Blood Glucose Agents

Question 1

KEY TERM: Adiponectin

Answer 1

Hormone that increases insulin sensitivity, decreases glucose released in the liver, protects blood vessels from inflammation.

Question 2

KEY TERM: Diabetes Mellitus

Answer 2

A chronic condition characterized by higher blood sugar levels due to insufficient insulin production or bodies inability to use insulin

Question 3

KEY TERM: Dipeptidyl-peptidase (DDP-4)

Answer 3

An enzyme that breaks down increatin hormones- help to regulate blood sugar levels by stimulating insulin release after eating.

Question 4

KEY TERM: Endocannabinoid receptors

Answer 4

Receptors in the body that are part of the endocannabinoid system - involved in regulating functions like appetite, mood and metabolism.

Question 5

KEY TERM: Glucagon- like polypeptide-1 (GLP-1)

Answer 5

A hormone released from the intestine that helps regulate insulin secretion, glucose metabolism and appetite.

Question 6

KEY TERM: Glycogen

Answer 6

a stored form of glucose found in the liver and muscles used by the body for energy when blood glucose levels are low

Question 7

KEY TERM: Glycosuria

Answer 7

The presence of excess glucose in the urine and is often indicative of poorly controlled diabetes.

Question 8

KEY TERM: Glycosylated hemoglobin A

Answer 8

A form of hemoglobin that is bound to glucose - used to measure long term blood sugar control

Question 9

KEY TERM: Hyperglycemia

Answer 9

A abnormally high sugar levels

Question 10

KEY TERM: Hypoglycemia

Answer 10

Abnormally low blood sugar levels which can cause symptoms like shakiness, confusion, and weakness.

Question 11

KEY TERM: incretins

Answer 11

Hormones which includes GLP 1 that are released by the gut after eating to enhance insulin secretion and help regulate blood glucose.

Question 12

KEY TERM: insulin

Answer 12

A hormone produces by the pancreas that helps regulate blood glucose levels by promoting the glucose uptake into cells for energy.

Question 13

KEY TERM: Ketosis

Answer 13

A metabolic state where the body produces ketones for energy due to lack of sufficient glucose, often seen in uncontrolled diabetes and starvation,

Question 14

KEY TERM: Polydipsia

Answer 14

Excessive thirst which is commonly associated with hypoglycemia or diabetes

Question 15

KEY TERM: polyphagia

Answer 15

Excessive hunger or eating which can occur when the body’s cells are not receiving enough glucose, are often seen in diabetes

Question 16

KEY TERM: Sulfonylureas

Answer 16

Class of oral medication used to treat type two diabetes by stimulating the pancreas to produce more insulin

Question 17

Glucose regulation

Answer 17

-Pancreas
Endocrine gland - produces insulin and glucagon hormones in the islets of langerhans
Exocrine gland - releases sodium bicarbonate and pancreatic enzymes directly into the common bile duct to be released into the small intestine
Neutralizes the acid chyme from the stomach and aids in digestion.

The dual function of the pancreas is crucial for both metabolic regulation and proper digestion.

Question 18

How the pancreas works to regulate glucose

Answer 18

When glucose levels are high, Like right after eating, the pancreas releases insulin which allows the cells to absorb the glucose.
When glucose levels are low the pancreas releases glucagon which signals the liver to to breakdown stored glycogen and release it into the bloodstream.

Question 19

What is insulin and how does it work to regulate glucose?

Answer 19

-Hormone produced by the beta cells in the pancreas in the islets of langerhans
-Released into the circulation when levels of glucose around these cells rise.
-Stimulates glycogen syntheses, conversion of lipid fat stored as adipose tissue, and synthesis of proteins from amino acids.
-Released after meals, causing blood glucose levels to fall.
-Huge factor in regulating metabolism and main ting balance in energy storage so body has steady supply of fuel even when fasting and after meals
Insulin is in charge to make sure blood glucose levels down go to High, sometimes not enough insulin is effective which happens when pancreas didn’t release enough or not enough receptor sites in the body which happens in obesity or the receptor sites lost their sensitivity to insulin.

Question 20

What is glucagon and how does it work to relegate glucose?

Answer 20

When blood sugar drops too low, the pancreas releases glucagon to signal the liver to breakdown stored glycogen down stored glycogen into blood glucose.
-tells the liver it is time to use excess sugar when needed.
-Released from the alpha cells into islets of langerhans in response to low Blood glucose
-Causes Immediate mobilization of glycogen stored in the liver and raises blood glucose levels.

Question 21

Other ways of glucose regulation

Answer 21

-Adipocytes secrete adiponectin whcih increases insulin sensitivity, decreases release of glucose from liver, and protects blood vessels from inflammation
-Endocannabinoid receptors keep the body in a state of energy gain to prepare for stressful situations- prepare body for fight or flight.
-Sympathetic nervous system decreases insulin release, increases release of stored glucose and increases fat breakdown
-Corticosteroids decrease insulin sensitivity, increase glucose release and decrease protein building
-Growth hormone decreases insulin sensitivity increase FFAs, increase protein building. - fluctuating growth hormone levels can affect your metabolism by disrupting how your body uses and stores your energy.

All of these factors are influenced by stress,- when we are super stressed, our body responds by preparing to fight or run.
-Our stress response is the same even if it is not life or death. Constant state of stress can impact health

Question 22

Metabolic changes occurring when insufficient insulin is released

Answer 22

-Hyperglycemia: Increased blood sugar-
-Glycosuria: Sugar is spilled into the urine - body cannot absorb it all - urine can appear frothy - cystitis - glucose allows bacteria to thrive-
-Polyuria: increased urination combined with high glucose in blood, makes person to feel extra thirsty which is known as Polydipsia.
-Polyphagia: Increased hunger- body cannot use glucose available , body thinks person is starving.
-Polydipsia: Increased thirst
-Lipolysis: Fat breakdown-
-Ketosis: Ketones cannot be removes effectively - because of use of fats for energy instead of glucose. The ketones that result from the breakdown of fat cannot be cleared from the body, and muscles start to break down for energy and a state of acidosis begins
-Acidosis: liver cannot remove all of the waste products - the waste products of ketones, proteins and glucose being used are going ot be acids- elevated BUN and Protein in the urine.

Question 23

What is diabetes mellitus and what are the characteristics, clinical signs?

Answer 23

A Chronic condition where the body has trouble regulating blood sugar.
Can occur bc pancreas doesn’t produce enough insulin like with type one diabetes or because the body becomes resistant to insulins effect with type 2 diabetes.
If left untreated can lead to heart dz, kidney damage and nerve problems
Long term effects of the body not being able to handle carbohydrate, fat , and protein metabolism can lead to vascular damage because of an increase in reactive o2 species which damages the endothelial cells that line our vessels.

-Characteristics: Complex disturbances in metabolism
Affects carbohydrate, protein, and fat metabolism
-Clinical Signs: Hyperglycemia (fasting blood sugar level greater than 126mg/dl)
Glycosuria: (the presence of sugar in the urine)
-long term results in vascular damage

Question 24

What are the most common signs of diabetes?

Answer 24

Glucose in the urine and a fasting glucose greater than 126mg per deciliter. That means that even after not eating after several hours, the persons glucose levels are still elevated.

Question 25

Disorders associated with diabetes

Answer 25

-Atherosclerosis: Heart attacks and strokes related to the development of atherosclerosis plaques in the vessel lining
-Retinopathy: With resultant loss of vision as tiny vessels in the eyes are narrowed and closed
-Neuropathies: With motor and sensory changes in the feet and legs and progressive changes in the other nerves as o2 is cut off - foot ulcers are common
-Neuropathy: With renal dysfunction relates to changes in the basement membrane of the glomerulus
-infections: Increases in frequency and severity due to decreased blood flow and altered neutrophil function
-Foot ulcers: Decreased wound healing due to vascular insufficiency unnoticed wounds and infections a=due to neuropathy decreased perception of pain.

Question 26

Classifications of diabetes mellitus

Answer 26

-Type 1: inuslin defendent mellitus
Usually a rapid onset; seen in younger preople
Caused by autoimmune destruction of the beta cells of the pancreas
Pts need insulin replacement
-Type 2: Non- insulin dependent diabetes mellitus
Usually occurs in mature adults
Has a slow and progressive onset
Decreased insulin sensitivity in peripheral cells (insulin resistance)
-Diabetes due to other causes
Hyperglycemia secondary to other causes
Medications (i.e. corticosteroids), cystic fibrosis, pancreatitis
-Gestational Diabetes

Question 27

Clinical signs and symptoms of hyperglycemia

Answer 27

-fatigue
-lethargy
-irritation
-Glycosuria
-Polyuria
-polyphagia
-Polydipsia
-frequent infections
-poor wound healing

Question 28

Signs of impending dangerous complications of hyperglycemia

Answer 28

-fruity breath as the ketones build up in the system and are excreted through the lungs
-dehydration as fluid and important electrolytes are lost through the kidneys
-Fast, deep respirations (Kussmauls respirations) as the body tries to rid itself of high acid levels
-loss of orientation and coma

Question 29

Hypoglycemia

Answer 29

-blood glucose <70 mg/dl
-initial response is parasympathetic stimulation, followed by fight or flight reaction
-breakdown of fat and glycogen to release glucose
-Pancreas releases glucagon to increase glucose and somatostatin

Question 30

Signs of hypoglycemia

Answer 30

-shakiness
-dizziness
-sweating
-hunger
-tachycardia
-inability to concentrate
-confusion
-irritability or moodiness
Result form hormonal changes because body is in survival mode.

Question 31

Use of anti-diabetics in children

Answer 31

Children
-Monitor closely for hyper and hypoglycemia
-insulin often needs to be diluted due to small dosages
-two nurse check for insulin
-challenging to treat in teens
-team approach - family, teachers, coaches etc
-metformin is the only oral DM drug approved for children
Don’t have the same sugar reserves as adults- bodies have less time to compensate

Question 32

Use of antidiabetics in adults

Answer 32

-Emphasized diet and exercise
-caution about OTC, herbal, and alternative therapies
-insulin is the best choice in pregnancy and lactation - during labor an insulin droop is usually used if needed.
-2 and a half hours of exercise a week

Question 33

Use of anti-diabetics in older adults

Answer 33

• underlying problems complicate diabetic therapy (i.e. poor vision)
  -Dietary deficiencies lead to fluctuations in glucose levels
  -renal or hepatic impariement may make oral agents not feasible
  -emphasize diet ecersize skin and foot care
  -more likely to experience end organ damage (ie kidneys)

Question 34

Insulin actions

Answer 34

Actions: Hormone that promotes the storage of the body’s fuel
Facilitates the transport of various metabolites and ions across cell membranes
Stimulates the synthesis of glycogen from glucose
Reacts with specific receptor sites on the cells

Question 35

Insulin indications

Answer 35

-Treatment of type 1 diabetes mellitus
-treatment of type 2 diabetes mellitus in pts whose diabetes can not be controlled by diet or other agents

Question 36

Insulin contraindications

Answer 36

There are no contraindications except episodes of hypoglycemia

Question 37

Insulin caution

Answer 37

Pregnancy and lactation