p.14
Glycosuria and Polyuria
What is the impaired production of ADH in the pituitary gland called?
Cranial diabetes insipidus.
p.10
Classification of Diabetes Mellitus
What is the significance of a positive family history for early onset diabetes in atypical type 1 diabetes?
It is positive in many relatives.
p.7
Clinical Presentation of Hyperglycemia
What are the signs of symptomatic hyperglycemia in acute, classic, and severe type 1 diabetes?
No clinical signs related. In fulminant cases: signs of severe dehydration and acidosis (DKA).
p.11
Prediabetes and its Natural History
What are the risk factors associated with IFG and IGT?
1 - Cardiovascular/cerebrovascular disease, 2 - A predictor for subsequent diabetes mellitus, 3 - Diabetic range glucose values unmasked with stress.
p.1
Glucose as the primary source of energy
How is excess glucose stored in the body?
As glycogen, which becomes liberated in times of fasting.
p.12
Diagnosis of Diabetes Mellitus
What should be done if symptoms of hyperglycemia are present during testing?
The test should be confirmed on a subsequent day.
p.12
Gestational Diabetes Mellitus (GDM)
What are the criteria for low risk of GDM?
Normal body weight, negative family history of DM in 1st degree relatives, negative history of abnormal glucose tolerance, age < 25 years, and negative history of poor obstetric outcome.
p.5
Clinical Presentation of Hyperglycemia
What are the causes of hyperglycemia?
Insulin deficiency, increased catabolism, and decreased anabolism.
p.8
Diagnosis of Diabetes Mellitus
What are the diagnostic criteria for diabetes mellitus?
Classical symptoms of hyperglycemia plus any one of three positive tests: Random plasma glucose ≥ 200 mg/dl, Fasting plasma glucose ≥ 126 mg/dl, or 2h - PPPG ≥ 200 mg/dl.
p.8
Prediabetes and its Natural History
What are the criteria for prediabetes?
FPG: 100 - 125mg/dl (impaired fasting glucose) and/or 2h - PPPG: 140 - 199 mg/dl (impaired glucose tolerance).
p.11
Prediabetes and its Natural History
What is the definition of Impaired Glucose Tolerance (IGT)?
When 2h - PPPG is 140 - 199 mg/dl; also called borderline, subclinical, or early diabetes.
p.4
Pathogenesis of Type 2 Diabetes
What are the two pathogenic defects in diabetes mellitus?
1 - Pancreatic defect: decreased insulin secretion. 2 - Target tissues defect: decreased insulin action (insulin resistance).
p.4
Pathogenesis of Type 2 Diabetes
What is the major contributor to fasting hyperglycemia?
Hepatic glucose production (HGP).
p.12
Diagnosis of Diabetes Mellitus
How is diabetes diagnosed based on fasting plasma glucose?
If it is greater than or equal to 126 mg/dl.
p.1
Classification of Diabetes Mellitus
What are the non-specific macrovascular complications often accompanied by Diabetes Mellitus?
Coronary, cerebral, peripheral blood vessels.
p.3
Pathogenesis of Type 1 Diabetes
Name some of the suggested viruses as environmental factors for diabetes.
Mumps, coxsackie - B, reovirus, and herpes.
p.10
Classification of Diabetes Mellitus
How is type 1.5 diabetes difficult to distinguish from type 1 diabetes?
It is difficult to distinguish due to atypical features.
p.5
Clinical Presentation of Hyperglycemia
What is hyperglycemia?
Elevated blood glucose levels above the normal values.
p.8
Clinical Presentation of Hyperglycemia
What does Glycosuria indicate?
It means urine is positive for glucose and requires urgent blood glucose measurements.
p.13
Diagnosis of Diabetes Mellitus
What are the diagnostic criteria for the 100 gm OGTT?
Fasting: ≥ 95 mg/dl, 1 hour: ≥ 180 mg/dl, 2 hours: ≥ 155 mg/dl, 3 hours: ≥ 140 mg/dl. GDM is diagnosed if two or more of these plasma glucose values are found.
p.13
Glycosuria and Polyuria
What are the causes of Renal glycosuria?
Pregnancy, Tubular dysfunction (Fanconi's syndrome), Renal glycosuria (benign type), False positive test (Lactosuria, Fructosuria, and Ascorbic aciduria).
p.13
Gestational Diabetes Mellitus (GDM)
When should OGTT be performed in the case of glycosuria during pregnancy?
If glycosuria occurs before the 16th week of gestation or on two or more occasions later in pregnancy.
p.4
Pathogenesis of Type 2 Diabetes
What happens in adipose tissue due to insulin resistance?
Increased lipolysis leads to increased circulating free fatty acids (FFAs).
p.4
Pathogenesis of Type 2 Diabetes
What happens in muscle due to insulin resistance?
Decreased glucose uptake.
p.12
Diagnosis of Diabetes Mellitus
When is diabetes diagnosed based on random plasma glucose?
If it is greater than or equal to 200 mg/dl.
p.14
Glycosuria and Polyuria
What is the term for a sudden, rapid heart rate originating above the heart's ventricles?
Paroxysmal supraventricular tachycardia.
p.1
Classification of Diabetes Mellitus
What are the types of Primary Diabetes Mellitus?
Type 1 (Autoimmune, Idiopathic) and Type 2 (Predominantly insulin resistance, Predominantly insulin secretory defect).
p.1
Classification of Diabetes Mellitus
What are the causes of Secondary Diabetes Mellitus?
Pancreatic diseases such as Pancreatitis, pancreatectomy, neoplasia, and hemochromatosis.
p.3
Pathogenesis of Type 1 Diabetes
What is the stage III of diabetes pathogenesis?
Immune activation: autoimmune insulitis and destruction.
p.12
Gestational Diabetes Mellitus (GDM)
What is the glucose challenge test (GCT) method for screening GDM?
Oral glucose load of 50 gm, no fasting, and plasma glucose level checked after one hour.
p.3
Pathogenesis of Type 1 Diabetes
What are some of the autoantibodies associated with diabetes?
ICS, GAD, and insulin antibodies.
p.8
Diagnosis of Diabetes Mellitus
What are the three blood tests used for the diagnosis of diabetes?
Random plasma glucose, Fasting plasma glucose, and 2-hour post oral glucose load plasma glucose.
p.14
Glycosuria and Polyuria
What is the inability to respond to ADH in the kidneys called?
Nephrogenic diabetes insipidus.
p.14
Glycosuria and Polyuria
What is the term for decreased concentrating capacity in the kidneys, seen in early stage CRF?
Chronic Renal Failure (CRF).
p.9
Pathogenesis of Type 1 Diabetes
What are the features of slowly progressive autoimmune type 1 diabetes (LADA)?
Age at onset usually > 35 years, clinical presentation as non-obese type 2 diabetes, initial control with diet or oral agents, progressive deterioration of insulin secretion, positive markers of autoimmunity to the β-cells.
p.6
Clinical Presentation of Hyperglycemia
What are the two clinical types of hyperglycemia?
Symptomatic and Asymptomatic.
p.6
Clinical Presentation of Hyperglycemia
What are the common symptoms of symptomatic hyperglycemia?
Increased urination (polyuria) and thirst (polydipsia).
p.2
Pathogenesis of Type 1 Diabetes
What are some drugs or chemicals that can induce endocrinopathies?
Corticosteroid, thiazide diuretics, thyroid hormone, and B-adrenergic agonists.
p.6
Clinical Presentation of Hyperglycemia
What are the causes of symptomatic hyperglycemia?
Primary Diabetes mellitus and Secondary diabetes mellitus.
p.3
Pathogenesis of Type 1 Diabetes
When does frank diabetes occur?
When more than 90% of beta cells have been destroyed.
p.3
Pathogenesis of Type 2 Diabetes
What causes Type 2 Diabetes?
Combination of decreased insulin action and inadequate insulin secretion.
p.3
Pathogenesis of Type 2 Diabetes
Name some environmental factors that contribute to Type 2 Diabetes.
Obesity, sedentary lifestyle, physical inactivity, hypertension, dyslipidemia, increased age, smoking, stress.
p.10
Classification of Diabetes Mellitus
What are the comparative clinical features of type 1 and type 2 diabetes?
Age of onset, duration of signs and symptoms, body weight, ketonuria, rapid progression, family history of diabetes, insulin or c-peptide levels, HLA association, and autoantibodies.
p.5
Clinical Presentation of Hyperglycemia
What are the clinical types of hyperglycemia?
There are no clinical types of hyperglycemia, it is a single condition.
p.5
Clinical Presentation of Hyperglycemia
What are the symptoms and signs of hyperglycemia?
Glycosuria, osmotic diuresis, polyuria, polydipsia, and loss of weight.
p.7
Prediabetes and its Natural History
What are the causes of asymptomatic hyperglycemia?
Primary Diabetes mellitus (mostly Type 2), Prediabetes (IFG, and IGT), GDM.
p.7
Diagnosis of Diabetes Mellitus
What are the signs of asymptomatic hyperglycemia in type 2 DM?
Pruritus vulvae or balanitis, Loss of ankle reflexes, Loss of Peripheral sensation, Hypertension and signs of atherosclerosis, Signs of insulin resistance.
p.11
Prediabetes and its Natural History
What is the natural history of Prediabetes patients after 10 years of follow up?
1 - 33% still having Prediabetes state, 2 - 33% develop type 2 DM, 3 - 33% become normal individuals.
p.11
Gestational Diabetes Mellitus (GDM)
What is Gestational Diabetes Mellitus (GDM)?
Any degree of glucose intolerance with onset or first recognition during pregnancy, which may or may not disappear after delivery and liable to recur with following pregnancies.
p.11
Gestational Diabetes Mellitus (GDM)
What are the factors that increase the risk of GDM?
1 - Marked obesity, 2 - Strong FH of DM, 3 - Previous history of GDM, 4 - Old age > 30 years, 5 - Glycosuria.
p.9
Pathogenesis of Type 1 Diabetes
What are the features of rapidly progressive type 1 autoimmune diabetes?
Clinical markers: Young < 30 years, classical, acute and severe presentation, never obese, ketosis prone, insulin requiring for survival. Laboratory markers: Plasma insulin and c-peptide levels are absent or very low, GAD-Abs, ICA, insulin autoantibodies, HLA-DR3, and/or DR4 associated.
p.1
Classification of Diabetes Mellitus
What are the specific microvascular complications often accompanied by Diabetes Mellitus?
Retina, renal, peripheral nerves.
p.4
Pathogenesis of Type 2 Diabetes
What happens if insulin resistance is the primary defect?
The pancreatic beta cells secrete more insulin to compensate for the peripheral defects of insulin action (hyperinsulinemia).
p.6
Clinical Presentation of Hyperglycemia
What blood glucose level causes symptoms of increased urination and thirst?
Above the renal threshold, which is on average 180 mg/dl.
p.12
Gestational Diabetes Mellitus (GDM)
When should screening for average risk of GDM be performed?
Between 24th-28th week of gestation.
p.3
Pathogenesis of Type 1 Diabetes
What happens in stage IV of diabetes pathogenesis?
Progressive loss of glucose-stimulated insulin secretion.
p.6
Clinical Presentation of Hyperglycemia
What are the clinical presentations of subacute symptomatic hyperglycemia?
Thirst, weight loss, polyuria, lack of energy, blurring of vision, balanitis or pruritus vulvae.
p.1
Classification of Diabetes Mellitus
What is the definition of Diabetes Mellitus (DM)?
A group of chronic metabolic disorders characterized by hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism.
p.12
Gestational Diabetes Mellitus (GDM)
When should high-risk women be reassessed for gestational diabetes mellitus (GDM)?
Between 24-28th week of gestation.
p.4
Pathogenesis of Type 2 Diabetes
What occurs when the beta cells can no longer secrete more insulin?
Decreased insulin secretion (stage of hyperglycemia).
p.2
Pathogenesis of Type 1 Diabetes
What are some examples of endocrinopathies?
Acromegaly, Cushing's syndrome, pheochromocytoma, and hyperthyroidism.
p.6
Clinical Presentation of Hyperglycemia
What is the commonest cause of symptomatic hyperglycemia?
Diabetes mellitus, especially Type 1.
p.6
Clinical Presentation of Hyperglycemia
What are the clinical presentations of acute, classic, and severe symptomatic hyperglycemia?
Polyuria, polydipsia, polyphagia, and weight loss.
p.10
Classification of Diabetes Mellitus
What is the predominant characteristic of non-obese individuals with type 2 diabetes?
Predominantly insulin secretory defect.
p.2
Prediabetes and its Natural History
What is the second stage in the natural history of type 1 diabetes?
Triggering by environmental factors.
p.2
Epidemiology of Diabetes Mellitus
What are the reasons why diabetes mellitus is considered a major public health problem worldwide?
Increased number of affected persons (Epidemic) and associated morbidity and mortality.
p.3
Pathogenesis of Type 1 Diabetes
What characterizes stage V of diabetes pathogenesis?
Progressive loss of beta cell function of islets of Langerhans.
p.2
Epidemiology of Diabetes Mellitus
Is the incidence of type 1 diabetes high or low compared to type 2 diabetes?
Low for type 1 diabetes, but high for type 2 diabetes.
p.2
Prediabetes and its Natural History
What is the first stage in the natural history of type 1 diabetes?
Genetic susceptibility, with one diabetogenic gene within the HLA being necessary.
p.10
Prediabetes and its Natural History
What is impaired fasting glucose (IFG) defined as?
When FPG is 100 - 125 mg/dl.
p.3
Pathogenesis of Type 1 Diabetes
What characterizes stage VI of diabetes pathogenesis?
Plasma insulin and c-peptide levels are absent or very low.
p.3
Pathogenesis of Type 2 Diabetes
What are the two main risk factors for Type 2 Diabetes?
Genetic susceptibility and environmental factors.
p.10
Classification of Diabetes Mellitus
What is the predominant characteristic of obese individuals with type 2 diabetes?
Predominantly insulin resistant.
p.10
Classification of Diabetes Mellitus
What does MODY stand for in the context of diabetes?
Maturity Onset Diabetes in the Young.
p.2
Pathogenesis of Type 1 Diabetes
What causes type 1 diabetes?
Destruction of the insulin-producing cells, with a strong genetic component and contribution from extragenetic factors.
