Podcast
Questions and Answers
What is the primary goal of glycemic control in diabetes management?
What is the primary goal of glycemic control in diabetes management?
What condition is most commonly linked to peripheral neuropathy in diabetes?
What condition is most commonly linked to peripheral neuropathy in diabetes?
Which of the following is a common presenting feature of diabetes related to Candida infections?
Which of the following is a common presenting feature of diabetes related to Candida infections?
What is a significant consequence of diabetic retinopathy?
What is a significant consequence of diabetic retinopathy?
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Which psychological issue is reported to be more common in individuals with diabetes?
Which psychological issue is reported to be more common in individuals with diabetes?
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In diabetes management, what does microalbuminuria indicate?
In diabetes management, what does microalbuminuria indicate?
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What characterizes the skin changes in patients with diabetes?
What characterizes the skin changes in patients with diabetes?
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Which of the following is a risk factor for eating disorders in young women with Type 1 diabetes?
Which of the following is a risk factor for eating disorders in young women with Type 1 diabetes?
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Which of the following is a primary characteristic of Type 1 Diabetes Mellitus?
Which of the following is a primary characteristic of Type 1 Diabetes Mellitus?
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What is a common complication associated with gestational diabetes mellitus?
What is a common complication associated with gestational diabetes mellitus?
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In which of the following conditions does diabetic ketoacidosis (DKA) most commonly occur?
In which of the following conditions does diabetic ketoacidosis (DKA) most commonly occur?
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Which test is used to assess blood glucose levels over the preceding three months?
Which test is used to assess blood glucose levels over the preceding three months?
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What mechanism is primarily responsible for insulin resistance in Type 2 Diabetes Mellitus?
What mechanism is primarily responsible for insulin resistance in Type 2 Diabetes Mellitus?
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What physiological change occurs in the body when blood glucose levels are low, triggering the release of glucagon?
What physiological change occurs in the body when blood glucose levels are low, triggering the release of glucagon?
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What is a characteristic symptom of hyperglycemia?
What is a characteristic symptom of hyperglycemia?
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Which of the following hormones increases insulin resistance during pregnancy?
Which of the following hormones increases insulin resistance during pregnancy?
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What is the main pathological mechanism behind Type 1 Diabetes Mellitus?
What is the main pathological mechanism behind Type 1 Diabetes Mellitus?
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The Somogyi effect is characterized by what phenomenon?
The Somogyi effect is characterized by what phenomenon?
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What condition is most likely to occur as a result of chronic hyperglycemia?
What condition is most likely to occur as a result of chronic hyperglycemia?
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What is the primary role of insulin in the body?
What is the primary role of insulin in the body?
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Which of the following tests is most useful for differentiating between Type 1 and Type 2 Diabetes Mellitus?
Which of the following tests is most useful for differentiating between Type 1 and Type 2 Diabetes Mellitus?
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Study Notes
Diabetes Mellitus (DM)
- Disorder of carbohydrate metabolism
- High blood glucose levels
- Body is unable to produce or utilize insulin effectively
- Increased morbidity and mortality
- Linked to various complications including cardiovascular disease, renal damage, peripheral vascular disease, neurological disorders, blindness, and amputation.
Four Major Categories of DM
- Type 1 Diabetes (T1DM): Lack of insulin production due to beta cell destruction in the pancreas. Requires insulin treatment.
- Type 2 Diabetes (T2DM): 90% of individuals with DM. Characterized by insulin resistance.
- Gestational Diabetes (GDM): Develops during pregnancy due to hormone changes that reduce insulin sensitivity. Increases the risk of macrosomia.
- Other: Due to factors such as pancreatitis, cystic fibrosis, or neonatal conditions.
Etiology
- T1DM: Autoimmune destruction of beta cells, antibodies present, no insulin production.
- T2DM: More gradual onset, insulin resistance, insulin is still produced, often associated with sedentary behavior and obesity.
Insulin and Carbohydrate Ingestion
- Insulin is produced by beta cells and facilitates glucose movement from blood to cells.
- When carbohydrates are ingested, glucose and insulin levels rise and fall synchronously.
Insulin Facilitates Glucose Uptake
- Increases glucose uptake in muscle and liver, leading to glycogen formation.
- Reduces lipolysis in adipose tissue.
- Is an anabolic hormone.
- Hyperinsulinism: Overcomes insulin resistance with high insulin levels.
- Hyperinsulinism hypoglycemia: Excess insulin results in low blood glucose levels.
Other Glucose-Regulating Hormones
- Glucagon: Released from alpha cells of the pancreas when blood glucose levels are low.
- Somatostatin: Released from delta cells of the pancreas. Diminishes insulin and glucagon secretion, slowing GI activity and absorption.
- Incretins: GI hormones. GLP-1 and GIP stimulate insulin and slow GI motility.
- Cortisol: Increases blood glucose levels.
- Epinephrine: Increases blood glucose levels.
T1DM Pathological Mechanism
- Autoimmune T-cell mediated attack of beta cells.
- Genetic influence is a factor.
- Often presents with DKA, leading to polyuria, polydipsia, and polyphagia.
T2DM Pathological Mechanism
- Insulin resistance with increased insulin levels.
- Molecular-level mechanisms include oxidative stress, inflammation, insulin receptor mutation, and mitochondrial dysfunction.
- Metabolic syndrome involves hypertension, dyslipidemia, hyperinsulinism, and centralized obesity.
- Hyperosmolar hyperglycemic syndrome (HHS) occurs with some insulin present, preventing ketone formation. DKA is not common in T2DM.
Gestational Diabetes Mellitus (GDM)
- Hormones of pregnancy can increase insulin resistance.
- Complications include fetal defects, premature delivery, newborn hypoglycemia, and macrosomia.
- Screening involves 2nd trimester OGTT.
- GDM normally resolves after pregnancy but can increase risk for T2DM.
Diabetes Tests
- Blood glucose: Fasting and random levels.
- Oral glucose tolerance test (OGTT): 75 grams of glucose ingested, blood glucose levels are measured.
- Glycated hemoglobin (A1c): Assesses average blood glucose levels over the preceding 3 months.
- eAG: Average blood glucose over the last several months.
- Islet cell autoantibodies (ICAs): Present in T1DM.
- C- peptide test: Indicator of endogenous insulin production. Used to differentiate between T1DM and T2DM.
Diabetes Tests: Urinalysis
- Glucosuria: Elevated blood glucose levels lead to increased glucose filtration at the glomerulus, and glucose appears in the urine.
- Ketonuria: Ketones are produced when glucose cannot be utilized. Ketones appear in the urine when ketone formation and renal filtration are increased. More common in T1DM.
Complications of DM
- Both acute and long-term complications.
- Hypoglycemia and hyperglycemia.
- Acute complications: DKA (T1DM), HHS (T2DM).
- Long-term systemic complications: Blindness, kidney failure, neuropathy, cardiovascular disease, and amputation.
Hypoglycemia
- Blood glucose levels less than 70 mg/dL.
- Causes: Excessive exogenous insulin, inadequate food intake, excessive physical activity, infection, illness, or drug interactions.
- Compensatory response includes epinephrine, glucagon, and activation of the sympathetic nervous system.
Hypoglycemia cont'd:
- Signs and symptoms: Activation of the sympathetic nervous system leads to sweating, hunger, dizziness, headache, heart palpitations, and confusion.
- Management: Fast-acting carbohydrates, avoid fats, and provide a meal or snack.
- In severe cases, IV glucose or subcutaneous glucagon injection may be needed.
Somogyi Effect and Dawn Phenomenon
- Somogyi Effect: Morning hyperglycemia present with hypoglycemia during sleep. Can be caused by excessive insulin dosage or peak during sleep.
- Dawn Phenomenon: Morning hyperglycemia present without hypoglycemia during sleep. Caused by nocturnal growth hormone elevation.
Classic Signs of Diabetes Mellitus
- Polydipsia: Increased thirst and drinking due to high blood glucose levels that increase plasma osmolarity.
- Polyphagia: Increased appetite due to cellular dehydration and lack of insulin response to glucose.
- Polyuria: Increased urination due to increased renal glucose filtration and osmotic diuresis.
Fluid Shifts
- High blood glucose levels draw water from the intracellular fluid (ICF) to the extracellular fluid (ECF).
Fluid/Glucose in Urine
- High blood glucose levels lead to increased excretion of fluid and glucose in urine.
Additional Signs of DM
- Blurred vision: Glucose accumulation in the aqueous fluid can alter light refraction and cause blurred vision.
- Fluid/Electrolyte imbalance: Fluid shifts from ICF to ECF causing dilutional hyponatremia. Electrolyte shifts can occur too.
Diabetic Ketoacidosis (DKA)
- Occurs when insulin is lacking.
- Without insulin, cells cannot utilize glucose, leading to lipolysis and ketone formation.
- More common in T1DM than T2DM.
- Ketones are acids and alter blood pH, causing metabolic acidosis.
- Diagnostic criteria: Blood glucose > 250 mEq/dL, pH < 7.3, HCO3− < 18 mEq/L, and blood osmolarity > 20 mOsm/L.
- Presentation: Nausea.
- Can often be a first sign of T1DM in children.
Hyperosmolar Hyperglycemic Syndrome (HHS)
- Occurs when hyperglycemia leads to severe dehydration with hyperosmolarity.
- Clinical progression can be insidious, developing over days to weeks.
- Presentation: Weakness, poor tissue turgor, tachycardia, thready pulse, and confusion.
- Causes: Infection, trauma, noncompliance with DM management.
- Treatment: IV fluids and insulin.
Long-Term Complications of DM
- Arteriosclerosis, peripheral angiopathy, diabetic retinopathy, diabetic neuropathy, autonomic neuropathy, diabetic nephropathy, poor wound healing, and immunosuppression.
Long-Term Complications of DM cont'd
- Complication risk is related to the duration of chronic hyperglycemia, genetic susceptibility, and damage to small and large arteries.
- Chronich hyperglycemia leads to oxidative stress and end-organ damage.
DM and Atherosclerosis:
- Patients with DM are 2 to 4 times more likely to experience acute cardiac events.
- Atherosclerosis can affect both large and small arteries.
- Vascular damage is influenced by hyperglycemia leading to oxidative stress.
DM and Peripheral Neuropathy
- Distal, symmetric polyneuropathy: Neural arteries are damaged leading to pain and tingling sensations.
- Sensorimotor nerves: Can cause burning sensations, blunted pain sensation (which can delay recognition of injury or serious disease), silent MIs, and motor weakness.
- Motor weakness: Gait abnormalities, Charcot joint (altered mechanics of the foot).
DM and Autonomic Neuropathy
- Autonomic neuropathy can affect various systems including cardiac (tachycardia, hypotension), GI (gastroparesis, gastric emptying abnormality, anorexia, nausea, bowel dysfunction), urinary (increased UTI risk), reproductive (erectile dysfunction), temperature regulation (decreased sweating, hyperthermia, dry skin), and glycemic control.
DM and Susceptibility to Infection
- WBC function is decreased.
- Increased colonization of infections such as staphylococcus aureus and candida (yeast).
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Description
This quiz covers essential aspects of Diabetes Mellitus (DM), including its types, complications, and etiology. Gain insights into Type 1, Type 2, and Gestational Diabetes, as well as the impact of insulin resistance and the importance of treatment. Perfect for those studying endocrinology or health sciences.
