Diabetes Diagnosis Criteria Overview
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Questions and Answers

What is the normal range for fasting plasma glucose in a healthy individual?

  • Less than 100 mg/dL (correct)
  • Over 126 mg/dL
  • Over 200 mg/dL
  • Between 100 and 126 mg/dL

    • What does the presence of ketones in the urine suggest?

  • Type II Diabetes
  • Gestational Diabetes
  • Pre-diabetes
  • Ketoacidosis (correct)

    • What is the normal range for 2-hour postprandial glucose in a healthy individual?

  • Less than 100 mg/dL
  • Between 140 and 200 mg/dL
  • Over 200 mg/dL
  • Less than 140 mg/dL (correct)

    • Which of the following is NOT a symptom of diabetes?

    <p>Increased appetite (B)</p> Signup and view all the answers

    A patient with an A1C level of 7.5% would be classified as having:

    <p>Diabetes (D)</p> Signup and view all the answers

    What is the estimated average glucose level for a patient with an A1C of 6.0%?

    <p>100 mg/dL (C)</p> Signup and view all the answers

    Which type of diabetes accounts for the majority of cases?

    <p>Type II Diabetes (C)</p> Signup and view all the answers

    What is the primary difference between Type I and Type II Diabetes?

    <p>All of the above (D)</p> Signup and view all the answers

    In which of these conditions would we expect to see suppressed first-phase insulin secretion?

    <p>Type II diabetes (C)</p> Signup and view all the answers

    What is the primary underlying issue in Type II diabetes?

    <p>Insulin resistance (D)</p> Signup and view all the answers

    Which of the following is NOT a common symptom of Type I diabetes?

    <p>Obesity (A)</p> Signup and view all the answers

    What is the usual treatment approach for Type II diabetes at the onset of the disease?

    <p>Oral medications (D)</p> Signup and view all the answers

    What is the main genetic abnormality associated with Type I diabetes?

    <p>Abnormalities in MHC class genes on chromosome six (D)</p> Signup and view all the answers

    Which of the following is a key indicator of Type I diabetes?

    <p>Presence of autoantibodies (A)</p> Signup and view all the answers

    Why does a patient with Type II diabetes often have high triglycerides?

    <p>Reduced insulin sensitivity (B)</p> Signup and view all the answers

    What is the main difference between the first-phase insulin secretion in normal individuals compared to those with Type II diabetes?

    <p>The peak of secretion is suppressed or absent in Type II diabetes (D)</p> Signup and view all the answers

    Which of the following conditions is closely associated with Type II diabetes?

    <p>Metabolic syndrome (A)</p> Signup and view all the answers

    What is the significance of finding albumin in the urine of a patient with Type II diabetes?

    <p>It implies kidney dysfunction (A)</p> Signup and view all the answers

    Flashcards

    Fasting Plasma Glucose

    A diabetes diagnosis criterion; over 126 mg/dL after 8 hours without calorie intake.

    2-Hour Postprandial Glucose

    Glucose level over 200 mg/dL measured 2 hours after eating or an OGTT.

    A1C (Glycated Hemoglobin)

    Reflects average glucose over the past few months; must be over 6.5%.

    Oral Glucose Tolerance Test (OGTT)

    Measures plasma glucose after consuming 75 grams of glucose; assesses glucose response.

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    Normal Individual Glucose Levels

    Fasting glucose <100 mg/dL, 2-hour glucose <140 mg/dL, no above 200 mg/dL.

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    Type I Diabetes (IDDM)

    Insulin-Dependent Diabetes Mellitus; accounts for less than 10% of diabetes cases.

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    Symptoms of Diabetes

    Includes polyuria, polydipsia, and polyphagia, indicating high blood sugar levels.

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    Pre-diabetes

    Glucose levels between normal and diabetic thresholds; risk factor for Type II.

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    Type I Diabetes

    An autoimmune disease where the immune system attacks pancreatic beta cells, causing insulin deficiency.

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    Ketoacidosis

    A dangerous condition in untreated Type I diabetes marked by high levels of ketones in the blood and urine.

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    Autoantibodies

    Antibodies present in Type I diabetes that attack beta cells, including ICA, IAA, and GAD.

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    Type II Diabetes

    A form of diabetes featuring insulin resistance, usually with gradual onset and often associated with obesity.

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    Symptomatic Presentation

    Type I diabetes typically has dramatic symptoms at diagnosis, while Type II may be asymptomatic.

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    Insulin Secretion Process

    Type I shows absent first-phase insulin secretion, while Type II shows suppressed or smaller secretion.

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    Obesity Link

    Type II diabetes is strongly associated with obesity, especially with increased fat tissue.

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    Maturity Onset Diabetes of the Young (MODY)

    A rare form of diabetes that accounts for about 1% of cases, often with a genetic basis.

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    First Phase Insulin Secretion

    In a normal individual, there is a high peak and short duration of insulin release after a meal; Type II may be absent.

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    C-Peptide Levels

    In Type II diabetes, C-peptide levels can be measured and indicate residual insulin production.

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    Study Notes

    Diabetes Diagnosis Criteria

    • Fasting Plasma Glucose: Greater than 126 mg/dL. Requires no food intake for at least eight hours.
    • 2-Hour Postprandial Glucose: Greater than 200 mg/dL. Measured after an oral glucose tolerance test (OGTT) or a meal.
    • Random Plasma Glucose: Greater than 200 mg/dL. Must be accompanied by symptoms such as polyuria, polydipsia, and polyphagia.
    • A1C (Glycated Hemoglobin): Greater than 6.5%. Represents average glucose levels over the past few months.

    A1C Details

    • A1C reflects the percentage of glycated red blood cells.
    • Glucose binds to red blood cells; higher glucose levels lead to more binding.
    • A1C reflects a three-month average glucose level due to red blood cell circulation duration.
    • A1C does not directly indicate current glucose levels.
    • Estimated Average Glucose Level = (28.7 x A1C value) - 46.7.

    Oral Glucose Tolerance Test (OGTT)

    • Measures plasma glucose concentrations over time after a glucose challenge.
    • Patients consume 75 grams of glucose dissolved in water.
    • Fasting glucose levels are measured before the glucose drink.
    • Glucose levels are measured at various time points (e.g., 30 minutes, 1 hour, 2 hours) after consuming the glucose.

    Normal vs. Diabetic OGTT Results

    • Normal Individual:
      • Fasting glucose: Less than 100 mg/dL
      • 2-hour glucose: less than 140 mg/dL
      • No values exceeding 200 mg/dL at any time.
    • Diabetes Patient:
      • 2-hour glucose: Over 200 mg/dL
    • Pre-diabetes: Values fall between these extremes.

    Diabetes Classification

    • Type I Diabetes (IDDM): Insulin-Dependent Diabetes Mellitus (Less than 10% of cases).

      • Caused by a loss or deficiency of insulin secretion due to an abnormal immune response. - Autoimmune disease where the immune system attacks beta cells in the pancreas
      • T-cells are key to immune destruction of beta cells, with characteristic autoantibodies present.
      • Often young onset (about 50% are diagnosed before age 21), but can occur later.
      • Symptoms typically dramatic.
      • Genetic component, but not completely predictive (33% concordance in identical twins). Linked to MHC class genes (chromosome 6).
      • Untreated Type I diabetes highly likely to experience ketoacidosis.
      • Insulin levels are near zero or zero.
      • Autoantibodies include: islet cell autoantibodies (ICA), insulin autoantibodies (IAA), antibodies to glutamic acid decarboxylase (GAD), IA-2 antibody (antibody to protein tyrosine phosphatase).

    • Type II Diabetes (NIDDM): Non-Insulin-Dependent Diabetes Mellitus (Over 8% of the US population, with 30-50% undiagnosed).

      • Primarily adult onset, but increasing in children due to obesity.
      • Symptoms less dramatic than Type I.
      • Main issue is insulin insensitivity.
      • Slow onset, less severe symptoms.
      • Can go undiagnosed for 7-13 years.
      • Initially does not require insulin; oral medications are often used.
      • Associated with overweight or obesity.
      • Fat tissue increases insulin insensitivity.
      • High genetic concordance; multiple genes involved.
      • Markedly impaired glucose tolerance
      • Increased fasting glucose levels
      • Decreased insulin secretion in response to a meal; reduced expression of GLUT-2
      • Suppressed first-phase insulin secretion.
      • Increased glucagon secretion, which opposes insulin's effects
      • Reduced insulin receptors in the liver
      • Reduced GLUT-4 glucose transporters in skeletal muscle.
      • 60-80% of patients are more than 15% over ideal body weight.
      • Strong ethnic characteristics (e.g., Native Americans, African Americans, Hispanics).
      • Some genetic defects, but only account for approximately 20% of cases, including glucokinase, insulin, and insulin receptor mutations.

    • Maturity-Onset Diabetes of the Young (MODY): ~1% of cases

    Insulin Secretion with a Meal: Normal vs. Type II Diabetes

    • Feature | Normal Individual | Type II Diabetes
      • | -- | -- First Phase Insulin Secretion | High peak, short duration | Suppressed or absent Second Phase Insulin Secretion | Present, longer duration | Present, but may be smaller or shorter

    Type II Diabetes & Metabolic Syndrome

    • Strongly associated with obesity and metabolic syndrome
    • Hyperinsulinemia (higher-than-normal insulin levels)
    • Dyslipidemia (high triglycerides, low HDL)
    • Increased atherosclerosis risk
    • Increased free fatty acids, suggesting adipocyte involvement.
    • Resistance secretion from white adipose tissue may contribute to insulin resistance.

    Type I vs. Type II Diabetes Comparison

    Feature Type I Diabetes Type II Diabetes
    Onset Abrupt Gradual
    Body Build Lean Obese or history of obese
    Insulin Resistance Absent Present
    Autoantibodies Present Rarely present
    Symptomatic at Diagnosis Very Symptomatic Often Asymptomatic
    Ketones Present Usually present Usually absent
    Need for Insulin Immediate Not immediate, may require insulin
    Complications Diabetic ketoacidosis Hyperosmolar hyperglycemic state (HHS)

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    Description

    This quiz focuses on the various criteria used to diagnose diabetes, including fasting plasma glucose, postprandial glucose, random plasma glucose, and A1C levels. It also covers details about the A1C test and the oral glucose tolerance test (OGTT). Test your knowledge on these essential topics in diabetes management.

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