Diabetes

Question 1

part of the pancreas that secretes hormones into the blood

• made up of approximately a million cell clusters called islets of Langerhans
• 4 main types of islets(alpha, beta, delta, pp cells)
• most endocrine cells are in direct contact with blood vessels by either cytoplasmic processes or direct apposition

Answer 1

endocrine system

Question 2

produces digestive enzymes and an alkaline fluid secretes them into the small intestine through a system of_______ ducts secrete a bicarbonate and salt rich solution into small intestine
-secretes products outwardly by duct

Answer 2

exocrine system

Question 3

is central to regulating carbohydrate and fat metabolism

• stops the use of fat as an energy source by inhibiting release of glucagon
• provided within the body in constant proportion to remove excess glucose from the blood which otherwise would be toxic

Answer 3

insulin

Question 4

compact collection of endocrine cells arranged in clusters and cords and are crisscrossed by a dense network of capillaries
-lined by layers of endocrine cells in direct contact with vessels

Answer 4

islet of langerhans

Question 5

increased secretion of______ released after meals helps maintain euglycemia (normal blood glucose)

• normal range 60-110mg/dL
• maintained by INTERNAL FEEDBACK mechanism involving pancreas and liver
• essential for the utilization of glucose for cellular metabolism as well as for proper metabolism of protein and fat

Answer 5

insulin

a peptide HORMONE produced by BETA CELLS of the pancreas

Question 6

small amounts of the _______ insulin are released into the ____ _____ in response to changes in blood glucose levels throughout the day

Answer 6

Hormone

blood stream

Question 7

insulin affects the conversion of glucose into glycogen for storage in the liver and skeletal muscles and allows for the immediate release and utilization of glucose by the cells

Answer 7

CARBOHYDRATE metabolism

Question 8

amino acid conversion occurs in the presence of insulin to replace muscle tissue or to provide needed glucose

Answer 8

protein metabolism

Question 9

storage of fat in adipose tissue and conversion of fatty acids from excess glucose occurs only in presence of insulin

Answer 9

fat metabolism

Question 10

a gland organ in the digestive and endocrine system-a dual function gland
-has features of both endocrine and exocrine glands

Answer 10

pancreas

Question 11

a simple monosaccharide found in plants

• one of 3 dietary monosaccharaides absorbed directly into the bloodstream during digestion
• cells use it as primary source of energy and a metabolic intermediate
• this fuels cellular respiration

Answer 11

glucose

Question 12

a metabolic disorder characterized by hyperglycemia and results from defective insulin production, secretion, or utilization

Answer 12

diabetes

Question 13

an absolute or relative lack of insulin produced by the beta cells/defect at cell level impaired secretory response of insulin to increase in glucose and increase nocturnal hepatic glucose production in type 2

Answer 13

diabetes

Question 14

insulin dependent and seen in juvenile diabetes

Answer 14

type 1

Question 15

little or no endogenous insulin and requires injections to control diabetes and prevent ketoacidosis

Answer 15

type 1

Question 16

5-10%of diabetic patients suffer this
autoimmunity, viral, genetics
most common in 30yr olds

rapid polydipsia, polyphagia, polyuria, and weight loss

Answer 16

type 1

Question 17

non insulin dependent
adult onset
caused by combination of insulin resistant and relative insulin deficiency
90% of patients have this

Answer 17

type 2

Question 18

strong hereditary component associated with obesity

slow and typically insidious with symptoms of fatigue, weight gain, poor wound healing, recurrent infection

Answer 18

type 2

Question 19

abnormality in glucose levels between normal and overt diabetes

• asymptomatic; can progress or remain the same
• may be at risk for hypertension, coronary heart disease and hyperlipidemia

Answer 19

prediabetes

impaired glucose tolerance: >140 <200 in 2 hour sample

Question 20

carbohydrate intolerance during pregnancy
-occurs in 4% of pregnancies and usually goes away after birth
-puts at higher risk for later diabetes
screening should occur between 24-28 weeks gestation

Answer 20

gestational diabetes

Question 21

what drugs decrease insulin activity resulting in hyperglycemia?

Answer 21

corticosteroids (prednisone)
thiazide diuretics (hydrochlorothiazide)
estrogen
phenytoin(Dilantin)

Question 22

what disease states affect the pancreas or insulin receptors?

Answer 22

pancreatitis
pancreatic cancer
cushing's 
muscular dystrophy
hunnington's

Question 23

accurate determination of capillary blood glucose assists patients in control/management of diabetes, helps evaluate effectiveness of meds, reflects glucose excursion after meals and helps determine treatment

Answer 23

blood glucose monitoring

patients with type 2 monitor at lease 2 times a day
patients with type 1 monitor 4-6 times a day

Question 24

involves SQ injection immediate, short or long term insulin
injection sites: upper arms, abdomen, upper thighs, and upper asscheeks!
do NOT shake, ROLL in palms and mix clear to cloudy injecting air into cloudy first

Answer 24

insulin therapy

Question 25

onset: 5-15 mins peak: 0.5-1.5 hours (30-90 mins) duration: <5 hours

Answer 25

immediate acting lispro(Humalog) aspart(novolog) apidra(glulisine)

Question 26

onset: 30-60 mins peak: 2-3 hours duration: 5-8 hours

Answer 26

fast/short acting humulin-R novolin-R

Question 27

onset: 2-4 hours peak: 4-10 hours duration: 10-16 hours

Answer 27

intermediate acting | insulin isophane, suspension. NPH, humulin N. novulin Nm

Question 28

onset: 3-8 hours peak: no peak duration: 15-13 hours

Answer 28

long acting | levemir(detemir)

Question 29

onset: 2-4 hours peak: no peak duration: 20-24 hours

Answer 29

long acting | Lantus

Question 30

designed to mimic the body's normal insulin responses to glucose uses multiple daily injections of insulin can be flexible to accommodate mealtimes and physical activity

Answer 30

intensive insulin therapy

Question 31

appropriate only in type 2 diabetes - NPH or long acting is given in the evening or oral sulfonylurea in the morning - BIDS: bedtime insulin daytime sulfonylurea

Answer 31

combination oral and insulin therapy

Question 32

continuous infusion of regular or lispro insulin via SQ catheter in abdomen - cath changes Q72hs and removed for bathing - usually only in type 1 but now common in type 2 who require multiple daily injections

Answer 32

pump therapy

Question 33

uses regular or intermediate insulin to retrospectively correct hyperglycemia - individualized to patient - exercise decreased blood sugar

Answer 33

sliding scale

Question 34

2x common in diabetics - increase risk of stroke, hypertension - change in mental status aphasia and hemiparesis - maintain target blood glucose, hyperglycemia leads to dehydration which affects platelet aggregation

Answer 34

CVD cerebrovascular disease

Question 35

A(alpha) cells secrete what?

Answer 35

glucagon

Question 36

B(beta) cells secrete what?

Answer 36

insulin

Question 37

O(delta) cells secrete what?

Answer 37

somatostatin

Question 38

PP cells secrete what?

Answer 38

pancreatic polypeptides

Question 39

drawn at anytime- non fasting - note time and content of last meal - sugar>200 with signs of diabetes - advise to refrain from smoking prior to test

Answer 39

random glucose

Question 40

drawn 2 hours after meal to evaluate glucose metabolism | -advise to refrain from smoking prior to test

Answer 40

postprandial test

Question 41

drawn after 8 hour fast to evaluate circulating amounts of glucose - FBS: >126 on 2 occasions - result of >100 demands close follow up and monitoring

Answer 41

fasting blood sugar

Question 42

evaluates insulin response to glucose loading. patient must remain seated and refrain from smoking - samples taken 1/2, 1, 2, 3 hours - usual diet and exercise must be followed for 3 days prior to test - oral contraceptives, diuretics, nicotine acid, can impair results

Answer 42

oral glucose tolerance test (OGTT)

Question 43

measures glycemic control over 60-100 day period by measuring the irreversible reaction of glucose to hemoglobin through freely permeable erythrocytes - no prior preparation - fasting and with holding insulin are necessary - results can be affected by RBCs

Answer 43

glycated hemoglobin A1C

Question 44

What are 4 main types of islets of langerhans and which one produces insulin.

Answer 44

alpha, beta, delta, pp cells. Beta cells

Question 45

What protein in the pancreas produces insulin.

Answer 45

C-peptide