Diabetes Flashcards
Define diabetes
a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization or both
diabetes is the leading cause of what diseases
end-stage kidney disease and nontraumatic lower limb amputations
what are the current theories about the causes of diabetes
single or combination of genetic, autoimmune, and environmental factors
where is insulin produced
in the Beta cells in the islets of langerhans of the pancrease
what is the stable normal blood glucose level
70-120 mg/dL
what is the average amount of insulin secreted by the pancreas
40-50 units
what does the rise in insulin after a meal stimulate
storage of glucose as glycogen in liver and muscle, inhibits glucogenenesis, enhances fat deposition of adipose tissue and increases protein synthesis
what does the fall of insulin level during normal overnight fasting facilitate in?
release of stored glucose from the liver, protein from muscle and fat from adipose tissue
what tissues are considered insulin-dependent
insulin dependent tissues are skeletal muscle tissue and adipose tissue
what are the counterregulatory hormones
glucagon, epinephrine, growth hormone, and cortisol
What is the etiology and pathophysiology of Type 1 DM
it is an immune mediated disease caused by autoimmune destruction of pancreatic beta cells
leading to absence of insulin production
what is the prediposition to type 1 diabetes
it is related to Human leukocyte antigens,
how do HLA contribute to type 1 DM
when exposed to a viral infection HLA destroy pancreatic beta cells either directly or through an autoimmune response
what is idiopathic diabetes
a form of type 1 DM that is strongly inherited not related to autoimmunity
what is latent autoimmune diabetes in adults (LADA)
a slowly progressing autoimmune form of type 1 DM usually occurs in people who are over the age of 35 and who are not obese
what is the onset of type 1 DM
the islet cell autoantibodies responsible for beta cell destruction are present for months to years before the onset of symptoms
what are the key manifestations of type 1 dm
polyphagia, polydipsia, polyuria
without insulin from an outside source what will happen to a type 1 DM
patient will develop diabetic ketoacidosis (DKA) a life-threatening condition resulting in metabolic acidosis
what is the most prevalent type of diabetes?
type 2 DM
what are risk factors for developing type 2 DM
overweight/obese
older age
family history
what is the etiology and pathophysiology of type 2 DM
the pancreas produces some endogenous insulin but the insulin produced is either insufficient for the needs of the body or is poorly used by the tissues or both.
what are the major metabolic abnormalities that have a role in the development of type 2 diabetes
- ) insulin resistance- body does not respond to the action of insulin because receptors are unresponsive or insufficient number
- ) decrease in the pancreas’s ability to produce insulin, as the beta cells become fatigued from the compensatory overproduction of insulin when beta cell mass is lost
- ) inappropriate glucose production by the liver
- ) alltered production of hormones and cytokines by adipose tissue
what is the onset of type 2 DM
usually gradual
what is prediabetes
individuals that are at increased risk of development of type 2 diabetes
how is preediabetes diagnosed
an impired glucose tolerance (140-199) or impaired fasting glucose (100-125 mg/dL)
how do people with prediabetes reduce their risk of developing type 2 DM
maintaining a health weight, exercising regularly, and eating a healthy diet
what is gestational diabetes
diabetes that develops during pregnancy and occurs in about 2-10% of pregnancies
women with gestational diabetes are at risk for
cesarean delivery, perinatal death, birth injury, and neonatal complications
who is at risk for gestational diabetes
women who are obese, advanced maternal age, family history of diabetes
when are women screened for gestational diabetes
at 24-28 weeks using a 2 hour oral glucose test
what are some disease or treatments that cause diabetes
cushing syndrome, hyperthyroidism, recurrent pancreatitis, cystic fibrosis, hemachromatosis, parenteral nurtrition.
What is diabetes?
a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization or both
what are the classes of diabetes?
Type 1
Type 2
Gestational
other specific types
What is the etiology of diabetes
combination of causative factors including
- genetics
- autoimmune
- environmental
where is insulin produced
by beta-cells in the islets of langerhans in the pancreas
when is insulin normally released
released continuously into bloodstream in small increments with larger amounts released after food
what is the normal glucose range
70-120mg/dL
what are the normal functions of insulin (5)
promote glucose transport in skeletal muscle and adipose tissue
- storage of glucose as glycogen
- inhibits gluconeogenesis
- enhance fat deposition
- increase protein synthesis
What are the counterregulatory hormones (4)
Glucagon
epinephrine
growth hormone
cortisol
what are the functions of counterregulatory hormones
oppose effects of insulin
stimulate glucose production by liver
decreased movement of glucose into cell
help maintain normal blood glucose levels
what is the onset of type 1 DM
younger- less than 40
what is the etiology of type 1 DM
- autoimmune destruction of beta cells
- total absence of insulin
- genetic predisposition and viral exposure
- HLA-DR3 and HLA- DR4
- idiopathic diabetes
- latent autoimmune diabetes in adults (LADA)
what is the manifestations of the development of type 1 DM
develop when pancreas can no longer produce insulin- rapid onset of ketoacidosis
what is the most prevalent form of DM
type 2
what are some risk factors of type 2 DM
overweight
obesity
advancing age
family history
what is the etiology of type 2 DM
pancreas continues to produce some endogenous insulin
insulin is insufficient or poorly utilized
what are the four major metabolic abnormalities associated with type 2 DM
- ) insulin resistance
- ) decreased insulin production by pancreas
- ) inappropriate hepatic glucose production
- ) altered production of hormones and cytokines by adipose tissue
what are the metabolic syndromes that increase the risk for developing type 2 DM
- elevated glucose levels
- abdominal obesity
- elevated BP
- high levels of triglycerides
- decreased levels of HDLs
what is the onset of type 2 DM
gradual onset
hyperglycemia may go many years without being detected
what is prediabetes
individuals that exhibit some symptoms of type 2 DM and are at greater risk for developing type 2 DM
what are the tests to determine if someone is prediabetic
Impaired Glucose Intolerance- oral glucose tolerance test and
impaired fasting glucose
what are some important teachings for prediabetes
- undergo screening
- mange risk factors
- monitor for symptoms of diabetes
- Maintain healthy weight, exercise, healthy diet
what is gestational diabetes
diabetes that occurs during pregnancy
what are some increased risks from gestational diabetes
increased risk of need for cesarean delivery
perinatal complications
when do you screen for gestational diabetes
high risk pt at first visit
others at 24-28 weeks
what are the clinical manifestations of type 1 diabetes
classical symptoms - polyuria - polydipsia - polyphagia wt loss weakness fatigue
clinical manifestations of type 2 diabetes
nonspecific symptoms polyuria polydipsia polyphagia fatigue recurrent infection recurrent fungal infection prolonged wound healing visual changes
what are the diagnostic studies of diabetes
hemoglobin A1C
Fasting plasma glucose
two-hour plasma glucose level during OGTT
Classic symptoms of hyperglycemia with random plasma glucose level
what level indicates diabetes with hemoglobin A1C
6.5% or higher
what level indicates diabetes with fasting plasma glucose level
126 mg/dL
what level indicates diabetes with two-hour plasma glucose levels during OGTT
200 mg/dL
what level indicates diabetes with random plasma glucose level
200 mg/dL
what are the goals of diabetes management
Goals of diabetes management Decrease symptoms Promote well-being Prevent acute complications Delay onset and progression of long-term complications
