Diabetes Mellitus Flashcards

Question

A1C levels and glucose level

Answer 1

6% = 126 mg/dL 7% = 154 mg/dL 8% = 183 mg/dL 9% = 212 mg/dL 10% = 240 mg/dL 11% = 269 mg/dL 12% = 298 mg/dL

Answer 2

abnormal thirst and dry mouth frequent urination lack of energy, fatigue blurred vision constant hunger sudden weight lost bed-wetting

Answer 3

excessive thirst and dry mouth frequent and abundant urination lack of energy, extreme tiredness blurred vision recurrent fungal infections of the skin slow healing wounds tingling or numbness in hands and feet

Answer 4

Worldwide prevalence of type 1 DM and type 2 DM has been increasing over the past three decades = 9.3% in 2019 in adults 20 years or older United States = 13% adults 18 and older

Answer 5

Hyperglycemia in all cases is due to a functional deficiency of insulin action Type 1= decrease in insulin secretion by the β cells of the pancreas Type 2 = decreased response to insulin by target tissues insulin resistance Increase in the counter-regulatory hormones = glucagon = oppose the effects of insulin

Answer 6

excretion of glucose in the urine renal threshold for glucose reabsorption (approximately 200 mg/dL) norm = no glucose in urine This causes an osmotic diuresis manifested clinically by polyuria and nocturia = Dehydration results

Answer 7

Glucosuria, Polydipsia, Polyuria, Polyphagia Stimulating thirst that results in polydipsia A significant loss of calories can result from glucosuria: urinary glucose losses can exceed 75 g/d (75 g × 4 kcal/g = 300 kcal/d)

Answer 8

excessive hunger high glucose levels lead to increased hunger, increased hunger & eating leads to increased glucose levels cravings are strongest for sugary food

Answer 9

excessive thirst excess glucose excreted in urine, fluids depleted with elimination of glucosuria, endocrine system signals thirst

Answer 10

both type 1 and symptomatic type 2 patients

Answer 11

Weight loss can also occur as a result of both dehydration, loss of calories in the urine, and breakdown of fats and protein

Answer 12

B-cell destruction, usually leading to absolute insulin deficiency autoimmune idopathic

Answer 13

ranges from predominantly insulin resistant with relative insulin deficiency to a predominant secretory defect with insulin resistance

Answer 14

any degree of glucose intolerance occurring or first being recognized during pregnancy, a time when insulin resistance and B-cell hyperplasia occur normally women diagnoses with gestational DM have a high risk for later developing type 2 DM

Answer 15

Approximately 10% of all DM cases usually occurs in younger patients but can occur at any age

Answer 16

Insulin producing pancreatic β-cell destruction may be caused by genetic susceptibility, autoimmune process or viral infection resulting in insulin deficiency Genetic susceptibility in combination with environmental factors is thought to play a critical role in development of type 1 DM

Answer 17

are thought to be released from beta cells by cellular turnover or damage and are processed and presented to T helper cells by antigen-presenting cells Resulting in Beta cell destruction

Answer 18

monosaccharides to glycogen for storage in muscle & liver = excess glucose stored for use later

Answer 19

fatty acid + glycerol = fat excess carbohydrates consumed results in fat storage

Answer 20

formation of glucose in the liver from non-carbohydrate sources

Answer 21

insulin secretion & glucagon inhibition

Answer 22

glucagon secretion & insulin inhibition

Answer 23

potentially life-threatening, not enough insulin to allow glucose into cells; liver breaks down fat for fuel = ketone byproduct

Answer 24

serious state occurs with hyperglycemic state; glucose passes into urine pulling excess fluid out of the body; severe dehydration

Answer 25

Life-threatening problem that affects people with diabetes: Type 1>>>>Type2 Increased serum glucose levels stimulates the body to break down fat at a rate that is much too fast. The liver processes the fat into an energy source = byproduct is ketones = causes the blood to become acidic

Answer 26

Normal blood pH is tightly regulated between 7.35 and 7.45 Lower the pH = acidosis Higher pH = alkalosis

Answer 27

Hyperglycemia: > 250 mg/dL Ketosis Characterized by a combination of insulin deficiency and glucagon excess Decreased peripheral glucose uptake secondary to insulin deficiency coupled with excess glucagon = hyperglycemia Type 1>>>Type 2 Diabetic ketoacidosis = medical emergency resulting from ketosis and emergent low pH blood level Precipitating factors: Infection, new-onset diabetes mellitus, stress, and insulin deficiency or non-compliance

Answer 28

normal metabolic process - When the body does not have enough glucose for energy, it burns stored fats instead results in a build-up of acids called ketones within the body Some people encourage ketosis by following a diet called the ketogenic or low-carb diet Ketosis leads to diabetic ketoacidosis = build up of ketone bodies

Answer 29

Symptoms: Nausea, vomiting, thirst, abdominal pain, weakness, and fatigue, dehydration Signs: Tachycardia; poor skin turgor and warm and dry skin = Patients also have ketones on breath and altered mental status Laboratory findings: > Hyperglycemia > Metabolic acidosis: pH <7.35 & low HCO3 > Serum ketones: blood & urine

Answer 30

90-95% of cases of diabetes mellitus = usually occurs in older patients (> 40 years) and obese individuals can occur in children as young as 6 years of age clinical presentation: Weakness, weight loss, and susceptibility to infections

Answer 31

Risk factors: sedentary lifestyle, poor nutrition,overweight and obesity Pathogenesis of type 2 diabetes mellitus: Genetic factors play a more important role in type 2 diabetes mellitus than in type 1 diabetes mellitus = Type 2 diabetes mellitus is due to peripheral resistance to insulin and often times inadequate secretion of insulin

Answer 32

Primary: Target tissue resistance to the effects of insulin = hallmark Secondary: Inadequate pancreatic Beta-cell insulin secretion

Answer 33

Major driver of the worldwide increase in diabetes prevalence 85% of patients with type 2 DM are obese A 5–10% weight loss in obese individuals with type 2 DM can minimize the disorder Insulin resistance ~ obesity = type 2 DM

Answer 34

Insulin sensitivity decreases = insulin-mediated glucose breakdown after a meal is impaired despite increased pancreatic insulin secretion With continued insulin resistance = pancreatic insulin secretion begins to fail = insufficient insulin production Type II DM can become Type II & Type I

Answer 35

Life-threatening = caused by extremely high blood sugar levels Most commonly occurs in people with type 2 diabetes Often triggered by illness or infection Body tries to rid itself of the excess blood sugar by passing it into your urine Untreated = can lead to life-threatening dehydration Urgent medical care Marked hyperglycemia = no metabolic acidosis or ketoacidosis

Answer 36

A complication of insulin treatment in both type 1 DM and type 2 DM Cause: oral hypoglycemic drugs that stimulate insulin secretion, exercise or fasting

Answer 37

low insulin levels with exercise or fasting allow the counter-regulatory hormone-mediated gluconeogenesis, increased hepatic glucose output, and stimulus for increased glucagon secretion = to restore blood glucose levels

Answer 38

exogenous insulin dosing & limited glucagon counter-regulation

Answer 39

Rapid oral administration of glucose at the onset of warning symptoms or the intramuscular administration of exogenous glucagon Rebound hyperglycemia can occur after hypoglycemia due to rapid intake of oral glucose and/or actions of counter-regulatory hormones

Answer 40

Not completely understood = diabetes influences atherosclerosis & CVD High blood glucose & High blood pressure = increased risk of endothelial cell damage of blood vessels Decreases HDLs & Increases LDLs Greatest risk Associated with Diabetes: Nephropathy, Retinopathy, Neuropathy, CVD, Skin 65%+ of individuals with uncontrolled diabetes die from heart disease or stroke

Answer 41

Pancreas: Reduction in number and size of islets Vessels: contributor to atherosclerosis in large & small blood resulting in hypertension Kidney: Microalbuminuria = associated with 10 to 20 x increased risk of progression to diabetic nephropathy = number one cause of ESRD Eye: Retinopathy or retinal vascular disease

Answer 42

Peripheral nervous system: Peripheral neuropathies (sensory loss >> motor loss); decreased sensation causes diabetics to be more prone to injury, falls & non-traumatic amputations Skin and soft tissue of extremities: Diabetics often develop ulcers and gangrene of the legs, requiring amputation. Decreased sensation causes diabetics to be prone to injury. These patients are unable to feel the damage occurring, and associated damage to vessels leads to poor perfusion that impairs healing Pregnancy: Large-for-gestational age infants are often born to diabetic mothers

Answer 43

Atherosclerotic macrovascular disease occurs with increased frequency in diabetes = increased incidence of myocardial infarction, stroke, claudication and gangrene of the lower extremities Accounts for significant morbidity and mortality in both types of diabetes Type 2 DM = responsible for approximately 75% of deaths Protective effect of gender is lost in women with diabetes = risk of atherosclerosis is equal to that of men

Answer 44

Increased risk of atherosclerosis in diabetes = independent risk factor Incidence of hypertension and hyperlipidemia increases 50% and 30% respectively vs age and gender matched norms Diabetes is synergistic with multiple known risk factors to increase atherosclerosis > Smoking > Physical Inactivity > HTN > Hyperlipidemia > Overweight or Obese

Answer 45

Leading cause of blindness in developed countries Diabetic retinopathy is present in one-third of all diabetics Increasing in frequency with disease duration = lifetime risk of 90% for type 1 diabetics vs. 60% for type 2 diabetics

Answer 46

Most common cause of end-stage renal disease (ESRD) worldwide ESRD occurs more frequently in Type 1>>>Type 2 type 2 DM accounts for more than half of the diabetic population with ESRD because of its greater prevalence Occurs in about 60% of both type 1 and type 2 DM patients Major cause of morbidity

Answer 47

distal, primarily sensory, symmetric polyneuropathy = most common (50% incidence) autonomic neuropathy, occurring frequently in individuals with distal polyneuropathy (>20% incidence) much less common, transient asymmetric neuropathies involving specific nerves, nerve roots, or plexuses

Answer 48

Occur in 10% of diabetics = can be complicated by osteomyelitis Amputation associated with high mortality = 50% by 3 years post-amputation Diabetic foot ulcers account for over 60% of nontraumatic amputations in the United States

Answer 49

increased injuries in insensate feet owing to symmetric polyneuropathy present in 75–90% of diabetics with foot ulcers can be detected clinically by decreased vibratory and cutaneous pressure sensation and the absence of ankle reflexes macrovascular and microvascular disease present in 30–40% of those with foot ulcers infections caused by alterations in neutrophil function and vascular insufficiency faulty wound healing caused by unknown factors

Answer 50

Demyelination of peripheral nerves = hallmark of diabetic polyneuropathy, affects distal nerves preferentially Usually manifested clinically by a symmetric sensory loss in the distal lower extremities = stocking distribution > Numbness & tingling = paresthesias > Sx begin distally and move proximally > In the hands = Glove Distribution

Answer 51

demyelination and loss of nerve fibers, accompanied by microvascular lesions, microvascular disease presence of antibodies to autoantigens in patients with neuropathy also suggests a possible immune component to this disorder

Answer 52

often accompanies symmetric peripheral neuropathy Occurs more frequently in type 1 DM Can affect all aspects of autonomic functioning = most notably cardiovascular, genitourinary, and GI systems Cardiovascular: Fixed, resting tachycardia and orthostatic hypotension Erectile dysfunction occurs in more than 50% of diabetic men Overflow IncontinenceL Neurogenic Bladder = Loss of bladder sensation and difficulty emptying the bladder Gastroparesis: Motor disturbances can occur throughout the GI tract, resulting in delayed gastric emptying, constipation, or diarrhea Anhidrosis: in the lower extremities can lead to excessive sweating in the upper body as a means of dissipating heat, including increased sweating in response to eating