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Pathophysiology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Insulin is produced by the ____ ____ of the Islets of Langerhans of the pancreas

A

Beta Cells

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2
Q

________ is a disease in which the body does not produce or properly use insulin

A

Diabetes

95% is Type 2, 5% is Type 1

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3
Q

_ leading cause of death of adults in the US

A

7th

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4
Q

Major risk factor for ______ disease and _____

A

Heart disease and stroke

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5
Q

1 cause of _______, ____, and non traumatic _____ _______ _________

A

Blindness
ESRD
Lower extremity amputations

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6
Q

As you get _____, risk increases for type 2 Diabetes

A

older

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7
Q

Diabetes is most prevalent (in this order)

A
  1. 9% - American Indian/Alaskan Natives
  2. 2% - Non hispanic blacks
  3. 8% - Hispanics
  4. 0% - Asians
  5. .6% - Non hispanic whites
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8
Q

Complications take around _ years of time (of hyperglycemia) to develop in both T1/T2

A

5 years

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9
Q

_____ lowers blood sugar by attaching to cells and allowing transport of glucose into cells to be used as a source of energy, or if in excess, to be stored as glycogen

A

Insulin

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10
Q

More actions of Insulin:

A
  • Prevents fat and glycogen breakdown
  • Inhibit gluconeogenesis and increase protein synthesis
  • Increase fatty acid transport into adipose cells
  • Inhibits adipose cell lipase
  • Increase transport of amino acids into cells
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11
Q

Insulin is not required for cellular uptake of glucose into _____ cells, _____, and ___ _____ ____

A

Liver cells
Brain
red blood cells

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12
Q

3 Mechanisms controlling blood glucose levels:

A
  1. Insulin secretion
  2. Uptake and utilization of glucose by peripheral tissues
  3. Glucose Production in the Liver
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13
Q

_______ is a risk factor for T2DM

A

Obesity

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14
Q

______ secretion causes transformation of glycogen (stored in liver) to glucose

Low levels of blood glucose stimulate the release of _______ from the pancreas

A

Glucagon

Can be given (IM/SC) to person with diabetes who is unconscious, at home, and has low blood sugar in order to cause the release of stored glycogen which then breaks down into glucose for body needs

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15
Q

Co-secreted with insulin from the beta cells

Plasma levels increase in response to nutrition stimuli to inhibit gastric emptying and glucagon secretion

A

Amylin

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16
Q

Amylin may cause _________ of the beta cells and contribute to development of T2DM

A

degeneration

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17
Q

Released by the Delta cells of the Pancreas

Inhibits release of both insulin and glucagon

Decreases gastrointestinal activity after ingestion of food, extends the time during which food is absorbed into the blood

A

Somatostatin

b/w the 4 hormones, they control the regulation and absorption of glucose, amino acids, and fatty acids

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18
Q

______ are intestinal hormones released in response to ingestion of food that increase the insulin response in a glucose-dependent matter

A

Incretins

original research in gila monster

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19
Q

Incretins are ___ and ___-1 and are degraded by an enzyme, ___-4

A

GIP
GLP-1
DPP-4

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20
Q

Absolute insulin deficiency

A). Immune mediated (autoimmune destruction of beta cells)
B). Idiopathic (unknown etiology)

A

Type 1 Diabetes

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21
Q

Combination of decreased insulin production and cellular resistance to insulin

A

Type 2 Diabetes

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22
Q

Develops during pregnancy

A

Gestational Diabetes (GDM)

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23
Q

Is autosomal dominant and linked to chromosomes 7 and 20

A

Mature Onset of Diabetes in the Young (MODY)

24
Q

A1C

component of RBC, tells us how much glucose has been produced in the last 3-4 months

A

4-6% normal

>6.5% lab needs to be certified and standardized to DCCT assay

25
Q

3 P’s of Type 1 Diabetes

A

Polydipsia (thirst)
Polyphagia (hunger)
Polyuria (increase urine) - no glucose should be in urine!

26
Q

Results from a severe, absolute lack of insulin caused by a reduction in beta-cell mass. Usually develops in childhood or up to about age 30.

A

Type 1 Diabetes

(MOST COMMON IN CAUCASIANS)

Must receive exogenous insulin injections or they will die

27
Q

Islet cell destruction believed due to:

A

Genetic susceptibility
Autoimmunity
Environmental insult

28
Q

90% of pts. have circulating _____ ____ ________ within a year of diagnosis

A

Islet cell antibodies (ICA)

29
Q

Insulin resistance signs of type 2 diabetes:

A

Acanthosis nigricans
Hypertension
Dyslipidemia
PCOS (polycystic ovarian syndrome)

30
Q

Normal
Prediabetes
Diabetes

A

<100
100-126 (5.7-6.4% A1C)
>126

31
Q

_______ may be used for prevention in T2D

A

Metformin

32
Q

Hyperglycemia despite the availability of insulin

Presence of insulin resistance; there may be a decrease in insulin receptors associated with obesity

Insulin secretion may be increased, normal, or decreased

A

Patho of Type 2 Diabetes

33
Q

Concordance rate

A

50% T1

90% T2

34
Q

Sign and Symptoms of T2

A
  • Hyperglycemia
  • Most common over age 40
  • Blurred vision, fatigue, paraesthesias (tingling), skin infections, foot ulcers, vulvovaginitis
35
Q

One of the mechanisms of Type 2 diabetes is that ________ _______ _______ continues even though a person is not eating

A

Hepatic Glucose Production

36
Q

Dyslipidemia Metabolic Defects in T2

A
  • Decreased beta cell insulin secretion
  • Increase triglycerides levels
  • Decreased HDL levels
  • Increased LDL levels
37
Q

_______ and ____________ raise BG levels during times of stress, e.g fever, surgery, emotional problems, pain

A

Epinephrine and norepinephrine

-Inhibits insulin release and promotes glycogenolysis by stimulating the conversion of muscle and liver glycogen to glucose

38
Q

Glucocorticoid Hormones Effects on BG

A

Raise BG by stimulating liver to break down glycogen to glucose

39
Q

3 Major Metabolic Problems in DKA:

usually type 1
slow onset over several days unlike hypoglycemia

A
  1. Hyperglycemia
  2. Ketosis
  3. Metabolic Acidosis
40
Q

DKA Lab findings:

A
  • Hyperglycemia > 250 mg/dl
  • Bicarbonate low <15 mEq/L
  • pH low < 7.3
  • Ketonemia, Ketonuria
  • Na low or nomral
  • K high or normal
41
Q

Clinical signs of DKA:

A
  • Osmotic effect of glucose polyuria
  • Abdominal pain/tenderness
  • Fruity odor to breath
  • Kussmaul’s respiration
  • Hypotension, tachycardia (hypovolemia)
  • Progression to coma; death
42
Q

Treatment of DKA:

A

IV insulin

Replacement of electrolytes: Na, K, PO4, Mg

43
Q

An acute complication of diabetes; low BG - cells are lacking glucose to perform cellular function

“insulin reaction”

Too much insulin or oral agents, too much exercise, too little food

53 mg/dL or LOWER

Requires fast intervention to prevent coma and death

A

Hypoglycemia

S/Sx: confusion, headache, slurred speech, sleepiness, hunger, hypotension, pale cool skin, tachycardia, coma, diaphoresis

Treatment: 15 gms glucose

44
Q

Person unable to feel effects of low blood sugar

A

Hypoglycemia Unawareness

45
Q

Hyperglycemia >600 mg/dL

Plasma Osmolarity >320

Dehydration

NO KETOACIDOSIS

Depressed Sensorium

A

HHS (Hyperglycemic Hyperosmolar State)

Seen frequently in elder T2

Complication: severe K loss, seizures, cerebral edema, severe dehydration

46
Q

DM is a major risk factor for development of ___ resulting in MI

A

CAD

47
Q

Thickening of the basement membrane of the walls of the blood vessels supplying the nerves

Demyelinization process occurs that causes a slowdown in nerve conduction

A

Neuropathy

48
Q

Managment of Diabetes

A
  1. Dietary Management
  2. Prescription for exercise (150min)
  3. Hyperglycemic control, insulin, oral agents, or both
  4. BG monitoring
  5. BP <130/80
  6. Dyslipidemia management (LDL < 70 or 100, HDL > 50, Tri < 150)
49
Q

Platelets in diabetes have decreased function activation (thromboxane A)

Give ________ ____

A

Antiplatelet Agents

50
Q

Regular Insulin:

A

Onset: 30-60 min
Peak: 2.5-5 hrs
Duration: 6-8 hrs

51
Q

Lispro (Humalog)

Rapid Acting

A

Onset: 5-15 min
Peak: 1-1.5 hr
Duration: 3-5 hr

52
Q

NPH

Intermediate

A

Onset: 60-90 min
Peak: 4-10 hr
Duration: 16-24 hr

53
Q

70% NPH, 30% Reg

A

Onset: 30-60 min
Peak: 3-4 hr and 8-12 hr
Duration: 12-18 hrs

54
Q

Lantus (Glargine)

Long acting

A

Onset: 2-4 hr
Peak: Peakless
Duration: 20-24 hrs

55
Q

Increases sensitivity to insulin

Decreases HEPATIC PRODUCTION of GLUCOSE

Decreases intestinal absorption of glucose

A

Biguanides: Metformin (glucophage)

decrease amount of insulin needed by type 2’s

Pathophysiology (18 decks)

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