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What type of diabetes is associated with ketoacidosis?
Type I
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What is ketoacidosis?
Accumulation of acidic ketone bodies in the blood due to lack of fatty acid utilization (as would normally be stimulated by insulin)
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What I Hemoglobin A1c?
Sugar attached to hemoglobin
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What does blood sugar in RBCs tell us?
Idea of how much sugar has been around during the last 3 months
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What is the normal range for Hemoglobin A1c?
4-5.9%
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In poorly controlled diabetes, what level is normal for hemoglobin A1c?
8% or more
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In well controlled diabetes, what level is normal for hemoglobin A1c?
Less than 7%
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What measure is more stable than blood sugar?
Hemoglobin A1c
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What are signs of Ketoacidosis?
- Blood pH decrease
- Acetone breath
- Nausea
- Vomiting
- Dehydration
- Coma
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What is the major complication of Diabetic ketoacidosis?
Death
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What type of diabetes usually causes ketoacidosis?
Type I
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What is the treatment of ketoacidosis?
- Immediate insulin
- IV Fluids
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Why are the eyes, nerves and kidneys involved in diabetes?
Microangiopathy
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What is Microangiopathy?
Thickening of the basement membrane of small vessels
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Why is Microangiopathy an important feature of diabetes?
It is the cause of Nephropathy, retinopathy and neuropathy
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What are major complications of Type I and II diabetes?
- Microangiopathy
- Macrovascular disease
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What is macrovascular disease?
- Accelerated atherosclerosis of large vessels, hypertension and stroke
- Causes diabetic foot
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What is the cause of Diabetic foot?
Macrovascular disease
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What type of neuropathy is found with Microangiopathy?
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What changes are seen in the kidney with Microangiopathy?
- Periglomerular fibrosis
- Kimmelstiel-Wilson (K/S) change in the glomerulus
- Tremendous protein loss
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What type of retinopathy is common in diabetes?
- Cataracts
- Small hemorrhages/microanuerysms in the eye
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What is Diabetic foot?
- Macrovascular disease causes reduced circulation to the peripheries
- Allows for infection and gangrene to grow in the foot
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What is Charcot foot?
Repeated unrecognized microtrauma due to neuropathy that reduces sensation of the foot
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What is the leading cause of new cases of blindness in working adults?
Diabetes
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What percent of lower extremity amputations are due to diabetes?
50%
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What percent of new cases of end state renal disease are due to diabetes?
35%
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What is the increase in risk for cardiovascular disease in individuals with Diabetes?
2 to 4 fold increase
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What percent of ischemic heart disease deaths are attributed to diabetes?
40%
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Is cancer associated with diabetes?
Yes
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What is the total annual cost of diabetes?
98 billion
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What is the per capita cost for healthcare of people with diabetes?
$10,071
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What is the per capita cost for healthcare of people without diabetes?
$2,699.00
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What is Metformin?
Type II diabetes drug that improves tolerance for glucose and improves insulin sensitivity
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What is Sulfonylurea
A drug that enhances insulin secretion from the Beta cells
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What is a surgical treatment for Diabetes?
Pancreas transplant
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What type of treatment differences are between type I and II diabetes?
- Type I is treated with insulin
- Type II is treated with insulin, diet, exercise, oral glucose lowing drugs
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What is secondary Diabetes Mellitus?
Diabetes due to drugs or other diseases
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What other diseases cause secondary diabetes mellitus?
- Pancreatitis
- Cystic fibrosis
- Iron overload
- Surgical removal of pancreas
- Endocrine disorders (Acromegaly, Cushing’s)
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What type of drugs cause secondary DM?
- Beta adrenergic agonists
- Thiazide diuretics
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