Week 12 Diabetes 750
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What differentiates Latent Autoimmune Diabetes in Adulthood (LADA) from Type 2 Diabetes Mellitus (T2DM)?

  • LADA often presents with an acute onset of symptoms.
  • LADA demonstrates severe insulin resistance.
  • LADA is characterized by an autoimmune response. (correct)
  • LADA has a higher incidence of ketosis than T2DM.

    • Which age group is typically associated with the diagnosis of Latent Autoimmune Diabetes in Adulthood (LADA)?

  • Adults over 30 years (correct)
  • Individuals in their 40s
  • Adolescents aged 13 to 19 years
  • Children under 12 years

    • What is a common symptom that should be screened for when assessing complications of diabetes?

  • Symptoms of hyperglycemia (correct)
  • Restless leg syndrome
  • Epileptic seizures
  • Peripheral vision loss

    • Which of the following statements is true regarding the beta cell function in individuals with Latent Autoimmune Diabetes in Adulthood (LADA)?

    <p>Beta cell function decreases gradually after diagnosis.</p> Signup and view all the answers

    In follow-up visits for diabetes management, which question is essential to determine changes in the patient's condition?

    <p>Any adverse reactions to the prescribed treatment?</p> Signup and view all the answers

    Which of the following statements accurately describes Type 1 diabetes?

    <p>It is associated with the destruction of pancreatic beta cells and absolute insulin deficiency.</p> Signup and view all the answers

    What is the primary complication associated with diabetes that accounts for the highest mortality rate?

    <p>Cardiovascular disease</p> Signup and view all the answers

    Which screening method is considered the most appropriate for diagnosing diabetes in asymptomatic adults?

    <p>Hemoglobin A1c</p> Signup and view all the answers

    When diagnosing diabetes, how many abnormal test results are typically required for a definitive diagnosis?

    <p>Two abnormal test results from the same sample or in two separate samples.</p> Signup and view all the answers

    Which of the following is NOT considered a common comorbidity associated with diabetes?

    <p>Craniocervical dystonia</p> Signup and view all the answers

    What underlying condition can lead to pancreatogenic diabetes?

    <p>Cystic fibrosis</p> Signup and view all the answers

    At what age should general adults begin screening for diabetes?

    <p>Age 45</p> Signup and view all the answers

    Which of the following factors is NOT associated with Type 1 diabetes?

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

    Which diabetes screening test requires fasting prior to the test?

    <p>Fasting plasma glucose test</p> Signup and view all the answers

    What percentage of people with diabetes might experience neuropathy during their lifetime?

    <p>50%</p> Signup and view all the answers

    Which of the following best describes a common symptom related to complications of diabetes?

    <p>Fatigue and weakness</p> Signup and view all the answers

    Which screening method is crucial for assessing potential diabetic complications in the eyes?

    <p>Dilated retinal exam</p> Signup and view all the answers

    What is the target fasting blood sugar (FBS) level for most diabetes patients?

    <p>80-120 mg/dL</p> Signup and view all the answers

    Which of the following factors does NOT typically lead to complications in diabetes?

    <p>Well-controlled blood glucose levels</p> Signup and view all the answers

    What is the recommended frequency for glycemic assessment in patients not meeting targets?

    <p>Four times a year</p> Signup and view all the answers

    Which of the following is NOT a common diagnostic criterion for diabetes?

    <p>A1c level of 5.0% or lower</p> Signup and view all the answers

    What lifestyle modification is most commonly advised for managing diabetes and preventing complications?

    <p>Regular physical activity</p> Signup and view all the answers

    What is the primary factor contributing to the development of complications in diabetes, as indicated by A1c levels?

    <p>1% reduction in A1c</p> Signup and view all the answers

    Which monitoring method provides real-time glucose levels using interstitial fluid?

    <p>Continuous glucose monitoring</p> Signup and view all the answers

    Which of the following is a common symptom associated with cardiovascular complications in individuals with diabetes?

    <p>Chest pain</p> Signup and view all the answers

    What is the typical duration before insulin dependence occurs in individuals diagnosed with Latent Autoimmune Diabetes in Adulthood (LADA)?

    <p>Over 6 months after diagnosis</p> Signup and view all the answers

    Which of the following features distinguishes Type 1 Diabetes Mellitus (T1DM) from Latent Autoimmune Diabetes in Adulthood (LADA)?

    <p>Onset age</p> Signup and view all the answers

    In which situation would the likelihood of ketosis be highest among diabetes types?

    <p>T1DM</p> Signup and view all the answers

    What is a potential risk concerning beta cell function in LADA compared to Type 2 Diabetes Mellitus (T2DM)?

    <p>Gradual decrease in beta cell function</p> Signup and view all the answers

    Which characteristic differentiates LADA from both T1DM and T2DM in terms of its progression?

    <p>Slow progressive autoimmune beta cell destruction</p> Signup and view all the answers

    What is the component of healthcare maintenance specifically focused on diabetes management?

    <p>Dilated retinal exam</p> Signup and view all the answers

    Which of the following best describes the monitoring frequency for A1c in patients who are meeting targets?

    <p>Every six months</p> Signup and view all the answers

    What symptoms are commonly associated with the endocrine complications of diabetes?

    <p>Polyuria, polydipsia, and polyphagia</p> Signup and view all the answers

    Which factor is considered a significant indicator for assessing the risk of diabetic complications?

    <p>A1c levels</p> Signup and view all the answers

    What is the primary purpose of self-monitoring blood glucose in diabetes management?

    <p>To identify trends and adjust treatment effectively</p> Signup and view all the answers

    Which blood pressure goal is generally recommended for most diabetes patients?

    <p>140/90 or less</p> Signup and view all the answers

    What type of glucose monitoring provides both real-time and intermittently scanned data?

    <p>Continuous glucose monitoring</p> Signup and view all the answers

    Which symptom is least likely to be associated with gastrointestinal complications in diabetes?

    <p>Chest pain</p> Signup and view all the answers

    What is the primary focus of monitoring vital signs for diabetes patients?

    <p>To evaluate weight and blood pressure changes</p> Signup and view all the answers

    What common misconception might patients have about fingerstick glucose monitoring?

    <p>It is the only method necessary for diabetes management</p> Signup and view all the answers

    Which of the following factors is least likely to trigger Type 1 diabetes?

    <p>High body mass index</p> Signup and view all the answers

    Which of the following complications is most commonly associated with diabetes-related neuropathy?

    <p>Non-traumatic amputations</p> Signup and view all the answers

    What is the relationship between diabetes and cardiovascular disease in terms of mortality?

    <p>Diabetes accounts for 2/3 of deaths in people with diabetes.</p> Signup and view all the answers

    How frequently should adults be screened for diabetes if their initial results are normal?

    <p>Every 3 years</p> Signup and view all the answers

    Which statement about gestational diabetes is accurate?

    <p>Fetal macrosomia is a potential outcome.</p> Signup and view all the answers

    What combination of abnormal test results is required for a diabetes diagnosis if hyperglycemia is not present?

    <p>Two abnormal results from different samples</p> Signup and view all the answers

    Which of these is not considered a common comorbidity associated with diabetes?

    <p>Insulinoma</p> Signup and view all the answers

    What is the impact of Type 1 diabetes on beta cell function?

    <p>It leads to absolute insulin deficiency.</p> Signup and view all the answers

    Which condition is associated with pancreatogenic diabetes?

    <p>Cystic fibrosis</p> Signup and view all the answers

    What is a potential long-term consequence of uncontrolled diabetes related to the kidneys?

    <p>Nephropathy</p> Signup and view all the answers

    What distinguishes Latent Autoimmune Diabetes in Adulthood (LADA) from Type 2 Diabetes Mellitus (T2DM) in terms of insulin dependence onset?

    <p>Insulin dependence in LADA typically occurs more than 6 months after onset.</p> Signup and view all the answers

    In terms of beta cell function, how does LADA compare to Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM)?

    <p>LADA presents a decrease in beta cell function similar to T1DM.</p> Signup and view all the answers

    What is a key characteristic of the autoimmune process in Latent Autoimmune Diabetes in Adulthood (LADA)?

    <p>Autoimmunity in LADA occurs gradually but is still present.</p> Signup and view all the answers

    Why might LADA be commonly misdiagnosed as Type 2 Diabetes Mellitus (T2DM)?

    <p>LADA has a slow progression similar to typical T2DM.</p> Signup and view all the answers

    Regarding the risk of ketosis, how does LADA compare to Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM)?

    <p>The risk of ketosis is rare in both LADA and T2DM.</p> Signup and view all the answers

    Which symptom is most indicative of endocrine complications in diabetes management?

    <p>Blurry vision</p> Signup and view all the answers

    What is the primary goal for fasting blood sugar in diabetes patients?

    <p>80-120 mg/dL</p> Signup and view all the answers

    What is the recommended maximum blood pressure goal for most diabetes patients?

    <p>140/90</p> Signup and view all the answers

    Which aspect of diabetes care is emphasized by self-monitoring blood glucose?

    <p>Understanding real-time effects of lifestyle changes</p> Signup and view all the answers

    Which monitoring method is best suited for intermittent glucose assessment in diabetes?

    <p>Fingerstick glucose monitoring</p> Signup and view all the answers

    What is the leading cause of non-traumatic amputations in individuals with diabetes?

    <p>Neuropathy</p> Signup and view all the answers

    What is the significance of a 1% reduction in A1c levels in terms of complication risk?

    <p>Reduces the risk of complications by approximately 30%</p> Signup and view all the answers

    Which of the following is NOT a recommended healthcare maintenance activity for diabetes patients?

    <p>Annual respiratory check-up</p> Signup and view all the answers

    Which of the following is a common comorbidity found in individuals with diabetes?

    <p>Osteoarthritis</p> Signup and view all the answers

    What is the primary purpose of performing a monofilament exam in diabetes patients?

    <p>Checking for signs of neuropathy</p> Signup and view all the answers

    Which of the following is primarily associated with Type 1 diabetes specifically?

    <p>Absolute insulin deficiency</p> Signup and view all the answers

    Which complication is commonly associated with gastrointestinal symptoms in diabetes?

    <p>Absorption disorders</p> Signup and view all the answers

    What is the consequence of gestational diabetes for both mother and child?

    <p>High risk for fetal macrosomia</p> Signup and view all the answers

    What is the primary aim of diabetes-related vaccines in healthcare maintenance?

    <p>Mitigate risk of viral infections</p> Signup and view all the answers

    What screening test is considered the most definitive for diagnosing diabetes?

    <p>Hemoglobin A1c</p> Signup and view all the answers

    Which characteristic is majorly present in Type 2 diabetes but not in Type 1 diabetes?

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

    When should the first diabetes screening occur in the general adult population?

    <p>At age 45</p> Signup and view all the answers

    What is a key factor influencing the screening frequency for diabetes in at-risk individuals?

    <p>Body mass index</p> Signup and view all the answers

    What percentage of individuals with diabetes are affected by kidney disease?

    <p>39%</p> Signup and view all the answers

    What distinguishes Maturity Onset Diabetes of the Young (MODY) from other forms of diabetes?

    <p>Autosomal dominant mutation</p> Signup and view all the answers

    Study Notes

    Diabetes Lecture: Week 12

    • Typical presentation of diabetes:

      • Jim, a 54-year-old patient, presented for routine care.
      • He had not had a physical in several years.
      • His spouse encouraged him to be seen.
      • He felt generally healthy but had gained some weight and experienced fatigue.
      • He was not taking any medications and had no significant past medical history.
      • Vital Signs: BP 158/90, HR 78, BMI 38.

    • Complications:

      • Leading cause of blindness, kidney failure, and non-traumatic amputations.
      • ~12% with some degree of visual problems.
      • ~39% with some degree of nephropathy.
      • Vascular disease accounts for 54% of nontraumatic amputations.
      • 50% of people with diabetes have neuropathy at some point.
      • Cardiovascular disease causes 2/3 of deaths in people with diabetes.
      • People with diabetes are twice as likely as non-diabetic patients to have cardiovascular disease (CVD).

    • Common comorbidities:

      • Hypertension
      • Dyslipidemia
      • Cardiovascular disease
      • Kidney disease
      • Nonalcoholic fatty liver disease
      • Osteoarthritis
      • Obesity
      • Sleep apnea
      • Depression

    3 Ps of Diabetes

    • Polyuria, polyphagia, polydipsia

    Type 1 Diabetes

    • Rapid Onset
    • Destruction of beta cells in the pancreas leading to absolute insulin deficiency.
    • Genetic predisposition, with specific HLA alleles found in 90% of patients.
    • Some shared genetic predisposition to celiac disease.
    • Increased risk in close relatives (50% in identical twins).
    • Triggers: perinatal factors, viruses, diet.
    • Large geographic variation (e.g., Scandinavia).

    Type 2 Diabetes

    • Insidious Onset
    • Decreased insulin secretion.
    • Decreased incretin effect.
    • Increased lipolysis.
    • Increased glucagon secretion.
    • Increased hepatic glucose production (HGP).
    • Increased glucose reabsorption.
    • Decreased glucose uptake.
    • Neurotransmitter dysfunction.
    • Ominous Octet (a summary of the factors involved in the development of type 2 diabetes).

    Other Forms of Diabetes

    • Gestational Diabetes:
      • High risk for fetal macrosomia.
      • Mom and baby at risk for development of type 2 diabetes later in life.
      • Pancreatogenic (Type 3c).
      • Cystic fibrosis.
      • Pancreatitis.
      • Drug or chemical induced (e.g., corticosteroids, thiazide-type diuretics, atypical antipsychotics).
      • Maturity-onset diabetes of the young (MODY).
      • Autosomal dominant mutation to beta cell receptors.

    Appropriate Diagnostic Tests

    • Screening:
      • Fasting plasma glucose.
      • 2-hour post-oral glucose tolerance test.
      • Hemoglobin A1c (HbA1c).
    • Diagnostic:
      • Casual glucose.
      • Fasting glucose.
      • HbA1c.

    Supportive Lab Tests

    • Insulin Levels:
      • Elevated in type 2 diabetes.
      • Absent or very diminished in type 1 diabetes.
    • C-peptide: Measures endogenous insulin secretion.
    • Normal to elevated: in type 2 diabetes.
    • Absent to very low: in type 1 diabetes.
    • Blood glucose must be high for c-peptide testing.
    • Antibodies: Assess for autoimmune form of diabetes (i.e., Islet cell antibody, anti-GAD antibody, insulin antibody).

    Differentiating the Types of DM

    • A table comparing the features of Type 1 Diabetes, Latent Autoimmune Diabetes in Adults (LADA), and Type 2 Diabetes.

    History

    • Symptoms of hyperglycemia, hypoglycemia
    • Onset of symptoms
    • Previous treatment for diabetes
    • Duration of diabetes
    • Recent lab results and trends.
    • Known complications
    • Impact on ADLs

    Questions for Follow-up Visits

    • Any new concerns?
    • Make changes recommended?
    • Any adverse reactions?
    • Review blood sugar log.
    • Revisit lifestyle modifications.
    • Adherence.
    • Symptoms associated with complications.
    • Review of Systems (ROS) concerning general health, cardiovascular, gastrointestinal, endocrine, and extremities.

    Physical Examination

    • Skin (acanthosis, dermopathy, tinea/yeasts)
    • HEENT (carotids, thyroid, mouth/dentition)
    • Eyes (visual acuity, fundoscopic examination)
    • Heart (arrhythmias, LVH, signs of heart failure)
    • Lungs (signs of heart failure)
    • GI (hepatomegaly)
    • Peripheral vascular (pulses, skin)
    • Neurological/Feet (monofilament exam, wound/infection evaluation)
    • Neurological Assessment (monofilament testing)
    • Vital signs (weight, BMI, BP, A1c)

    Laboratory Assessment

    • Glucose control (A1c, meter interpretation)
    • Chemistry (assessing for complications, medication safety, e.g. electrolytes, creatinine)
    • Lipid profile (assessing risk for CVD)
    • Urinary albumin to creatinine ratio (UACR) for complications assessment.

    Ongoing Monitoring of Diabetes

    • Hemoglobin A1c (HbA1c).
    • Elevated Alc best indicator of development of complications.
    • 1% reduction in A1c about 30% reduction in complications.

    Self-Monitoring Blood Glucose

    • Scheduling depends on treatment and patient.
    • HbA1c insufficient for trend identification and treatment adjustment.
    • Glycemic Assessment.
    • Twice a year in patients meeting targets, four times a year in patients not meeting targets or with treatment changes.

    Other Forms for Diabetes

    • Diabetes Care: updates guidelines annually.
    • American Association of Clinical Endocrinologist.
    • Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2024. (Decision Cycle for Person-Centered Glycemic Management in Type 2 Diabetes; Components of comprehensive diabetes medical evaluation at initial, follow-up and annual visits; Assessment and Treatment Plan)
    • Screening for Type 2 Diabetes/Prediabetes: Recommendations concerning risk groups ( BMI, family history, race, ethnicity).

    Complications of Diabetes

    • Acute: Hypoglycemia, Hyperglycemia, Hyperosmolar Hyperglycemic Nonketotic Syndrome, Diabetic Ketoacidosis.
    • Chronic: Macrovascular (Cardiovascular disease, Peripheral arterial disease, Stroke), Microvascular (Diabetic Nephropathy, Diabetic Retinopathy) Disease, Neuropathy.
    • Hypoglycemia: relates to treatment rather than diabetes itself.

    Other forms of diabetes

    • Gestational Diabetes:
    • Other forms:
      • Pancreatogenic (Type 3c)
      • Cystic fibrosis
      • Pancreatitis
      • Drug or chemical induced(e.g., corticosteroids, thiazide-type diuretics, atypical antipsychotics)
      • Maturity-onset diabetes of the young (MODY)
      • Autosomal dominant mutation to beta cell receptors.

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    Week 12-14 Diabetes + Genetics Final Document PDF

    Description

    Test your knowledge on the differences between Latent Autoimmune Diabetes in Adulthood (LADA) and Type 2 Diabetes Mellitus (T2DM). This quiz covers symptoms, age group associations, beta cell function, and essential follow-up questions for effective diabetes management. Enhance your understanding of diabetes types and their implications for patient care.

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