Diabetes Flashcards
what are central themes to diabetes management?
interdisciplinary team where person w/ diabetes is central to team, education focused on self management
definition of diabetes:
metabolic disorder characterized by presence of hyperglycemia due to defective insulin secretion and/or defective insulin action
long term complications of diabetes?
kidney, eye, nerves, heart, blood vessels
prevalence vs. incidence
existing vs. new cases
why increase in type 2?
excess food, obesity, sedentary, aging, indigenous, new immigrants with predisposition
primarily a result of pancreatic beta cell destruction and prone to ketoacidosis
type 1
ranges from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance
type 2
glucose intolerance with onset or first recognition during pregnancy
gestational diabetes mellitus
uncommon forms of diabetes:
pancreatitis, removal of pancreas, cystic fibrosis, excess glucocorticoids (acts opposite of insulin)
pathogenesis of type 1
autoimmune destruction of insulin producing beta cells in pancreas by CD4 and CD8 T cells and macrophages infiltrating the islets
insulin resistance caused by:
diminished tissue response to insulin(impaired signaling cuz postreceptor defects)
insulin secretion is a ____ defect
metabolic
what are primary effects of insulin on blood glucose?
act on liver release, act on muscles for uptake
fasting hyperglycemia caused by:
abnormally high hepatic gluc output due to hepatic resistance to insulin action
post prandial hyperglycemia caused by:
abnormal insulin secretion by beta cells in response to meal, too much liver production of glucose, defective gluc uptake by peripheral insulin-sensitive tissues (muscle)
how does chronic hyperglycemia exacerbate the situation?
decrease insulin secretion by beta cells, decrease tissue sensitivity to insulin
why is obesity major effect in causing insulin resistance?
hormones, cytokines, metabolic fuels (non esterified FFA) originate in adipocyte mass and interfere with insulin signaling (how it binds to receptor and initiates metabolic pathway)
factors that affect insulin production and release
increased blood glucose, increased blood amino acids, activation of autonomic nervous system (decreases insulin)
2 primary actions of insulin to lower BG:
^ transport and utilization of gluc to peripheral tissues, decrease gluconeogenesis and glycogen breakdown in liver
ketone body examples:
betahydroxybutyric acid, acetone, acetoacetic acid
type 1 DM symptoms:
hyperglycemia, glucosuria, polyuria, polydipsia, polyphagia
why type 2 less likely ketosis?
because adipose tissue is highest priority for sensitivity to insulin, meaning less lipolysis and fat oxidation
how to do OGTT
fasting plasma gluc, then glucose drink of 75g for adults (1.75 g/kg for kids), take plasma gluc measurements at intervals (120 minute important for diagnosis along with FPG)
diabetic post prandial features:
1) fasting value is high 2) peak is high 3) long time to normalize