Diabetes

Question 1

Angiopathy.

Answer 1

blood vessel disease; damage to the large and small blood vessels

Question 2

DM.

Answer 2

a multi system disease related to abnormal insulin secretion, impaired insulin action or both. Clinical signs of DM are hyperglycemia (fasting blood sugar level greater than7 mmol/L)
glycosuria (the presence of sugar in the urine)

Question 3

Diabetic Ketoacidosis.

Answer 3

DKA.
An acute metabolic complication of diabetes occurring when fats are metabolized in the absence of insulin (affects DM1); characterized by hyperglycemia (BG > 14), ketosis, acidosis, and dehydration.

Question 4

Diabetic retinopathy.

Answer 4

refers to the process of microvascular damage to the blood vessels in the retina as a result of chronic hyperglycemia, presence of nephropathy and hypertension in pts with DM

Question 5

Euglycemia.

Answer 5

normal concentration of blood glucose

Question 6

Hyperosmolar hyperglycemic nonketotic syndrome (HHS)

Answer 6

• ECFD (extracellular fluid depletion)
• hyperosmolarity
• occurs in DM2 pts
• severe hyperglycaemia, osmotic diuresis and ECF depletion
• BG>34

Question 7

Impaired fasting glucose.

Answer 7

• prediabetes

- 6.1-6.9 mmol/L for IFG

Question 8

Impaired glucose tolerance.

Answer 8

• prediabetes

- 7.1-11 mmol/L for IGT

Question 9

Insulin resistance syndrome.

Answer 9

• also known as metabolic syndrome or syndrome X, or dysmetabolic syndrome
• is a collection of risk factors that increase an individual’s chance of developing cardiovascular disease and DM.
• Dx in indivuduals that have 3 or more of the conditions listed in table 43-10.

Question 10

Where is insulin produced.

Answer 10

beta cells in the islets of langerhans of the pancreas

Question 11

Basal rate.

Answer 11

release of insulin in small increments

Question 12

Bolus rate.

Answer 12

increased release when food is ingested.

Question 13

Normal glucose levels.

Answer 13

4-6mmol/L

Question 14

What hormones have the opposite effect of insulin.

Answer 14

Glucagon, epinephrine, growth hormone, and cortisol

Question 15

What is used as a beta cell function indicator?

Answer 15

C peptide in serum.
(low would indicate insulin deficiency)

Insulin is released from β cells as a precursor to proinsulin, and is then routed through the liver; proinsulin is composed of peptide chains A and B which are linked by C-peptide chain; Insulin is formed when C cleaves off leaving A and B chains

Question 16

What tissues are considered insulin dependent?

Answer 16

SKELETAL MUSCLE and FAT
(Although liver is not considered an insulin dependent tissue, insulin receptor sites in the liver facilitate the hepatic uptake of glucose and its conversation to glycogen)

Question 17

What does insulin do?

Answer 17

facilitates transport of glucose into cell cytoplasm and thus the store of insulin as glycogen in the liver and muscles, inhibits gluconeogenesis, enhances fat deposition in adipose tissue and increases protein synthesis; at night insulin falls and sugars are released

Question 18

DM1.

Answer 18

· Results from progressive destruction of β cells owing to an autoimmune process in susceptible individuals causing a reduction of 80-90% of normal β cell function before hyperglycemia and other manifestations occur
· contributing factors are genetic predisposition and viral exposure or idiopathic
· Predisposition is believed to be human leukocyte antigens (HLAs); when HLA types are exposed to viral infection the beta cells are destroyed

Question 19

Manifestations of DM1.

Answer 19

• acute symptoms of impending or actual ketoacidosis
• Hx of recent sudden weight loss as well as classic symptoms polydipsia (excessive thirst), polyuria, and polyphagia
• may experience honey moon period 3-12 months before more beta cells are destroyed

Question 20

Risk factors for DM2.

Answer 20

o Member of high risk group (Aboriginal, Hispanic, South Asian, Asian, or African)
o Hx of IGT or IFG
o Presence of complications associated with DM
o Hx of GDM
o Hx of macrosomic infant
o Hypertension
o Dyslipidemia
o Being overweight (abdominal obesity)
o Polycystic ovary syndrome (PCOS)
o Acanthosis nigricans (velvety, light brown to black hyperpigmented thickening of skin)
o 3 times higher in ppl with schizophrenia; r/t antipsychotic medications
o Over the age of 55

Question 21

Pathophysiology of DM2.

4 major metabolic abnormalities

Answer 21

1. Insulin resistance in glucose and lipid metabolism
2. Marked decrease in the ability of the pancreas to produce insulin.
3. inappropriate glucose production by the liver (increase glucagon production from alpha cells)
4. Alteration in the production of hormones and cytokines by adipose tissue.

Question 22

Onset of DM2 is gradual; if pt with DM2 has marked hyperglycaemia (_____mmol/L), a sufficient endogenous insulin supply may prevent ___from occurring however osmotic fluid and electrolyte loss related to hyperglycemia may become severe and lead to _____

Answer 22

28-58mmol/L
DKA
HHS

Question 23

Dx of DM.

Answer 23

1. Hemoglobin A1C (A1C) ≥6.5%, using a standardized, validated assay, in the absence of conditions that affect the accuracy of the A1C.
2. Fasting plasma glucose (FPG) level ≥7 mmol/L. Fasting is defined as no caloric intake for at least 8 hours.
3. Random, or casual, plasma glucose measurement ≥11.1 mmol/L, plus classic symptoms of DM, such as polyuria, polydipsia, and unexplained weight loss. Casual is defined as any time of day without regard to the interval since the last meal.
4. Two-hour OGTT level ≥11.1 mmol/L, using a glucose load of 75 g.

Question 24

Collaborative therapy includes.

Answer 24

• nutritional therapy
• exercise therapy
• drug therapy (insulins or oral anti diabetic meds)
• vascular protection (ASA 80-325mg, ACE inhibitors or ARBs, lipid lowering therapy)
• SMBG
• Blood pressure control