Pathophys Exam 2

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Epidemiology of DM
- 20.8 million diagnoses
- type 1 = 1 million
- type 2 = 19.8 million
Epidemiology of prediabetes

54 million
Populations with a predisposition for diabetes
- american indian/alaska natives 15.1%
- african americans 13.3 %
- hispanic americans 9.5%
Etiology of type 1 diabetes
- autoimmune disorder
- destruction of pancreatic beta cells
- absolute deficiency of insulin
Etiology of type 2 diabetes
- genetic
- older age
- insulin resistance
- eventual impairment of beta cells
- increased glucose production by the liver
Risk factors for type 1 DM
- family history
- beta cell autoimmunity
- infection
- environmental exposure
- chemical exposure
- dietary exposure
Risk factors for prediabetes and type 2 DM
- family history
- overweight
- hypertension
- history of GD
- polycystic ovary syndrome
- cardiovascular disease
- Sedentary lifestyle
- increased triglycerides and low HDL
- delivery of infant >9lbs
- psyciatric illness
Risk factors for gestational diabetes
- family history
- history of stillbirth
- abnormalities of previous pregnancy
- previous heavy infant
- obese
- age
- > 5 pregnancies
Signs and sypmtoms of Type 1 DM
- polyuria
- intracellular dehydration = increased thirst
- cellular starvation
- weight loss
- blurred vision
- paresthesias
Signs and symptoms of type 2 diabetes
- polyuria
- intracellular dehydration = increased thirst
- blurred vision
- paresthesias
Prefered diagnostic test for DM

Fasting blood glucose (8hrs)
Oral glucose tolerance test
- used in pregnancies
- measures ability of body to store glucose by removing it from blood
- 75g glucose load
HbA1C
- hemoglobin binds to glucose when glucose levels are high
- A1c shows index of BG over 6-12 weeks
Normal FPG levels

< 100 mg/dl
Normal Glucose tolerance test level

<140 mg/dl
Prediabetes HbA1c

5.7 - 6.4%
Diagnostic criteria for DM
- HbA1c > 6.5%
- FPG > 126 mg/dl
- 2 hr glucose tolerance test > 200 mg/dl
- casual plasma glucose >200 mg/dl plus symptoms
Diagnostic criteria for gestational diabetes
- same as DM
- retest between weeks 24-28
When to test for DM
- > 45 years of age
- 1st degree relative with DM
- signs and symptoms and risk factors of DM
- previous positive test for DM
monitoring DM
- home blood glucose tests
- A1c repeated ~ 3 months
Goals of DM therapy
- stabilize blood glucose levels
- optimize risk factors
- prevent complications
- reduce morbidity and mortality
Non-pharmacologic treatment of DM
- Medical nutrition therapy
- optimize BG and lipid levels
- Exercise
optimal BG and lipid levels
- not less than 130g of carbs/day
- <7% daily calories from saturated fat
- <200 mg cholesterol daily
- minimize trans fat
Exercise goals for DM
- 30 min a day 5x a week
- weight management
- improve insulin sensitivity
- could result in hypoglycemia
Oral agent treatment options for type II diabetes
- stimulate insulin secretion from pancrease
- decrease glucagon secretion
- increaes sensitivity to insulin
- inhibit hepatic glucose produciton
- delay absorption of glucose from the GI tract
Injectable treatment option

insulin
other treatment options
- decrease glucagon secretions
- decrease appetite by delaying gastric emptying
Targets of treatments for DM in the pancrease
- impaired insulin secretion
- excessive glucagon secretion
Targets for treating DM in the intestines

carbohydrate absorption
targets for treating DM in the liver

increased basal hepatic glucose produciton
targets for treating DM in the muscle and fat cells

decreased insuli stimulated glucose uptake
Accute complications of DM
- Diabetic ketoacidosis
- hyperosmolar hyperglycemia state
- hypoglycemia
chronic complications of DM
- impaired immune system
- microvasculature problems
- macrovascular problems
Microvascular complications of DM
- Kidney
- Eye
- Nerves
Macrovascular complications of DM
- Peripheral vascular disease
- MI
- Stroke

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Card Set

Pathophys Exam 2

Description

Pathophysiology of Diabetes Mellitus

Updated

2010-10-08T00:57:03Z

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