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FN 125 LE2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Weight is ____ proportional to insulin resistance

A

Directly

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2
Q

What type of fat promotes insulin resistance

A

Visceral fat

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3
Q

Excess macronutrients causes ____ fatty acids

A

increased

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4
Q

What general methods are done/prescribed for weight management (DBW)

A
  • +/- 500 kcal
  • DBW x PA (Krause)
  • BMI method
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5
Q

Formula to get ideal weight using BMI

A

sqrt of BMI x height (m) = weight (kg)

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6
Q

Hormone responsible for lowering blood glucose

A

insulin

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7
Q

Hormone responsible for increasing blood glucose

A

Glucagon

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8
Q

Difference between type 1 and type 2 DM

A

Type 1: no insulin at all
Type 2: low production of insulin/insulin resistance

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9
Q

3 Ps of DM

A
  • Polyuria
  • Polydipsia
  • Polyphagia
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10
Q

Excessive urination

A

Polyuria

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11
Q

Excessive thirst

A

Polydipsia

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12
Q

Excessive hunger

A

Polyphagia

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13
Q

Why is excessive hunger a sign of diabetes

A

The brain signals the need for higher glucose uptake since cells cannot take in glucose due to insulin insensitivity

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14
Q

Etymology of diabetes mellitus

A

Diabetes = excessive passage of urine
Mellitus = sweet taste or honey-like
Diabetes Mellitus = excessive passage of urine with a sweet taste

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15
Q

What 2 process are responsible for glucose formation

A
  • glycogenolysis
  • gluconeogenesis
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16
Q

What are other effects of high blood sugar

A
  • muscle wasting
  • dehydration
  • increase ketones
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17
Q

What happens if there is a high deposition of sugar in blood vessels

A

Damage lining of blood vessels causing inflammation

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18
Q

What condition is associated with blockage in blood vessels from high blood sugar

A

Atherosclerosis

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19
Q

Functions of insulin (7)

A
  1. Facilitates transport of glucose through insulin receptors in cell membrane
  2. Enhance conversion of glucose or glycogen and its storage in liver
  3. Stimulate lipogenesis
  4. Inhibit lipolysis and protein breakdown
  5. Promote amino acid uptake by Skeletal muscle and increase protein synthesis
  6. Influence glucose oxidation (glycolysis pathway - enzyme glucokinase)
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20
Q

What cells are insulin sensitive

A
  • adipose
  • muscle
  • monocytes
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21
Q

True or False: Insulin receptors increase with weight gain and physical activity

A

False: weight loss

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22
Q

Screening tests for DM (5)

A
  • urine test
  • random blood sugar
  • fasting plasma glucose test
  • oral glucose tolerance test
  • glycosylated hemoglobin (A1C) level
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23
Q

What test is done by measuring glucose & ketones by dipping indicator paper strips or reagent strips in urine

A

Urine test

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24
Q

Percentage in urine test that indicates diabetes

A

0-0.25%

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25
Q

What test is done where blood is drawn but fasting is not necessary

A

Random blood sugar

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26
Q

What result from random blood sugar indicate DM

A

Greater than or equal to 200 mg/dl

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27
Q

What test is done after an overnight fast for at least 8 hrs

A

Fasting plasma glucose test

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28
Q

What test is done after an overnight fast for at least 8 hrs

A

Fasting plasma glucose test

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29
Q

Normal levels for fasting plasma glucose test

A

70-100 mg/dl

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30
Q

Safe levels for fasting plasma glucose test

A

90-100 mg/dl

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31
Q

What result of FBG may indicate DM

A

Greater than or equal to 126 mg/dl

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32
Q

Test that evaluate a person’s ability to tolerate a glucose load after fasting

A

Oral glucose tolerance test

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33
Q

Common protocol for OGTT

A
  • ingestion of 75 g glucose load
  • measurement of plasma glucose after 2 hrs interval
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34
Q

Results of OGTT that indicates diabetes

A

200 mg/dl or 11 mmol/L

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35
Q

Results of OGTT that indicates diabetes

A

200 mg/dl or 11 mmol/L

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36
Q

Upper normal limit for OGTT

A

140 mg/dl (7.8 mmol/L)

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37
Q

What is the interpretation if OGTT results is between 140 and 200

A

Impaired glucose tolerance

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38
Q

Provides average blood glucose levels over the past 2-3 months

A

HbA1C

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39
Q

How does glycosylation of rbc occur

A

Glucose molecules attach themselves to the hemoglobin

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40
Q

Ideal percentage of glycosylated hemoglobin

A

Less than 7%

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41
Q

4 stages of DM

A
  1. Prediabetes
  2. Subclinical diabetes
  3. Latent diabetes
  4. Over diabetes
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42
Q

Meaning of IGT

A

impaired glucose tolerance: takes time for bg to be normal

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43
Q

Period from conception until development of IGT

A

Prediabetes

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44
Q

FBS and OGTT are normal

A

subclinical diabetes

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45
Q

abnormal OGTT, no symptoms

A

latent diabetes

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46
Q

Abnormal OGTT w/ symptoms as polydipsia, polyphagia, fasting hyperglycemia, glycosuria

A

Over diabetes

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47
Q

Precursor of diabetic coma

A

ketoacidosis

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48
Q

What medicine used for diabetes is used for weight loss

A

metformin

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49
Q

Cause of gallstones

A

High cholesterol deposits

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50
Q

pre-diabetic stage

A

impaired glucose homeostasis

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51
Q

How is impaired glucose homeostasis detected

A
  • impaired fasting glucose level (above normal but lower than diabetic values)
  • detected primarily through OGTT
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52
Q

Risk factors of impaired glucose homeostasis

A
  • familial disposition
  • race
  • obesity
  • age (>45 years old)
  • birth to large babies (greater than or equal to 9 lbs)
  • women who developed GDM
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53
Q

Any degree of glucose intolerance during pregnancy

A

Gestational DM

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54
Q

How many percent are normoglycemic after delivery

A

90%

55
Q

Risks factors of GDM

A
  • Occurence of GDM in previous pregnancy
  • Delivery of previous macrosomic infant
  • family history
  • maternal obesity (> 120% of DBW)
56
Q

Pathophysiology of GDM

A
  • Placental & ovarian hormones decreases insulin sensitivity
  • lack of pancreatic reserves
57
Q

Screening OGTT results for OGTT

A
  • fasting: ≥ 95 mg/dl
  • 1 hr: ≥ 180 mg/dl
  • 2 hr: ≥ 155 mg/dl
  • 3 hr: 140 mg/dl
58
Q

Nutritional goals of IGT and GDM

A
  • to provide adequate energy
  • to prevent weight gain
  • to achieve and maintain normoglycemia
  • to prevent ketone body formation
59
Q

Is a normal blood sugar should be the goal

A

Not necessarily but blood sugar should not fluctuate

60
Q

Dietary & non-dietary strategies

A
  • individualization of meal plans
  • monitoring of plasma glucose, appetite, and weight
  • insulin therapy (if medically advised)
  • CHO: maximum of 50% of total kcal
  • CHO properly spaced throughout the day
  • be physically active
61
Q

Specifc goal for nutrition therapy of DM

A
  • achieve physiologic blood glucose levels
  • attain and maintain desirable body weight
  • maintain desirable plasma lipid levels
  • reduce likelihood of specific diabetic complications
  • retard development of atherosclerosis
62
Q

General goal for nutrition therapy of DM

A
  • Consume health-promoting selection of nutrients
  • maintain energy needs in timely manner
  • address special requirements (e.g pregnancy)
  • Tailor for therapeutic needs (e.g., renal disease)
63
Q

Characteristics of T1DM

A

Person does not secrete enough insulin to control blood glucose level

64
Q

Other terms for T1DM

A
  • Insulin-dependent DM
  • Juvenile diabetes
  • Juvenile-onset diabetes
  • ketosis-prone diabetes
65
Q

2 types of T1DM

A
  • idiopathic T1DM
  • Immune-mediated DM
66
Q

Forms of the disease that have no known etiology (mostly Asian and African origin)

A

Idiopathic T1DM

67
Q

Results from autoimmune destruction of beta cells of pancreas

A

Immune-mediated DM

68
Q

Etiology of T1DM

A
  1. Increase human leukocyte Antigen (HLA)-B8 and HLA-B15
  2. Formation of islet cell antibodies
  3. Attack of beta cells in the pancreas
  4. Hyperglycemia
  5. T1DM
69
Q

MNT goals for T1DM

A
  • maintain blood glucose levels within a desirable range to prevent or reduce risk of complications
  • supply adequate calories for weight maintenance
70
Q

Nutrient Recommendations for DM

A
  • CHO = 50-60%; complex type; low GI vs High GI
  • CHON = 20%
  • Fats = max 30% (1/3 SFA + 2/3 PUFA; Cholesterol < 300 mg/day; if LDL is high, 7% kcal from SFA & 200 mg/day cholesterol)
  • Increase dietary fiber
71
Q

Dietary Strategies for DM

A
  • timing of meals
  • CHO counting
72
Q

What is needed to do for timing of meals as dietary strategy

A
  • eat regular meals that are evenly spaced
  • 3 meals + 3 snacks
73
Q

What is needed to do for CHO counting as dietary strategy

A
  • counting the grams of CHO provided by foods
  • Counting CHO portions, expressed in terms of servings
74
Q

Goal of Insulin Therapy

A

To mimic natural insulin secretion to meet metabolic needs

75
Q

Differences of forms of insulin

A
  • onset activity
  • timing of peak activity
  • duration of effects
76
Q

What is needed to be considered for Insulin Therapy

A

A diabetic’s diet must be planned so that there is a distribution of CHO and kcal to coincide with the type of insulin used

77
Q

Characteristics of Rapid Acting Insulin

A

Preparations: Lispro Apart
Onset of Action: 15 min
Peak Activity: 30 min- 2 hr
Duration of Action: 3-5 hr

78
Q

Characteristics of Short Acting Insulin

A

Preparations: Regular
Onset of Action: 30 min
Peak Activity: 2 - 4 hr
Duration of Action: 5-8 hr

79
Q

Characteristics of Intermediate Acting Insulin

A

Preparations: Lente NPH
Onset of Action: 1-3 hr
Peak Activity: 5 - 10 hr
Duration of Action: 18-24 hr

80
Q

Characteristics of Long Acting Insulin

A

Preparations: Ultralente
Onset of Action: 4-6 hr
Peak Activity: 8 - 12 hr
Duration of Action: >30 hr

81
Q

Characteristics of Insulin Mixtures

A

Preparations: NPH/regular (70:30); NPH/regular (50:50)
Onset of Action: Variable; depends on formulation
Peak Activity: Variable; depends on formulation
Duration of Action: Variable; depends on formulation

82
Q

descending order of Glucose infusion rate of different types of insulin

A

Insulin lispro aspart, glulisine > Regular > NPH > Insulin detemir > Insulin glargine

83
Q

___% of total daily insulin replace insulin overnight

A

40-50%

84
Q

50-60% Total daily insulin does for carbohydrate coverage (food) and high blood sugar correction

A

Bolus insulin replacement

85
Q

Insulin to CHO ration

A

9g CHO : 1 unit of insulin

86
Q

Formula for calculating CHO coverage insulin dose

A

CHO insulin does = total g of CHO in meal/ g of CHO disposed by 1 unit of insulin

87
Q

Blood sugar correction
- 1 unit will drop blood sugar 50 pts
- high blood sugar correction factor: 50
- Pre-meal blood sugar target: 120 mg/dl
- Actual blood sugar before lunch is 220 mg/dl

A

220 - 120 mg/dl = 100 mg/dl
Correction dose = difference between actual and target blood glucose (100mg/dl)/correction factor (50) = 2 units of rapid acting insulin

88
Q

Formula for Total Meal Insulin Dose

A

Total Meal Insulin Dose = CHO insulin dose + High blood sugar correction dose

89
Q

Time between peak activity two types of insulin

A

Point of intersection

90
Q

Ratio of CHO to insulin unit (point of intersection)

A

1 unit : 10-15 g CHO

91
Q

2 primary defects of T2DM

A
  • insulin resistance (diminished tissue sensitivity to insulin)
  • impaired beta cell function (delayed or inadequate insulin release)
92
Q

Other names for T2DM

A
  • non-insulin dependent diabetes mellitus
  • adult-onset diabetes mellitus
93
Q

Risks to T2DM

A
  • heredity
  • poor diet
  • aging
  • obesity
  • lack of physical activity
94
Q

Etiology of T2DM

A
  1. overeating
  2. increased blood glucose level
  3. increased production of insulin
  4. hyperinsulinemia
  5. chronic demand for insulin exhausts B-cells
  6. insulin production falters
95
Q

Should you give insulin if GDM is present

A

If severe enough, insulin may be given since some oral medications are contraindicated or the mother is undergoing insulin therapy even before pregnancy

96
Q

Etiology of T2DM from Obesity

A
  1. obesity
  2. enlarged fat cells
  3. increased abdominal fat
  4. insulin resistance: set amount of insulin produces a subnormal effect
97
Q

MNT goals and strategies for T2DM

A
  • Achieve and maintain DBW
  • Energy restricted diet
  • diet should allow weight reduction of 1-2 lbs/week
98
Q

Exercise goals and strategies

A
  • glycemic control and weight loss
  • lowers blood glucose and fattu acid levels; raises HDL levels
  • Aerobics & strength training; mild or moderate exercise is prescribed at first
99
Q

Mode of action of medications that end with -ide

A

stimulate insulin secretion by pancreas

100
Q

Possible side effects of medicine for insulin secretion

A
  • hypoglycemia
  • weight gain
  • GI side effects
  • cramps
  • allergic skin reactions
101
Q

Mode of action of metformin

A

Inhibits liver glucose production

102
Q

Possible side effects of metformin

A
  • anorexia
  • metallic taste
  • GI side effects
  • cramps
103
Q

Mode of action of medicine that ends with -zone

A

increase insulin sensitivity

104
Q

Possible side effects of medicine that ends with -zone

A
  • fluid retention
  • edema
  • weight gain
  • anemia
105
Q

Mode of action of medicine like acarbose and miglitol

A

delays glucose absorption

106
Q

Possible side effects of medicine

A

GI side effects

107
Q

Cause of diabetic ketoacidosis

A

severe lack of insulin

108
Q

Characteristics of diabetic ketoacidosis

A
  • ketosis: acetone breath
  • acidosis: hyperventilation
  • hyperglycemia: polyuria
109
Q

Blood glucose level of diabetic ketoacidosis

A

> 250 mg/dl

110
Q

Blood pH of diabetic ketoacidosis

A

<7.3

111
Q

Other symptoms of diabetic ketoacidosis

A

weakness, nausea, vomiting, and affected mental state

112
Q

T or F: Diabetic ketoacidosis is more common in T1DM

A

True

113
Q

Events leading to DKA

A
  1. increase ketones
  2. acidic plasma
  3. destruction of enzymes
  4. coma
  5. death
114
Q

Events leading to hyperglycemia

A
  1. Hyperglycemia
  2. Polyuria
  3. Dehydrated cells
  4. shock
  5. coma
  6. death
115
Q

Condition of sever hyperglycemia that usually develops in the absence of significant ketosis

A

hyperosmolar hyperglycemic state

116
Q

T or F: hyperosmolar hyperglycemic state is more common in T2DM

A

True

117
Q

Blood glucose level of hyperosmolar hyperglycemic state

A

> 600 mg/dl

118
Q

Low blood glucose

A

hypoglycemia

119
Q

T or F: Hypoglycemia is a result of appropriate management of diabetes

A

False: inappropriate

120
Q

Symptoms of hypoglycemia

A

Hunger, sweating, shakiness, heart palpitations, slurred speech and mental confusion

121
Q

Prolonged hypoglycemia may cause ___

A

brain damage

122
Q

Which type of diabetes is hypoglycemia is commonly observed

A

T1DM

123
Q

Disorders that affect the large blood vessels

A

Macrovascular diseases

124
Q

Caused by accumulation of advanced glycation end product (AGEs) that accelerates atherosclerosis

A

macrovascular disease

125
Q

example of AGEs (advanced glycation end products)

A

glucose/glucose fragments + CHON

126
Q

Disorders that affect arterioles and capillaries

A

microvascular diseases

127
Q

3 microvascular diseases

A
  • diabetic retinopathy
  • diabetic nephropathy
  • diabetic neuropathy
128
Q

Early background lesions in capillaries of the eye

A

retinopathy

129
Q

Lesions in capillaries of the eyes result from

A
  1. microaneurysms, minute sacs formed on the capillary membrane at points of membrane weakness caused by insufficient numbers of endothelial cells
  2. hard exudates from capillary leakage
130
Q

T or F: Diabetics are vulnerable to nerve damage and diminish transmission of nerve impulses that affect muscle function & sensory perception

A

true

131
Q

what types of sugar do schwann cells convert glucose using enzymes aldose reductase and sorbitol dehydrogenase into?

A

sorbitol and fructose

132
Q

T or F: sorbitol & glucose diffuse poorly across cell membranes and are osmotically active

A

True

133
Q

earliest clinical sign of microalnuinuria

A

nephropathy

134
Q

Basement membrane of glomerulus thickens and diffuse tissue involvement follows

A

nephropathy

FN 125 LE2 (8 decks)

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