Diabetes Mellitus Flashcards
What is the difference between type I and type II
diabetes?
Type I diabetes is caused by an immune-related destruction of
beta cells in the pancreas. Type II diabetes is not immunerelated
and results from a deficiency of insulin and/or a defect in
insulin receptors.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 376-377.
What percent of patients with diabetes mellitus are
type I?
5-10%
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 376.
What are the acute complications that occur due to
diabetes mellitus?
Hypoglycemia, diabetic ketoacidosis, and hyperglycemic
nonketotic coma.
Fleisher LA. Anesthesia and Uncommon Diseases. 6th ed.
Philadelphia, PA: Elsevier Saunders; 2012: 428-429.
What immune cell is implicated in the autoimmune
destruction of beta cells in type I diabetes?
The destruction of beta cells is mediated by T cells although the
exact mechanism that triggers the destruction is unknown.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 376-377.
What lab values are diagnostic of type I diabetes?
A random blood glucose greater than 200 mg/dL and a
hemoglobin A1C greater than 7.0%
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 377.
How long after the onset of type I diabetes does it
take before the onset of symptoms?
Clinical symptoms of diabetes may not present for as long as 10
years. About 80-90% of beta cells must be destroyed before
hyperglycemia will appear.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 377.
What is the function of insulin?
Insulin facilitates the transport of glucose and potassium into
the cell, and is important for the cellular uptake of glucose with
the exception of the brain and liver where it does not affect
glucose transport.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1343.
How is insulin metabolized?
Insulin is metabolized by both the liver and kidneys
Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia. 5th
ed. Philadelphia, PA: Lippincott Williams and Wilkins: 2006:
1145.
What is the normal insulin prodution in a day?
Normal insulin production in the adult is about 40 to 50 units per
day
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1343.
What forms of insulin are considered short-acting?
Human regular, Lispro (Humalog), and Aspart (Novolog).
Human regular insulin lasts about 5-8 hours and Humalog, and
Novalog both last about 3-6 hours.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 380.
What forms of insulin are considered intermediateacting?
Human NPH and Lente which both last about 10-20 hours
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 380.
What forms of insulin are considered long-acting?
Ultralente which lasts 24-48 hours and glargine (Lantus) which
lasts about 24 hours.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 380.
How do alpha-glucosidase inhibitors help control
blood glucose levels?
Alpha-glucosidase inhibitors decrease postprandial glucose
absorption.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1344.
How do sulfonylureas help control glucose?
Sulfonylureas increase insulin secretion by beta cells.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 857.
How do thiazolinediones and metformin help control
blood glucose levels?
Thiazolinediones and metformin (a biguanide) enhance tissue
sensitivity to insulin
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1344.
What are the symptoms of hypoglycemia?
Hypoglycemia is associated with a sympathetic response and
symptoms such as hypertension, tachycardia, diaphoresis, and
lacrimation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 860.
How do elevated glucose levels cause end-organ
damage?
Vasodilation caused by hyperglycemia prevents the organs
from protecting themselves from hypertension by increasing
systemic vascular resistance in organ vasculature.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 856.
What percent of type I and type II diabetics develop
end-stage renal disease?
40% of type I diabetics and about 5% of type II diabetics
develop end-stage renal disease.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 383.
What is the progression of symptoms as renal
disease associated with diabetes develops?
The symptoms begin with hypertension, albuminuria, and
peripheral edema, and progress to a decrease in glomerular
filtration rate due to glomerulosclerosis and tubulointerstitial
disease.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 383.
What is the chief indicator that diabetes associated
renal impairment has progressed to advanced
glomerulonephritis?
atients can be asymptomatic for as long as 15 years, but the
appearance of proteinuria is the hallmark sign the
glomerulosclerosis is severe.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 383.
What percentage of diabetics will develop peripheral
neuropathy?
About 50% of patients with diabetes over 25 years will develop
peripheral neuropathy.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 383.
How does diabetic retinopathy occur and how can it
be prevented?
Diabetic retinopathy occurs as a result of occlusion and dilation
of retinal arterioles, microvascular aneurysms, hemorrhages,
and fibrotic changes. Strict maintainance of glucose within
normal ranges helps prevent these alterations.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 383.
How does hyperglycemia affect connective tissue?
Elevated glucose levels promote glycosylation reactions that
decrease elasticity in connective tissue resulting in stiff-joint
syndrome and atlanto-axial stiffness. This can also lead to
impaired wound healing.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 856.
How does blood glucose affect global ischemia?
Studies have correlated elevated glucose levels with poor shortterm
and long-term outcomes in patients with brain damage
from global ischemia.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 710.
