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PATHOPHYSIOLOGY > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What do body cells require for energy

A

Glucose

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2
Q

What is the normal level for blood glucose in healthy adults?

A

3.5-6.5mmol/L

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3
Q

Which two hormones regulate blood glucose levels?

A

Insulin and glucagon

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4
Q

Name three simple sugars

A

Sucrose, lactose and glucose

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5
Q

Glucose is a monosaccaride and can be absorbed directly into the blood- true or false

A

TRUE

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6
Q

Starch is a complex carbohydrate containing thousands of glucose molecules and firstly needs breaking down before it can be absorbed into the blood- true or false?

A

TRUE

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7
Q

What is the ‘glycemic index’ of foods?

A

A measure of the effect a food has on an individuals blood sugar level. It relates to how quickly the carbohydrate content of the food is digested and absorbed into the blood stream.

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8
Q

Food with a low glycemic index causes blood sugar levels to rise slowly or quickly?

A

Slowly

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9
Q

Where in the pancreas are alpha and beta cells located?

A

Within the islets of langerhans

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10
Q

What is the role of beta cells within the pancreas?

A

To synthesise and release insulin

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11
Q

What is the role of alpha cells in the pancreas?

A

To synthesise and release glucagon

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12
Q

What does insulin bind to?

A

Receptors on the cell surfaces of the liver, skeletal muscle and adipose tissue.

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13
Q

What does the binding of insulin to receptors on cell surfaces cause?

A

Glucose transporter proteins to open- allowing glucose into cells

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14
Q

As glucose passes into cells, the blood glucose level rises or falls?

A

Falls

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15
Q

What does a low blood glucose level prevent?

A

The release of further insulin from beta cells in the pancreas.

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16
Q

What is the role of insulin in skeletal muscles?

A

To produce energy or be stored as glycogen

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17
Q

What is the role of insulin in the liver?

A

To be stored as glycogen

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18
Q

What is the role of insulin in the adipose tissue?

A

To be stored as fat

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19
Q

What triggers the release of glucagon from the alpha cells in the pancreas?

A

Decreases in blood sugar levels or the fall of circulating insulin.

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20
Q

What is the primary role of glucagon?

A

To break down glycogen into glucose within the liver

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21
Q

What happens following glucagon breaking down glycogen into glucose within the liver?

A

Glucose is released into the bloodstream

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22
Q

As blood glucose level rises, what is suppressed to prevent further glucagon release?

A

Alpha cells in the pancreas

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23
Q

Glucagon breaks down glycogen into glucose within the liver- what is this process called?

A

Glycogenisis

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24
Q

What happens during the two phases of insulin release?

A

Phase 1: occurs 2-10 minutes following a rise in blood glucose level. Rapid release prevents blood glucose levels from rising too high.
Phase 2: A controlled release of insulin determined by the rise in blood glucose level and the glycemic index of the ingested food.

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25
Q

How long does the phase 2 release of insulin continue for?

A

Until circulating blood glucose levels return to a normal level which no longer trigger the release of insulin

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26
Q

Which hormone triggers the phase 1 release of insulin?

A

GLP-1 hormone

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27
Q

What is the role of the GLP-1 hormone?

A

To delay gastric emptying, suppress glucagon release within alpha cells of the pancreas and causes a feeling of ‘fullness’.

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28
Q

Are type 2 diabetics able to produce the GLP-1 hormone?

A

No

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29
Q

What happens to glucose as blood passes through the kidneys?

A

It is filtered by the nephrons. Typically, 100% of glucose should be filtered by the nephrons.

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30
Q

Where in the nephrons does 90% of glucose absorption take place?

A

In the proximal tubules

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31
Q

What is the renal threshold (maximum level) for glucose absorption?

A

10mmol/L

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32
Q

What happens if the renal threshold within the kidneys is reached and what does this cause?

A

Glucose will remain in the filtrate causing an increase in osmotic pressure in the renal tubule.

33
Q

What does an increase in osmotic pressure in the renal tubule cause and what does this lead to?

A

Water retention and a reduction in the absorption of water. Leading to glucosurea and increased urine production.

34
Q

Describe 4 features of type 1 diabetes.

A
  1. It is an autoimmune condition leading to distruction of beta cells in the pancreas
  2. The body is unable to produce insulin
  3. Thought to be associated with an environmental trigger such as a virus
  4. Generally occurs at a young age and onset is rapid
35
Q

Does the body produce insulin in type 2 diabetes?

A

Yes, but it is unable to use the insulin effectively

36
Q

What does insulin resistance in type 2 diabetes cause?

A

Increased levels of insulin needed to help glucose enter the body cells.

37
Q

What do beta cells do to attempt to manage insulin resistance in type 2 diabetes?

A

Increase the production of insulin

38
Q

If beta cells are unable to keep up with insulin production in response to insulin resistance what will happen?

A

Blood glucose levels will rise as glucose is unable to enter the body cells

39
Q

What happens to beta cells if blood glucose levels rise too much?

A

They become damaged leading to a further reduction in insulin production.

40
Q

Name 3 risk factors for developing type 2 diabetes:

A
  1. Obesity
    2, Physical inactivity
  2. Ethnicity
41
Q

When does type 2 diabetes occur?

A

When beta cells can no longer produce enough insulin to keep up with demand.

42
Q

What is gestational diabetes?

A

Diabetes which occurs for the first time during pregnancy.

43
Q

Why does gestational diabetes occur?

A

There are thought to be links between pregnancy hormones and the development of gestational diabetes

44
Q

How long following delivery must women with gestational diabetes be reviewed?

A

6 weeks

45
Q

Gestational diabetes increases the risk of a woman developing type 2 diabetes in the future- true or false?

A

True

46
Q

Name 4 symptoms of type 1 diabetes:

A 
Increased thirst
Large amounts of urine passed
Tiredness
Dizzyness
Weight loss 
Blurred vision
47
Q

Is type 2 diabetes symptomatic?

A

Type 2 diabetes is often symptom free however repeated episodes of thrush, itchy skin and poor wound healing may indicate the condition.

48
Q

Give 6 methods of diagnosing diabetes:

A
  1. HbA1c measurement
  2. Fasting blood glucose level- blood glucose given after a period of fasting (often first thing in the morning)
  3. Random blood glucose check-
  4. Oral glucose tolerance check- blood sugars taken after fasting and then after a glucose based drink
  5. Capillary blood glucose level
  6. Urinalysis for ketones in urine
49
Q

If an individual is diagnosed with type 2 diabetes, what can be recommended?

A

Lifestyle changes such as increased exercise, weight loss and dietry changes as well as regular diabetes check ups.

50
Q

What does a HbA1c hormone test measure?

A

Level of haemoglobin in the blood with glucose attached. The amount of glucose attached to haemoglobin is directly proportional to blood glucose level over the time period measured.

51
Q

What is the HbA1c range?

A

20-42mmol/L

52
Q

What is hypoglycemia?

A

A blood glucose reading below 4mmol/L (LOW READING)

53
Q

How does hypoglycemia trigger a stress response? What symptoms does the stress response cause?

A

It alerts the sympathetic nervous system to release adrenaline and noradrenaline which further lead to the release of cortisol. Release of these hormones lead to tachycardia, sweating, peripheral vasodilation and release of glucose from the liver to increase blood glucose levels.

54
Q

How is hypoglycemia corrected?

A

By raising blood glucose levels- a fast acting carbohydrate will be given. Once blood glucose levels have risen above 4mmol/L a slower acting carbohydrate is given. If the blood glucose does not rise above 4mmol/L then IV glucagon or IM glucose is given.

55
Q

Which three body states indicate diabetic ketoacidosis?

A
  1. hyperglycemia
  2. ketoaemia
  3. ketonurea
56
Q

Is DKA most common in type 1 or tye 2 diabetics and why does it occur?

A

Type 1 diabetics. Occurs as a result of incorrect insulin dosage being given or if the bodies insulin demand is higher due to stress or illness.

57
Q

How does the body gain energy if it is unable to utilise glucose due to insulin deficiency?

A

From fat stores (fatty acids are broken down to produce ATP)

58
Q

Which three hormones are released during DKA to trigger the conversion of glycogen in the liver into glucose (glycogenisis)?

A

Adrenaline, cortisol and glucogen

59
Q

Why are large amounts of urine present in DKA patients?

A

The renal threshold is met in the nephrons. Glucose is left unabsorbed leading to osmotic diuresis. Unabsorbed glucose in the kidneys draws water into the tubules by osmosis (water follows glucose). Both water and glucose remain unabsorbed leading to large volumes of urine with glucose presence.

60
Q

Why does ketonurea occur?

A

Fatty acids are converted into ketones and released into the blood stream. Ketones are then excreted in the urine as waste.

61
Q

How does acidosis occur?

A

The ketones released from fatty acid stores in the liver have a low pH which lower the pH of the blood causing acidosis.

62
Q

Which 3 fundimental steps must be taken to correct DKA? How is this achieved in hospital?

A
  1. correction of dehydration
  2. clearance of ketones
  3. correction of electrolyte imbalance
    This is achieved by giving normal saline alongside a fixed rate insulin infusion and potassium supplimentation.
63
Q

What does HHS stand for with relation to diabetes?

A

A Hyperosmolar Hyperglycaemic State

64
Q

What is a hyperosmolar hyperglycaemic state?

A

A condition developed by those with type 2 diabetes. Characterised by hypovolaemia, hyperglycemia without acidosis or ketonurea.

65
Q

What causes a hyperosmolar lyperglycemic state?

A

Stress such as illness or infection will cause a reduction in circulating insulin. The bodies ability to produce insulin further drops leading to lypovoleamia and hyperglyceamia.

66
Q

How is hyperosmolar hyperglycaemia managed?

A

By cautiously re hydrating the patient,. Insulin should not be commenced until rehydration has had its full effect on insulin levels in the body. Prevention of aterial and venous thrombosis as well as ulceration is also a priority.

67
Q

Name 4 long term complications of diabetes:

A
  1. Neuropathy- damage to small vessels leading to nerve damage causing reduced sensations- can lead to ulceration
  2. Microvascular complications- damage to capillaries and tiny vessels due to hyperglycemia and hypertension
  3. Retinopathy- damage to the vessels supplying the retinas of the eyes leading to scar tissue and causing eventual blindness
  4. Macrovascular complications- conditions of the cardiovascular system due to hyperglycaemia, lifestyle factors and medications taken
  5. Nephropathy- progressive kidney disease caused by damage to capillaries in the kidney nephrons- eventually caused renal failure.
68
Q

Why does ketosis not occur during HHS?

A

There is still the presence of circulating insulin in the blood stream- it just cannot be utilised/effectively maintain blood glucose levels.

69
Q

What are two complications of rapid rehydration/glucose replacement within HHS?

A 
Cerebral oedema (fluid in the brain) 
Central pontine myelinolysis (electrolyte imbalance causing water to be drawn out of brain cells)
70
Q

Why is HbA1c a good measure of blood sugar levels over a period of time?

A

HbA1C refers to the binding of glucose to haemoglobin within red blood cells. As red blood cells typically last for 20 days (8-12 weeks) measuring HbA1C can measure an average blood sugar level over this period of time.

71
Q

Name three micro vascular complications of diabetes:

A

Nephropathy
Neuropathy
Retinopathy

72
Q

Why does retinopathy occur?

A

Hyperglcaemia causes damage to the retinal cells which regulate the blood flow to the retina. Damaged retinal cells cause the weakening of the capillary wall as well as increased blood flow. Increased thickening of the basement membrane and increased vascular permeability causes a narrowing of the capillary bed leading to ischaemia and vascular proliferation causing the blood vessels to haemorrhage and become perminantly damaged.

73
Q

Why does nephropathy occur?

A

Damage to the capillaries supplying the kidneys. Thickening of the glomerular basement membrane and expansion of supporting tissues as well as fibrotic changes in the renal arteries. Albumin leaks into the nephron filtrate and presents as proteinurea. Eventually causes end stage kidney failure.

74
Q

Why does neuropathy occur?

A

Hyperglycaemia causes damage to schwann cells causing them to degenerate. Ischaemic effect due tot damage to the capillaries supplying the nerve cells which impairs wound healing.

75
Q

What is polyneuropathy?

A

Numbness and tingling with impaired pain. It effects several different nerves generally located in one specific area but on both sides of the body.

76
Q

What is mononeuropathy?

A

Loss of sensation, pain and motor weakness due to damage to a few nerves located around the body.

77
Q

Name three macrovascular complications of diabetes:

A

Stroke, coronary heart disease, peripheral vascular disease

78
Q

Why do macrovascular complications occur during diabetes?

A

Persistant hyperglycaemia causes endothelium cells to take up glucose. This causes the release of a reactive oxygen species as a by product. This stimulates the inflammatory response increasing vascular permeability and the release of monocytes. LDL’s are therefore able to enter the cells more easily leading to increased risk of atherosclerosis.

PATHOPHYSIOLOGY (14 decks)

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