diabetes mellitus

Question 1

what is diabetes mellitus

Answer 1

systemic metabolic disorder in which there is chronic hyperglycemia

Question 2

what are the two reasons for diabetes mellitus

Answer 2

1. decrease in production/secretion of insulin (t1)

2. a decrease in the cells ability to utilize the insulin-receptor problem (t2)

Question 3

insulin deficiency results in

Answer 3

impaired use of CHO, fats and proteins

Question 4

chronic hyperglycemia causes

Answer 4

structural abnormalities in the vasculature of many organs

Question 5

in the lock and key concept, insulin is which

Answer 5

key

Question 6

where does insulin come from

Answer 6

pancreas (beta cells)

Question 7

what is glute 4

Answer 7

glucose transporter protein

Question 8

where does insulin and glucose bind on a cell?

Answer 8

to the tyrosine kinase receptors

Question 9

glute 4 allows glucose and insulin to ender cells by what

Answer 9

facilitated diffusion

Question 10

type one is also called what

Answer 10

juvenile onset

Question 11

type two is also called what

Answer 11

adult onset

Question 12

which type of DM is most common

Answer 12

type 2 (85-90%)

Question 13

what is the age of onset for type one

Answer 13

usually before 30 (abrupt)

Question 14

why does type one happen?

Answer 14

theory is that beta cells are destroyed by an inappropriate autoimmune response supported by the presence of islet cell antibities

Question 15

what is the cause of type two

Answer 15

resistance to insulin in the cell membrane receptors or a decrease in the number of receptors

Question 16

what are the risk factors for type two

Answer 16

age
obesity
heredity

Question 17

what are the manifestations of type one

Answer 17

polyuria
polydyspia (thirst)
polyphagia (hunger)
weight loss (gluconeogenisis)
weakness/fatigue

Question 18

what are the clinical manifestations of type two

Answer 18

same as type one or may be asymptomatic

Question 19

what is the management of type one

Answer 19

insulin

diet/exercise

Question 20

what is the management of type two

Answer 20

diet/exercise
oral hypoglycemic meds
insulin possibly

Question 21

which DM type is easy to control

Answer 21

type two if adhere to diet

Question 22

how do they diagnose DM

Answer 22

FBS > 126
presence of islet cell antibodies
glycosylated hemoglobin >5.5%
glucose tolerance test

Question 23

What is the criteria for good DM control

Answer 23

1. maintain optimal weight
2. glycosylated hgb <7%
3. FBS under 140
   4, Postprandial bs no higher than 180

Question 24

What is diabetic ketoacidosis (diabetic coma)

Answer 24

hyperglycemia of 300-800 with ketonuria

Question 25

what is the patho of diabetic ketoacidosis

Answer 25

marked decrease in insulin not enough insulin illness psychologic stress

Question 26

what is the patho chain for diabetic ketoacidosis

Answer 26

body senses lack of cellular fuel-> glycogenolysis and gluconeogenisis-> makes things worse because we don't need more glucose

Question 27

what happens due to the high blood sugar in DK

Answer 27

osmotic diruesis

Question 28

what does osmotic diuresis in DK

Answer 28

fluid moves toward glucose causing increase in BV | leads to dehydration as kidneys pee out extra BS

Question 29

what is increased lipolysis (breakdown of lipids) in DK

Answer 29

ketone production and accumulation of acids leads to ketonuria and acidosis when then leads to hyperkalemia via ion switch

Question 30

what is the breakdown product of lipolysis

Answer 30

ketones

Question 31

how does the body in DK get rid of ketones

Answer 31

excretion of ketone acids by lungs (hard, deep, fast)

Question 32

what kind of breathing is seen with those in DK

Answer 32

kussmaul's hard, deep, fast gets rid of excess ketone acids

Question 33

what is increased proteolysis in DK

Answer 33

increase in gluconeogenisis

Question 34

what are the clinical manifestations of DK

Answer 34

``` hyperglycemia ketonurea polyuria, polydipsia, polyphagia N/V, abdominal pain, kussmauls respirations osmotic diuresis (tachy, hypot, shock, cardiac arrhythmias) ```

Question 35

what is the management of someone in DK

Answer 35

1. shift from fat catabolism to CHO catabolism 2. Correct fluid and electrolyte imbalances 3. correct the cause

Question 36

what is hypoglycemia

Answer 36

BS level less than 60

Question 37

how does hypoglycemia happen

Answer 37

OD of insulin inadequate food intake increased amts of exercise

Question 38

what are the 2 clinical manifestations of hypoglycemia

Answer 38

1. neurogenic reaction when the hypothalamus senses decreased glucose levels 2. cellular malnutrition

Question 39

what is the neurogenic reaction when the hypothalamus sensies decreased glucose levels in hypoglycemia

Answer 39

``` increaded HR and RR diaphoresis palor tremors cool skin ```

Question 40

what happens due to cellular malnutrition in hypoglycemia

Answer 40

(mostly brain things) | HA, dizziness, irritability, confusion, fatigue, vision changes, hunger, seizures, coma

Question 41

what is the management with a hypoglycemic person

Answer 41

give glucose correct fluid and electrolyte imbalance correct cause

Question 42

What are the 4 chronic complications of DM

Answer 42

1. microvascular degenerative changes 2. microvascular disease (degenerative change) 3. neuropathy 4. Infection

Question 43

What is macrovascular degenerative change

Answer 43

In the major vessels | Lipolysis-> hyperlipidmia->atherosclerosis-> CAD/DVD/CVA

Question 44

what is microvascular disease

Answer 44

Affects the Capillary | thickening of the basement membrane leading to vascular cell proliferation of cap wall

Question 45

what two things cause microvascular disease

Answer 45

1. glycoslation of protein/collagen (glucose binds with no enzyme) forms/deposits advanced glycosylation end product in vessel walls 2. Protein kinase c (enzyme) is inappropriately activated by high BS

Question 46

what is the patho chain of microvascular disease

Answer 46

vascular cell prolif-> thickens basement membrane of caps-> decreased perfusion-> hypoxia/ischemia

Question 47

what does microvascular disease mainly affect

Answer 47

retina (diabetic retinopathy) kidney (nephropathy, renal failure) also affects extremities

Question 48

what is neuropathy related to

Answer 48

microvascular disease

Question 49

what causes neuropathy in DM

Answer 49

vascular ischemia-> nerve endings are destroyed in the ischemic areas

Question 50

what is peripheral neuropathy mani in DM

Answer 50

pain and tingling in extremities | decreased sensation

Question 51

what is autonomic nervous system mani of nuropathy in DM

Answer 51

``` gastropanesis (delayed emptying of GI) neurogenic bladder (decreased bladder emptying) sexual dysfunction CV- no HR variability ```

Question 52

why does infection occur with DM

Answer 52

glucose is a good media for growth decreased sensation/decreased possible prevention hypoxia/ischemia causes poor wound healing