Diabetes Mellitus Flashcards
what is diabetes mellitus?
multisystem disease related to:
1) abnormal insulin production
2) impaired insulin utilization
3) both
what is insulin
hormone produced by the beta cells in the islets of langerhans of the pancreas
what is the normal range for insulin?
4-6 mmol/L
what hormones counteracts insulin?
1) glucagon
2) epinephrine
3) growth hormone
4) cortisol
how do they work? by increasing blood glucose levels by stimulating glucose production and output by the liver and decreasing the movement of glucose into the cells
what does insulin do after meals?
it increases and stimulates storage of glucose as glycogen in liver and muscle
- it also inhibits glycogenesis
- enhances fat deposition
- increases protein synthesis
what tissues are insulin-dependent
skeletal muscle and adipose tissue
which tissues aren’t insulin dependent?
brain, liver, blood cells
who does type 1 diabetes mellitus usually affect?
usually occurs in younger people < 30yrs
what type of body is it usually seen in type 1 DM?
lean bodies
What happens in type 1 DM?
progressive destruction of pancreatic beta cells due to an autoimmune process. pt will require exogenous insulin (outside source so basically human engineered insulin) to sustain life if not DKA
What is the onset for type 1 DM?
autoantibodies to islet cells cause a reduction of 80-90% of normal beta-cell functioning before hyperglycemia and other manifestations occur.
these manifestations occur when pancreas can no longer produce insulin
what are these manifestations from onset of type 1 DM?
1) They are RAPID
2) pt presents with emergency ketoacidosis
3) classic symptoms; polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger)
how is pre diabetes testing done? including the ranges
basically you have to fast OR have a 2 hour plasma glucose lever higher than normal.
PRE-DIABETIC range for impaired FASTING glucose = 7.1- 7.11 mmol/L
PRE-DIABETIC range for impaired GLUCOSE tolerance = 6.1- 6.7 mmol/L
note: they also test hemoglobin A1C and regular blood glucose
discuss type 2 DM aka what?
- MOST prevalent
- people> 35yrs old
- most POWERFUL risk is OBESITY aka lose weight if you big
what is another additional factor thats important to remember about type 2 DM?
Metabolic syndrome: abdominal obesity, hypertension, dyslipidemia, insulin resistance, dysglycemia
what happens in type 2 DM?
Pancreas continues to produce some insulin but it is either insufficient or poorly utilized or both.
what are 4 major metabolic abnormalities in type 2 DM?
1) insulin resistance
2) decreased ability of the pancreas to produce insulin as beta cells become fatigued from compensatory overproduction of insulin or when beta-cell mass is lost
3) inappropriate glucose production by the liver
4) alteration in the production of hormones and cytokines by adipose tissue
what is the onset for type 2 DM?
gradual onset. may go many years with undetected hyperglycemia (asymptomatic)
usually caught doing routine lab
discuss gestational diabetes
- develops during pregnancy
- detected at 24-28 weeks of gestation usually via glucose tolerance test
- glucose levels usually regulate themselves at 6 weeks post party
THERAPY: FIRST-nutrition, SECOND- insulin therapy
discuss secondary diabetes
treatment of a medical condition that causes abnormal blood glucose level and usually resolves once the medical condition is fixed
- some conditions using can be schizophrenia, hyperthyroidism or some medications
does type 2 DM have islet cell abnormalities?
no
what are the 4 methods to diagnostic studies?
1) glycated hemoglobin (A1C) >= 6.5%
2) fasting blood glucose >= 7mmol/L (no caloric intake for 8 hours)
3) random plasma glucose measurements >= 11.1 mmol/L (anytime of the day without regard to the interval since the last meal)
4) 2 hour plasma glucose level in a 75g OGTT >= 11.1mmol/L
repeated twice on a different day without hypoglycemia. if symptoms of hyperglycemia present = confirmatory test no required before treatment initiated
discuss glycated hemoglobin as diagnostic studies
determines glycemic control over time
- it shows the amount of glucose that has been attached to hemoglobin molecules, which are attached to the RNC for the life of the cell
- indicates overall glucose control for the previous 90-120 days
discuss medication therapy for insulin in terms of DM
type 1:
- always needs insulin and dose depends on the individual stress or illness
type 2: depends
what are the 2 types of insulin
1) mealtime insulin (bolus)
2) long or intermediate-acting (basal) background insulin
discuss mealtime insulin (bolus)
theres 2 types:
1) rapid acting
- Onset 10-15min
- Best mimics natural insulin secretion in response to a meal
- give 10-15 min before a meal and up to 15 min after a meal
2) regular
- give 30-45 min before a meal
- onset 30 - 60min
what are some examples of rapid and regular insulin
1) rapid acting = humalog
2) regular = humulin R
what are the 2 types of long and intermediate-acting (basal) background insulin?
1) Long-acting
- released steadily and continuously over 24-42 hours
- Does NOT have a peak of action
2) Intermediate-acting
- duration 10-16 hrs
- peak 4-10 hrs
- LESS risk for hypo-glycemia
what are some examples of long and intermediate insulin
1) Long-acting = NPH
2) Intermediate = Lantus
which route is insulin given? and why?
subcutaneously.
it is inactivated by gastric juices if taken orally
which sites of injection have higher absorption from high to low?
1) abdomen
2) arm (back)
3) thigh and butt
what are some cautions after administrating insulin?
1) do not exercise the area used for injection. this increases body heat and can increase rate or absorption and speed up insulin onset action
2) rotate sites to prevent lipodystrophy which is lumps and dents in the skin due to repeated injection in the same spot
what are some forms of insulin administration tools?
1) insulin pen
2) insulin pump (the one on TikTok)
- subcutaneous insulin infusion
- the catheter in it delivers insulin 24 hours a day
- meal times require bolus insulin
what are some complications with insulin therapy?
1) Somogyi effet
- insulin overdose cause hypoglycemia and usually during hours of sleep
-counter-regulatory hormones released
- rebound hyperglycemia and ketosis may occur
2) Dawn phenomenon
- hyperglycemia present on awakening in the morning usually bc of release of counter-regulatory hormones in predawn hours
- GH and cortisol possible factors
discuss antihyperglycemic agents in terms of medication therapy
improves the mechanisms by which insulin and glucose are produced and used by the body
works on 3 defects of DM type 2:
1) insulin resistance
2) decreased insulin production
3) increased hepatic glucose production
what is the nutritional therapy for type 1 DM
- meal plan is based on individual usual food intake w/balance of insulin and exercise
- may require increase caloric intake o achieve desired body weight and restore body tissue
- equal distribution of carbs throughout meals or insulin activities
what is the nutritional therapy for type 2 DM
- emphasis on achieving glucose, lipid and blood pressure goals
- reduction in caloric intake desirable for overweight or obese ppl
- diet alone may be sufficient for glucose control
- equal distribution of calories and LOW FAT diet
what micronutrients give us more energy
carbs
fat
protein
what does exercise of for diabetes management?
increase insulin receptor sites
lowers blood glucose
small carb snacks can be taken every 30 minute during exercise to prevent hypoglycemia
what can fat ppl do for diabetes?
bariatric surgery
