definition
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Term
| GDM increases the risk that their children will have _____________ and the daughters will have ____________. |
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Definition
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Term
| What is the criteria for pre-diabetes? |
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Definition
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Term
| What are some risk factors for Pre-diabetes? |
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Definition
1. Age
2. Lack of exercise
3. Family history of Type 2
4. Overweight
5. Previous GDM |
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Term
| Prediabetics have a _______% chance to develop diabetes in 30 yrs. |
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Definition
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Term
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Definition
A1C
Blood pressure
Cholesterol |
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Term
| A1C is glycosylated HgB, what is the target % for Diabetes patients? |
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Definition
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Term
| 73% of diabetics are on anti-hypertensive drugs, the B.P. target is ________. |
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Definition
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Term
| What are the target goals for cholesterol in Diabetes patients? |
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Definition
LDL < 100 mg/dl
HDL > 50 mg/dl (women) >40 (men)
TG< 150 mg/dl |
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Term
| What % of doctors did not know what the ABCs are? |
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Definition
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