Diabetes Mellitus

Question 1

Name and define the types of diabetes

Answer 1

Type I – Absolute insulin deficiency, Juvenile onset
Type II – Adult onset secondary to relative deficiency
Type III – Genetic defect resulting in DM
Type IV – Gestational DM

Question 2

Define the words “Diabetes Mellitus” (hint: Greek-> English translation) What does this refer to about the patient?

Answer 2

Diabetes= to siphon/pass through
Mellitus= sweet as honey
Sweet urine- comes from gluose levels about 250, spill into urine producing sweet smelling urin

Question 3

Can the brain use fatty acids/lipids for energy if no glucose is available?

Answer 3

no, the CNS requires glucose as an energy source and therefore needs insulin to bring the gluocse within the cells

Question 4

If insulin is absent or not working properly, would extracellular or intracellular glucose levels be elevated?

Answer 4

Extracellular

Question 5

After the removal of the pancreas, what would you see evelate first, blood glucose or free fatty acids? What would the use of fatty acids by cells lead to?

Answer 5

Blood glucose would rise, bc the pancreas which produces and releases insulin to the body would be no more. The body would then breakdown lipids into fatty acids, these levels would rise. By using fatty acids for energy, acetoacetic acid would build up.

Question 6

In a type II diabetic, what would be the first type of medication they would be put on?

Answer 6

A medication to increase the potency of insulin, in order to increase the sensitivity to the receptor

Question 7

As a person continues to gain weight, what happens to the insulin and the insulin receptors?

Answer 7

it increases the demand on insulin to drive glucose into the cells, the causes an increase in size of the insulin receptors. Which leads to a decrease sensitivity to the receptors, which means you need more and more insulin to drive glucose into the cells

Question 8

What is the most common type of diabetes in today population?

Answer 8

type II 80%

Question 9

Which type of diabetic would not be able to survive without insulin?

Answer 9

Type I

Question 10

In type I diabetes, what cells are attacked?

Answer 10

The beta cells of the islets (where insulin is produced) within the pancreas, they are attacked by antigens and destroyed

Question 11

In the pre-diabetes phase, what could a person do to reverse their condition?

Answer 11

exercise

Question 12

What are the two defects in the two principal defect model that lead to type II diabetes?

Answer 12

insulin resistance and beta-cell dysfunction/failure

Question 13

Name in order the six steps in progression to type II diabetes.

Answer 13

1- prediposing factors 2- insulin resistance 3- imparied gulcose tolerance 4- increased beta cell produciton of insulin 5- beta cell exhaustion 6- inadequate insulin for the dree of insulin resistance

Question 14

What is the fasting blood glucose magic number used to diagnosis type II diabetes?

Answer 14

> 126 mg/dl

Question 15

What are some symptoms of hypoglycemia?

Answer 15

nervous, shakey, dizzy, confused, headache, hunger, cold clammy skin, fast heartbeat, irritability

Question 16

What are some symptoms of hyperglycemia?

Answer 16

weak, tired, freuent urination, increased thirst, decreased appetite, blurry vision, itchy dry skin, breath smells fruity

Question 17

What are the first signs of type II diabetes?

Answer 17

frequent urination, increased thirst

Question 18

What are the three life threatening complications of diabetes?

Answer 18

1- Diabetic ketoacidosis 2-hyperosmolar, nonketotic coma 3- hypoglycemia

Question 19

What are the four ways to treat DKA, and what is the correct order in treatment?

Answer 19

in order: 1st- give insulin, 2nd- give D5W to supplement glucose, 3rd- IV fluids to replace intravascular volume, 4th- give potassium to correct hypoK

Question 20

During DKA, what is being metabolized? what is the end product of this metabolism?

Answer 20

fatty acids; ketone bodies

Question 21

A build up of ketone bodies results in what?

Answer 21

anion gap acidosis

Question 22

What are usual signs/symptoms of DKA?

Answer 22

dyspnea, abdominal pain, nausea and vomiting, mental status changes

Question 23

What is the first and most important treatment in a hyperosmolar coma? what are the other treatments?

Answer 23

IV fluids!; give insulin, correct acidosis ( usually fixed by giving the IV fluids)

Question 24

After there is a relative insulin deficiency and illness of injury, what are the two major mechanism that happen and ultimately begin the progression to hyperosomolar nonketotic coma?

Answer 24

Liver increases glucagon production and there is a decrease intracellular glucose, both of these together lead to hyperglycemia

Question 25

In diabetic patients who take insulin, they are at risk for becoming hypoglycemic. What are the signs/symptoms of hypoglycemia?

Answer 25

diaphoresis, tachycardia, restlessness, confusion, coma, glucagon, and epinephrine

Question 26

What are the five major complications of having diabetes and therefore elvated blood glucose levels for long period of time?

Answer 26

1- HTN 2- cardiovascular disease (CAD) 3- cerebral vascular disease 4- peripheral and autonomic neurophathies 5- renal failure

Question 27

Why may it be hard to recognize a MI in a diabetic patient?

Answer 27

They may have whats called a silent MI, they wont feel the same pains and symptoms and person without diabetes would, because a diabeteic patient nerves are damage. They may just feel fatigued during an MI.

Question 28

True or false: Diabetes can cause stiff joints.

Answer 28

True.

Question 29

True or false: adrenal activity is increased in diabetic patients.

Answer 29

False. adrenal activity is decreased

Question 30

What is your goal glucose level to stay under during the perioperative period?

Answer 30

<150 mg/dl

Question 31

What can increased levels of glucose cause during the perioperative period?

Answer 31

impaired would healing, hyperosomolality, increased infections, decreased catecholamines

Question 32

True or false: diabetes can have increased sweating.

Answer 32

False- one of the autonomic neuropathies is decreased sweating