Diabetes

Question 1

diabetes Mellitus is the most common disorder related to … (3 words)

Answer 1

pancreatic islet dysfunction

Question 2

DM resulted in _________ serum glucose due to lack of _______ or lack of insulin _______ of both

Answer 2

elevated
insulin
effect

Question 3

what is prediabetes? and which type are they at risk for?

Answer 3

elevated blood glucose, but not high enough to be diabetes (over 100, under 120)
type 2 DM

Question 4

what are the 4 criteria for diagnosing DM?

Answer 4

fasting plasma glucose >/= 126 mg/dL

2-h PG >/= 200 mg/dL

hemoglobin A1C >/= 6.5%

random plasma >/= 200 mg/dL with classic symptoms

Question 5

what are the 3 types of cells that make up the islet of Langerhans?

Answer 5

alpha
beta
delta

Question 6

which organ exclusively uses glucose for energy?

Answer 6

brain

Question 7

which cells secrete insulin?

Answer 7

beta cells

Question 8

what is released in response to low glucose levels?

Answer 8

glucagon

Question 9

what is released in response to high glucose levels?

Answer 9

insulin

Question 10

glucagon: stimulates _______ breakdown (in the ______) to raise blood sugar

Answer 10

glycogen, liver

Question 11

_________ is a transporter that moves glucose INTO cells

Answer 11

insulin

Question 12

3 main types of DM

Answer 12

type 1
type 2
gestational

Question 13

type 1 DM: what is it?

Answer 13

destruction of pancreatic beta cells = decreased insulin levels and beta cell mass

Question 14

type 1 DM
Etiology: (2)
patho: (1)
manifestations: (3)
__________ syndrome

Answer 14

E: genetics (chromosome 6) and destruction of beta cells
P: immune-mediated type 1 diabetes (body produces specific auto-antibodies that attack islet cell antibodies)
M: 3 polys, increased blood sugar, catabolic disorder
catabolic

Question 15

what are the 3 polys

Answer 15

polydipsia (inc thirst)
polyphagia (inc hunger)
polyuria (inc urination)

Question 16

what causes polyuria?

Answer 16

increase in serum osmolarity = increased renal filtration of glucose (requires more H2O for secretion) = more urine = osmotic diuresis

Question 17

what causes polydipsia?

Answer 17

increase loss of water stimulates the thirst center

Question 18

what causes polyphagia?

Answer 18

loss of large glucose –> cells are starved and need energy = hungry!

weight loss due to loss of body fluid and tissue mass via destruction

Question 19

non-insulin-dependent, which one?

Answer 19

type 2 diabetes

Question 20

type 2 DM: what is it?

Answer 20

occurs despite the availability of insulin (autoimmune destruction of beta cells doesn’t occur but insulin can not act on tissues)

Question 21

type 2 DM:
Patho: (1)
risk factors: (5)
manifestations: (7)
__________ syndrome

Answer 21

P: insulin resistance
RF: heredity, gender (F >M), age, diet, body weight
M: 3 polys, obesity, increased blood sugar levels (fatigue, blurred vision, numbness/tingling, poor wound healing, infections)
metabolic

Question 22

what are the 3 aspects of catabolic disorder of type 1 DM?

Answer 22

absolute lack of insulin
elevation in blood glucose
breakdown of body fats/proteins

Question 23

what are the 3 aspects of metabolic disorder of type 2 DM?

Answer 23

caused by insulin resistance
inflammation + hypoperfusion + free fatty acids

Question 24

what is insulin resistance?

Answer 24

cells “build up a tolerance” to insulin and it’s less effective

Question 25

when a patient has type 2 diabetes and is overweight there is decreased perfusion or ________ and then tissues become _______ and _________

Answer 25

hypoperfusion hypoxic inflamed

Question 26

what causes metabolic syndrome in type 2 DM?

Answer 26

insulin resistance

Question 27

what is insulinemia?

Answer 27

since insulin cells are not working correctly, the pancreas produces a LOT of insulin to maintain a safe blood glucose but this compensatory mechanism can not be maintained

Question 28

why is dyslipidemia seen with DM?

Answer 28

Insulin normally inhibits the breakdown of fat, so when there is no insulin, there is a release of free FA

Question 29

onset of DM type 1: type 2:

Answer 29

1. suddenly 2. gradually, subtle can be asymptomatic

Question 30

what is gestational diabetes?

Answer 30

glucose intolerance that occurs in the 2nd or 3rd trimester due to hormone changes that cause insulin resistance greater risl for developing type 2 DM later

Question 31

manifestations of gestational diabetes (more mild) pregnancy __________: (4) fetal ________________: (7) (teratongenic: 3)

Answer 31

pregnancy complications (pre-eclampsia, a lot of amniotic fluid, prolonged labor (c-section), infection) fetal abnormalities: macrosomia (large baby) --> birth trauma, respiratory issues (insulin inhibits surfactant production), hypoglycemia (loss source/mom), hypocalcemia, polycythemia, hyperbilirubinemia teratogenic: clef lip palats, cardiac issues, imperforated anus

Question 32

what are the 3 acute complications of DM?

Answer 32

DKA hyperosmolar hyperglycemic state hypoglycemia

Question 33

acute DM type 1: ______ type 2: ______

Answer 33

1. DKA 2. HHS

Question 34

what are the 3 major metabolic derangements of DKA?

Answer 34

hyperglycemia (osmotic diuresis = more urine = dehydrated) ketosis (fats broken down = ketones = low pH = metabolic acidosis

Question 35

what induces DKA?

Answer 35

physical or emotional stress (infection, inflammation, pregnancy, extreme anxiety)

Question 36

manifestations of DKA: (8)

Answer 36

blood sugar >/= 250 mg/dL kussmaul respirations (inc rate and depth) hypotension tachycardia 3 polys CNS depression abdominal pain fruity breath

Question 37

what is a hyperosmolar hyperglycemic state?

Answer 37

hyperglycemia, hyperosmolarity with dehydration, the absence of ketoacidosis, and depression of the sensorium

Question 38

walk through the cause of HHS: _______ = lots of H2O loss with ________ = severe dehydration = ________ insufficincy = further __________ glucose = _______ pulled out of cells (______!!)

Answer 38

diuresis hyperglycemia renal elevated water brain

Question 39

manifestations of HHS (5)

Answer 39

>600 mg/dL neurologic alterations weakness/fatigue polyuria polydipsia

Question 40

what is hypoglycemia?

Answer 40

low blood sugar (less than 70 w or w/o S/S) related to aggressive treatment, stress, illness, altered diet, or exercise

Question 41

why does exercise cause hypoglycemia?

Answer 41

cells need energy fast, so muscles pull glucose into cells and blood glucose drops

Question 42

manifestations of hypoglycemia: (5)

Answer 42

autonomic NS activated (BP, RR, motor, GI into fight or flight) altered brain function hunger (early) blurred vision weakness/shakiness confusion

Question 43

what is the primary goal of diabetic treatment?

Answer 43

glycemic control

Question 44

what is the best predictive factor for diabetic complications?

Answer 44

level of chronic hyperglycemia

Question 45

what are the 3 kinds of chronic complications for DM?

Answer 45

microvascular complications macrovascular complications skin and infections

Question 46

what are the 5 types of microvascular complications?

Answer 46

neuropathy somatic neuropathy autonomic neuropathy nephropathy retinopathy

Question 47

what is the leading cause of kidney failure in the US

Answer 47

nephropathy

Question 48

what is the leading cause of vision loss and blindness in the US

Answer 48

retinopathy

Question 49

microvascular complications are more common in type ___ DM

Answer 49

2 because more fat tissue leads to tissue hypoxia and oxidative stress

Question 50

_________ effects: peripheral nerves, brain, spinal cord, cranial nerves, and autonomic nervous system and causes NUMBNESS and TINGLING

Answer 50

neuropathy neurons are affected by DKA and fluctuations i blood sugars

Question 51

____________ neuropathy: Associated with sensory loss and motor weakness in distal extremities

Answer 51

somatic accumluation of metabolites and myelin destruction = painful and loss of sensation

Question 52

___________ neuropathy : affects sympathetic and parasympathetic nervous system changes Postural hypotension, impaired GI and GU function ( diarrhea, difficulty voiding, ED)

Answer 52

autonomic

Question 53

__________: Glucose causes renal vascular lesions that further lead to renal insufficiency (proteinuria)

Answer 53

nephropathy

Question 54

__________= alterations in blood flow through the retina --> Retinal/macular degeneration and atrophy of vessels = toxicity of glucose

Answer 54

retinopathy

Question 55

skin issues for those with chronic DM: _________ → Poor skin turgor _________ deficits → ignore minor trauma and infection Vascular disease → impaired ______ → ineffective healing

Answer 55

Dehydration Sensory circulation

Question 56

Hyperglycemia and glycosuria may influence the growth of ___________ and increase ________ of infections

Answer 56

microorganisms severity

Question 57

Chronic vascular complication __________ response to infection bc of ...

Answer 57

inhibit Poor functioning of neutrophils and decreased numbers of WBCs with circulation problems

Question 58

3 examples of macrovascular complications of DM

Answer 58

CAD CVD and stroke peripheral vascular disease (PVD)

Question 59

since lipid deposits: cholesterol, triglycerides, and phospholipids form more easily this is the cause of

Answer 59

coronary artery disease

Question 60

Peripheral Vascular Disease (PVD) example and cause:

Answer 60

Diabetic foot ulcers Impaired sensation causes individuals to be unaware of trauma being done to the foot Improper fitting shoes, improper weight bearing, hard object in shoes, infections