Ch. 33 Diabetes Mellitus and the Metabolic Syndrome

Question 1

Where is insulin found?

Answer 1

insulin is secreted by Beta Cells which are found in the Islets of Langerhans in the Pancreas

Question 2

function of insulin

Answer 2

• transporter of glucose from circulation to cells
• w/o insulin, glucose stays in circulation and cells starve
• if there is an excess of insulin, the body will store it

Question 3

elevated blood sugar

Answer 3

• insulin secreted by Beta cells
• insulin causes glucose to reenter cells
• blood glucose is lowered

Question 4

decreased blood sugar

Answer 4

• glucagon released by alpha cells
• glucagon stimulates release of glucose from liver
• blood glucose is raised

Question 5

Glucose

Answer 5

• brain requires constant supply
• hypoglycemia/brain death
• blood glucose level
• ingested
• liver regulation

Question 6

liver regulation of glucose

Answer 6

• glycogenesis
• glycogenolysis
• gluconeogenesis

when blood sugar drops (like during sleep) the liver releases glycogen so the blood sugar level can stay normal—–> if liver is saturated with glycogen, then glucose is turned into triglycerol (fat cells) which is usually seen in people who have diets high in carbohydrates

Question 7

glycogenesis

Answer 7

make glycogen

Question 8

glycogenolysis

Answer 8

breakdown of glycogen

Question 9

gluconeogenesis

Answer 9

makes glucose out of other sources in the body

BADDDDD
occurs when not enough is consumed and the liver storage is depleted

Question 10

Insulin

Answer 10

• released by beta cells
• only hormone known to lower blood glucose
• increases transport of glucose into cells
• inhibits gluconeogenesis
• increases protein production (glycemic control for wound healing)

Question 11

glucagon

Answer 11

• produced by alpha cells
• provides increase in blood glucose during fasting
• initiate glycogenolysis
• regulated by blood glucose level
• increases conversion of amino acids to glucose

Question 12

Diabetes Mellitus

Answer 12

• hyperglycemia
• impaired glucose regulation
• imbalance - gestational diabetes
• 2 types: type 1 and type 2

Question 13

Type 1

Answer 13

• onset b/w 10-14 (but can be diagnosed later)
• treated with pump, shots/injection of insulin, organ (pancreas) transplant
• no insulin production
• symptoms 3Ps
  - polyuria- increased urine production
  - polydipsia- increased thirst
  
  • polyphagia- increased hunger (cells starving so they keep signaling )
• other S/S : sweet/fruity breath, weight loss w/o trying, elevated ketones

Question 14

Type 2

Answer 14

• insulin resistance
• 90-95% of diabetes patients
• most diagnosed over 40, but now in obese children
• multifactorial (genetic, environmental/food)
• treated with oral hypoglycemic agents(stimulate B cells to produce more insulin)
• could result in an insulin dependent diabetic if not controlled
• macrovascular disease
• low levels of HDL (good cholesterol)

Question 15

What increases risk of Type 2 diabetes

Answer 15

smoking, sedentary lifestyle, overweight, high fat and cholesterol levels,hypertension

Question 16

DM1

Answer 16

IDDM - Insulin dependent

Question 17

DM2

Answer 17

NIDDM - non insulin dependent

Question 18

Can a type 1 diabetic respond to oral anti diabetic medications?

Answer 18

no

Question 19

plasma insulin levels in type 1/type 2

Answer 19

type 1: absent or low

type 2: normal to high(not enough for the body)

Question 20

Gestational diabetes

Answer 20

• associated with pregnancy
• insulin requirements increase
• production decreased or same
• can be treated with oral medication but have to be aware of tetragenics(cause birth defects)

Risk factors

• family history of type 2
• age
• gestational diabetes previously
• previous pregnancy w/baby >9 lbs
• impaired glucose tolerance or impaired
• smoking

Question 21

Which type of diabetes manifests more slowly

Answer 21

type 2: creeps in cant identify short time

type 1: manifests more suddenly

Question 22

Casual blood glucose

Answer 22

used in the ER and times when fasting blood glucose cant be taken

Question 23

glycosylated hemoglobin test HgA1C

Answer 23

HgA1C

• best predictor of blood glucose levels over time
• RBC live for 120 days, normally don’t contain glucose, but is blood glucose is elevated for a while they will begin to pick up some of the glucose

Question 24

diagnostic tests for diabetes

Answer 24

• fasting blood glucose
• oral glucose tolerance
• casual blood glucose
• capillary blood glucose
• urine test
• glycosylated hemoglobin test HgA1C

Question 25

Management of DM

Answer 25

normalize blood sugar, exercise, diet, insulin, pills, keep lipid levels down (cardiovascular risk), keep Blood pressure down

Question 26

why is exercising with type 1 risky?

Answer 26

insulin is set for what they need normally so when they exercise it burns up the glucose and they don't have any stored because they lack storing mechanisms. need to eat complex carbs to prevent a fast and high peak in blood sugar levels.

Question 27

acute complications

Answer 27

Diabetic ketoacidosis and Hyperosmolar Hyperglycemic Non Ketotic state = hyperglycemia but can lead to hypoglycemia

Question 28

DKA

Answer 28

Type 1 - acidosis is result of ketones - response to stress, illness - lack of insulin: mobilization of fatty acids ---> excess ketone production by the liver - often initial presentation in the ER S/S - nausea - vomiting - polyuria - polydipsia - dehydration - mental status change - Kussmal breathing/rapid breathing - fruity smell on breath-from ketones

Question 29

HHNS

Answer 29

type 2 will come in ER with even high blood glucose because of glycosuria and water loss - stress, infections and trauma cause an increase in release of cortisol thus increasing blood sugars - NO KETONES - very dehydrated - could result in HHNK coma with extremely high glucose levels

Question 30

hypoglycemia

Answer 30

- insulin reaction - complication of therapy - parasympathetic stimulation followed by sympathetic stimulation

Question 31

peripheral Neuropathy

Answer 31

complication of DM - somatic neuropathy- feeling in extremities - autonomic neuropathy- decreased cardiac responses, inability to empty bladder, GI tract, sexual dysfunction

Question 32

Nephropathy

Answer 32

chronic complication of DM - affecting the kidneys - leading cause or ESRD - end stage renal disease is usually caused by damage to glomeruli where glucose is being filtered - Microalbuminuria is the 1st renal manifestation

Question 33

Retinopathy

Answer 33

chronic complication of DM - affecting the eyes : leading cause of blindness - due to retinal hemorrhage

Question 34

Vascular Disease

Answer 34

chronic complication of DM -macrovascular :coronary artery disease, vascular disease, stroke and -microvascular : kidney, eyes, nerves

Question 35

foot ulcers

Answer 35

- most common complication leading to hospitalization - neuropathy is a major risk factor Common Sites: - back of heel - great toe - plantar metatarsal

Question 36

common infections

Answer 36

- soft tissue of extremities - osteomyelitis - UTI - candidal infections (yeast) - tuberculosis

Question 37

why are infections common in DM patients?

Answer 37

- sensory deficits - macrovascular compromise - high blood glucose levels can impair host defences