Snap Shot A 56-year-old woman comes to your clinic for her annual physical exam. She reports increased urinary frequency and thirst, but is otherwise feeling generally well. She is obese, does not exercise, and regularly eats fried foods. A random blood glucose is 223 ml/dL. Her hemoglobin A1c is 9.2. Introduction Type 1 diabetes immune-mediated destruction of β-cells and loss of insulin production by pancreas may also have antibodies against insulin 10% of diabetes cases classically occurs in thin people younger than 30 sudden onset (after about 90% β-cells destroyed) result of self-reactive T-cell destruction of β-cells not necessary to have a family history associated with HLA-DR3 and -DR4 also seen concurrently with other autoimmune diseases (e.g., Graves', Hashimoto, etc.) Type 2 diabetes insulin insensitivity in peripheral organs requiring increased insulin production pancreas cannot produce enough insulin gradual onset 90% of diabetes cases typically in older individuals, though increasingly found in children with obesity common to have a family history associated with obesity amyloid deposition in β-cells Complications are due to poor glycemic control if diabetic maintains glucose in normal range prognosis is good damage mediated by non-enzymatic glycosylation which makes vessels more permeable increased synthesis of type IV collagen in basement membrane osmotic damage which is secondary to glucose conversion to sorbitol by aldose reductase cause of cataracts and neuropathy Presentation Symptoms type I polyuria polydipsia polyphagia fatigue weight loss DKA type II blurry vision candidal infections (especially vaginitis) hyperosmolar nonketotic coma acanthosis nigricans: a velvety hyperpigmentation of the skin and found in body folds Evaluation Labs: 4 options hemoglobin A1c > or equal to 6.5% best single test for diabetes mellitus random blood glucose of > or equal to 200mg/dL AND diabetic symptoms 2 separate fasting glucoses of > or equal to 126 mg/dL (fasting means no intake for > 8 hours) 2-hour postprandial glucose (glucose tolerance test) of > or equal to 200 mg/dL Treatment See Diabetes pharmacology Complications of treatment peripheral neuropathy duloxetine (serotonin/norepinephrine reputake inhibitor), venlafaxine, tricyclic antidepressants, pregabalin, or gabapentin diabetic kidney disease ACE-inhibitor gastroparesis metoclopramide Prognosis, Prevention, and Complications Macrovascular complications coronary artery disease 4 times more likely in DM patients peripheral vascular disease stroke Microvascular complications nephropathy arteriosclerosis leading to hypertension nodular sclerosis Kimmelstiel-Wilson nodules progressive proteinuria chronic renal failure ocular retinopathy proliferative changes involve neovascularization of retina nonproliferative changes involve microaneurysms cataracts glaucoma blindness peripheral neuropathy numbness and paresthesias burning sensation ↓ deep tendon reflexes ↓ vibration sense central neuropathy 3rd nerve palsy sparing the pupil also CN IV and VI autonomic dysfunction impotence bladder retention and incontinence gastroparesis GI discomfort postural hypotension skin dysfunction necrobiosis lipoidica diabeticorum yellow plaques on legs diabetic foot combination of vascular and nerve disease higher likelihood of infection, pressure ulcers can lead to amputation infectious disease urinary tract infections due to increased glucose in urine rhinocerebral mucormycosis Pseudomonas malignant external otitis
QUESTIONS 1 of 12 1 2 3 4 5 6 7 8 9 10 11 12 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.14.11) A 36-year-old obese African American female presents to her primary care physician complaining of blurry vision and increased fatigue. Aside from obesity, her past medical history includes multiple candidal infections in the past six months. Her physician sends her for laboratory testing, with the following results: hemoglobin 12.0 g/dL, glucose tolerance test of 212 mg/dL at 2 hours, sodium 137 mEq/L, potassium 4.1 mEq/L, and creatinine 0.9 mg/dL. Which of the following findings would be the most likely be found on physical exam? Tested Concept QID: 103804 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 11% (3/27) 2 Figure B 74% (20/27) 3 Figure C 7% (2/27) 4 Figure D 4% (1/27) 5 Figure E 4% (1/27) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.13.115) An 18-year-old Caucasian female presents to your clinic because of a recent increase in thirst and hunger. Urinalysis demonstrates elevated glucose. The patient's BMI is 20. Which of the following is the most common cause of death in persons suffering from this patient's illness? Tested Concept QID: 100416 Type & Select Correct Answer 1 Renal failure 15% (36/234) 2 Myocardial infarction 65% (151/234) 3 Infection 3% (6/234) 4 Peripheral neuropathy 2% (4/234) 5 Coma 14% (33/234) M 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (M1.EC.13.52) A 14-year-old Caucasian male of normal weight presents for a well-child checkup. During physical examination, his parents state that their son has been frequenting the bathroom more often than usual and his weight has decreased despite an increase in his caloric intake. Which of the following is most consistent with their son's symptoms? Tested Concept QID: 100353 Type & Select Correct Answer 1 Increased insulin production by beta-cells 7% (4/55) 2 Self-reactive T-cells 49% (27/55) 3 Amyloid deposits in pancreatic islet cells 25% (14/55) 4 Absence of leukocytic infiltrates in the pancreas 2% (1/55) 5 Hypoglycemia 5% (3/55) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (M1.EC.13.91) A 19-year-old Caucasian college student is home for the summer. Her parents note that she has lost quite a bit of weight. The daughter explains that the weight loss was unintentional. She also notes an increase in thirst, hunger, and urine output. Her parents decide to take her to their family physician, who suspects finding which of the following? Tested Concept QID: 100392 Type & Select Correct Answer 1 Evidence of amyloid deposition in pancreatic islets 26% (7/27) 2 High T4 and T3 levels 11% (3/27) 3 Elevated ketone levels 63% (17/27) 4 Hypoglycemia 0% (0/27) 5 Hyperinsulinemia 0% (0/27) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
PMID: 8366922 N. Engl. J. Med.. 1993 Sep;329(14):977-86. [PMID]8366922[/PMID] The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Researc Endocrine - Diabetes Mellitus 1993 9/1/1993 4 views 0.0
All Videos (5) Login to View Community Videos Login to View Community Videos type II diabetes Gio Sabal Endocrine - Diabetes Mellitus E 8/28/2015 66 views 0.0 (0) Login to View Community Videos Login to View Community Videos Type I diabetes Gio Sabal Endocrine - Diabetes Mellitus E 8/28/2015 58 views 0.0 (0) Login to View Community Videos Login to View Community Videos Diabetes Mellitus Overview Chris Battista Endocrine - Diabetes Mellitus D 6/6/2014 42 views 4.7 (3) See More See Less