Diabetes Flashcards
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
endocrine system
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
exocrine system
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
insulin
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
islet of langerhans
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
insulin
a peptide HORMONE produced by BETA CELLS of the pancreas
small amounts of the _______ insulin are released into the ____ _____ in response to changes in blood glucose levels throughout the day
Hormone
blood stream
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
CARBOHYDRATE metabolism
amino acid conversion occurs in the presence of insulin to replace muscle tissue or to provide needed glucose
protein metabolism
storage of fat in adipose tissue and conversion of fatty acids from excess glucose occurs only in presence of insulin
fat metabolism
a gland organ in the digestive and endocrine system-a dual function gland
-has features of both endocrine and exocrine glands
pancreas
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
glucose
a metabolic disorder characterized by hyperglycemia and results from defective insulin production, secretion, or utilization
diabetes
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
diabetes
insulin dependent and seen in juvenile diabetes
type 1
little or no endogenous insulin and requires injections to control diabetes and prevent ketoacidosis
type 1
5-10%of diabetic patients suffer this
autoimmunity, viral, genetics
most common in 30yr olds
rapid polydipsia, polyphagia, polyuria, and weight loss
type 1
non insulin dependent
adult onset
caused by combination of insulin resistant and relative insulin deficiency
90% of patients have this
type 2
strong hereditary component associated with obesity
slow and typically insidious with symptoms of fatigue, weight gain, poor wound healing, recurrent infection
type 2
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
prediabetes
impaired glucose tolerance: >140 <200 in 2 hour sample
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
gestational diabetes
what drugs decrease insulin activity resulting in hyperglycemia?
corticosteroids (prednisone)
thiazide diuretics (hydrochlorothiazide)
estrogen
phenytoin(Dilantin)
what disease states affect the pancreas or insulin receptors?
pancreatitis pancreatic cancer cushing's muscular dystrophy hunnington's
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
blood glucose monitoring
patients with type 2 monitor at lease 2 times a day
patients with type 1 monitor 4-6 times a day
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
insulin therapy
onset: 5-15 mins
peak: 0.5-1.5 hours (30-90 mins)
duration: <5 hours
immediate acting
lispro(Humalog)
aspart(novolog)
apidra(glulisine)
onset: 30-60 mins
peak: 2-3 hours
duration: 5-8 hours
fast/short acting
humulin-R
novolin-R
onset: 2-4 hours
peak: 4-10 hours
duration: 10-16 hours
intermediate acting
insulin isophane, suspension. NPH, humulin N. novulin Nm
onset: 3-8 hours
peak: no peak
duration: 15-13 hours
long acting
levemir(detemir)
onset: 2-4 hours
peak: no peak
duration: 20-24 hours
long acting
Lantus
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
intensive insulin therapy
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
combination oral and insulin therapy
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
pump therapy
uses regular or intermediate insulin to retrospectively correct hyperglycemia
- individualized to patient
- exercise decreased blood sugar
sliding scale
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
CVD cerebrovascular disease
A(alpha) cells secrete what?
glucagon
B(beta) cells secrete what?
insulin
O(delta) cells secrete what?
somatostatin
PP cells secrete what?
pancreatic polypeptides
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
random glucose
drawn 2 hours after meal to evaluate glucose metabolism
-advise to refrain from smoking prior to test
postprandial test
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
fasting blood sugar
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
oral glucose tolerance test (OGTT)
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
glycated hemoglobin A1C
What are 4 main types of islets of langerhans and which one produces insulin.
alpha, beta, delta, pp cells. Beta cells
What protein in the pancreas produces insulin.
C-peptide
