Diabetes-Exam 2 Flashcards by Megan Zurek

DM definition

group of metabolic diseases characterized by hyperglycemia from insulin secretion/action or both

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Type 1 diabetes

hyperglycemia as a result of beta-cell destruction and no insulin production

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Type 2 diabetes

hyperglycemia as a result of insufficient insulin production or an indulin resistance

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Macrosomia

term used to describe babies that their mothers were diagnose with gestational diabetes; higer risk for diabetes in the future

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Type 1 DM cause

autoimmune disease of the destruction of beta-cells of the pancreas; why this happens in unknown; may be viral and genetic

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Type 2 DM cause

Genetic predisposition; no real cause; risk factors incluse older age, obesity, and physical inactivity

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Insulin

hormose secreted by the b-cells of the islet of langerhaans of the pancreas

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Insulin-anabolic or catabolic?

anabolic

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Insulins job as an anabolic hormone

Decrase BG, BFA, BAA, and increase muscle protein

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What hormone opposes insulin

glucagon

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Is glucagon catabolic or anabolic?

catabolic

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Glucagons key metabolic function

lipolysis
glycogenolysis
gluconeogenesis

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Pro-insulin

Precursor to insulin-A,B,C peptides

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Insulin

Made from pro-insulin- A and B peptides (C is cleaved)

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Will DM1 have high or low c-peptide

Low

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Glucose intake by insulin cascase

insulin binds–>translocation of GLUT–>influx of glucose–>glycogen synthesis–>glycolysis–>fatty acid synthesis

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How many different GLUT proteins are there

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Cellular insulin effects

Increase glycogen synthesis
Increase FA synthesis
Increase esterficiation of FA
Increased AA uptake
Increase K uptake
Ineease HCl secretion for digestion

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Anti-catabolic roles of insulin

Inhibit proteolysis, lipolysis, gluconeogensis, glycogenolysis

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Normal blood glucose

<100mg/dL

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Glucose conversion

0.0555*mg/dL=mmol/L

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Diagnostic criteria for DM

FBG>126mg/dL
2-h PG during OGTT >200mg/dL
A1C>6.5%
Random plasma glc >200md/dL

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Stage 1 DM stage

autoimmunity
normoglycemia
presymptomatic

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Stage 1 DM diagnostic criteria

Autoantibodies

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Stage 2 DM stage

autoimmunity dysglycemia presymptomatic

STage 2 DM diagnostic criteria

autoantibodies FBG 100-125mg/dL 2hPG during OGTT 140-199mg/dL A1C 5.7-6.4%

Stage 3 DM stage

hyperglycemia | symptomatic

Stage 3 DM diagnostic criteria

clinical symptoms | diabetes by standard criteria

Pre-DM criteria

FBG 100-125mg/dL 2hPG during OGTT 140-199mg/dL A1C 5.7-6.4%

non-insulin dependent tissues

kidneys, eyes, nerves, RBC

Renal threshold

250 mg/dL

Urine ketones in DM1, DM2 or both?

DM1 only

When are urine ketones present?

when BG consistenty >300 mg/dL

What happens to Na+ with high glucose?

Decrease 1.6mEq/L for each 100mg/dL above normal

Diabetic ketoacidosis DM1, DM2 or both

DM1 only

What is diabetic ketoacidosis?

fat is converted to ketones for energy and when in large numbers can be life thretening

Symptoms of diabetic ketoacidosis

polyuria, polydipsia, hyperventilation, dehydration, fruity breath

Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) DM1, DM2 or both?

DM2 only

What is HHNS?

super high blood glucose leading to dehydration

HHNS symptoms

loss of conciousness or mental state

Hypoglycemia DM1, DM2 or both

both

What causes hypoglycemia

mismatched insulin and carbs | inconsistent meal patterns

Hypoglycemia treatment plan

15/15-15gCHO and recheck in 15mins

Are chronic complicatins the same for DM1 and DM2?

yes

Macrovascular complications

cardiovascular-low LDL and high TG Stroke HTN

Nephropathy affects what tissue

Kidney

Nephropathy problems

Damage to glomerulus of kidney--> leads to chronic kidney failure

Retinopathy affects what tissue

eye

Retinopathy problems

blindness

Neuropathy affects what tissue

nervous system

Neuropathy problems

autonomic and cardiac nervous system problems | leads to many amputations

Diabetes control and complications trial results

more intensive therapy and lifestyle changes led to better management of diabetes

Diabetes prevention program results

lifestyle is most effective in managing diabates

Glucotrack

earlobe monitor instead of pricking finger for insulin

Basal insulin

insulin that works the and background and provides the needs for the day

Bolus insulin

the insulin needed for each meal

ADA reccomendations fo A1C

<7%

How do you reccomend an A1C goal for a patient

needs to be personal depending on their needs

Old insulin protocol

NPH and Regulat (70/30)

New gold standard of insulin

Lantus and Humalog

Insulin needs for t1DM

0.5-1 unit/kg (50% basal 50% bolus)

Somogyi effect cause

patient was hypoglycemic and liver made glucose--> no insulin to cover glucose overnight-->hyperlycemia

Somogyi effect cure

decrease insulin | have bedtime snack

Dawn phenomenon cause

hormones cause a glucose increase in the am

Dawn phenomenon cure

limit CHO at bedtime | increase insulin or use one that peaks later

what should you do before changing insulin amounts

check many times in the middle of the night

MNT goals BG

BG in closest to normal range as safely as possible (<100mg/dL) A1C <7%

MNT goals lipids

profile that reduces macrovascular complications (normal blood lipids)

MNT goals BP

in normal range as safely as possible <140/90

Protein MNT

15-20% or 1-1.5g/kg | protein rich carbs cannot be used to treat hypoglycemia

Fat MNT

20-35% and general population reccomendations

Alcohol MNT

limit as much as possible

Sodium MNT

<1500mg is reccomended

Micronutrient MNT

check b12 in metformin users

diabulemia

not providing enough insulin to cover the carbohydrates resulting in weight loss from mobilized fat stores