Diabetes Flashcards
what is the normal plasma glucose level?
Homeostatic mechanisms of the body generally maintain glucose at a level <6.0 nmol/L
autonomic symptoms, able to self-treat
mild hypoglycemia
autonomic and neuroglycopenic symptoms, able to self–treat
moderate hypoglycemia
unable to self-treat, requires assistance, unconsciousness may occur
severe hypoglycemia
what is the blood glucose for severe hypoglycemia?
<2.8 mmol/L
Generally hypoglycemia occurs when BG levels are between _____
2.5-3.3 mmol/L
etiology in diabetes
- relative excess of insulin in the blood
- deficits in glucose counterregulation
____ occur due to an abrupt cessation of glucose delivery to the brain
neuroglycopenic symptoms
treatment for mild to moderate hypoglycemia
15 g carb - 2.1 mmol/L increase within 20 mins
treatment for severe-conscious hypoglycemia
20g carb - 3.6 mmol/L increase at 45 mins
treatment in unconscious person with severe hypoglycemia >5 years of age
- 1 mh glucagon SC or IM
- IV glucose 10-25 over 1-3 mins
Acid-base imbalance specifically metabolic acidosis due to ketoacidosis is always present in ___
DKA
Electrolyte imbalances occurs due to
metabolic acidosis and osmotic diuresis
The result of glycogenolysis and gluconeogenesis is
hyperglycemia
total body deficit of water in adults in DKA
5-7 L
total body deficit of water in adults in HHNKS
7-12 L
acteone breath and Kussmaul-Kein respiration present
DKA
glucose > 14 mmol/L
DKA
glucose > 34 mmol/L
HHNKS
pH is usually normal in ….
HHNKS
has severe ECFV depletion (osmolality >320)
HHNKS
- Is an alternative metabolic pathway for tissues not requiring insulin for glucose transport.
- These include the kidney, RBCs, blood vessels, eye lens, and nerves
Polyol Pathway
sorbitol + fructose -> increased intracellular osmotic pressure -> cell injury
polyol pathway
basement membrane components in the microcirculation
Glycoproteins or AGEs
chronic complications arise from a decrease in O2 delivery in small vessels
Tissue oxygenation/oxidative stress
defect in RBC ->
release of O2 Hgb impaired
chronic hyperglycemia ->
increases production of ROS
intracellular hyperglycemia increases the synthesis of DAG which activates ___
protein kinase C
vascular damage and associated disease of the retina, kidney and nerves can be caused by activation of ___ in these blood vessels.
PKC
characterized by thickening of the basement membrane, endothelial cell hyperplasia, thrombosis and pericyte degeneration
microvascular disease
involves retina, nerves, kidneys and GI tract
microvascular disease
may involve the spinal cord, posterior root ganglia or the peripheral nerves
somatic neuropathy
Neuropathic pain may be managed with
tricyclic antidepressants, anticonvulsants and opioid analgesia.
What glomerular changes are seen in nephropathy?
- capillary basement membrane thickening
- diffuse glomerular sclerosis
- nodular glomerulosclerosis
what is one of the 1st clinical manifestations of nephropathy?
microalbuminuria
The underlying pathophysiology of macrovascular complications is
atherogenesis or atherosclerosis
most common cause of death in people with T2DM, common in T1DM as well
CAD - coronary artery disease
what type of stroke in more common?
Ischemic
goal for A1C
<7%
