Diabetes Mellitus Flashcards
Exocrine function
secretes through ducts
- secretes enzymes that catabolize digestion
- Protein (trypsin)
- Carbohydrates (amylase)
- Fats (lipase)
- secretin
Secretin
a hormone secreted by the duodenal mucosa that stimulates sodium bicarbonate secretion by the pancreas & bile secretion by the liver
Endocrine function
secrete directly into bloodstream; islets of Langerhans
-Insulin
Insulin
produced by beta cells
- hypoglycemic agent
- lowers blood sugar by promoting movement of glucose into muscle & fat cells
Amylin
- also secreted by the beta cells
- Co-secreted with insulin (100:1)
- Slows liver’s glucose production to decrease post meal glucose spikes
- Acts a satiety agent
Glucagon
- hormone that stimulates the release of glycogen
- hyperglycemic agent
- produced by alpha cells
- Glycogen is the form in which glucose is stored in the liver & muscle cells for future conversion into sugar in the bloodstream
Somatostatin
-released by the delta cells
Hypoglycemic effect
- interferes with release of growth hormone from the pituitary gland & interferes with glucagon release from the pancreas
- also somatostatin is secreted by the hypothalamus & gastric glands of the stomach
DM
characterized by chronic hyperglycemia, degenerative vascular changes & neuropathy
- inadequate insulin secretion from the pancreas or
- Insulin required to metabolize carbohydrate, protein and fat
Function of insulin
- transports & metabolize glucose for energy
- stimulates storage of glucose as glycogen in the liver & muscle cell
- signals liver cells to stop the release of glucose
- enhances storage of dietary fat in adipose tissue
- accelerates transport of amino acids (dietary protein) into cell
- facilitates the transport of potassium into the cells
- inhibits the breakdown of stored glucose, protein & fat
Insulin deficiency
- decreased glucose uptake by the cells
- decreased storage of glycogen & fat
- Glycogenolysis
- Liver initiates the production of glucose from amino acids, lactate and glycerol called gluconeogensis
- lipolysis
- defective protein uptake by the cell
- insulin deficiency results intracellular starvation: POLYPHAGIA
- accumulation of glucose and fat products in the blood are not going into the cells
Glycogenolysis
occurs when body needs energy & glycogen stores are depleted
Lipolysis
fat breakdown for energy
Why might increased urination occur?
- decreased intracellular potassium
- increased extracellular potassium
- low bicarbonate
- pH of the body decreases (acidosis)
- DKA
Kussmaul respirations
occurs to decrease acid load by blowing off CO2
Dehydration
occurs as kidneys try to remove excess glucose & acetone with large urine output
Does the brain need glucose?
yes
Type 1 Diabetes
- an autoimmune disease
- onset any age, but usually <30
- thin & malnourished at diagnosis
- genetic, immunologic, or environmental
- little or no endogenous insulin
- ketosis prone
- must have exogenous insulin to survive
Type 2 diabetes
- onset at any age, but usually >30
- usually obese
- causes: obesity, heredity & environmental
- impaired insulin secretion or insulin resistance
- may control with weight loss, exercise, oral antidiabetic drugs
- at some time will need insulin
- ketosis uncommon except with an infection or stress
Pre-diabetes
-precursor to diabetes
metabolic syndrome (syndrome x)
- central obesity
- High blood pressure
- high triglycerides
- low HDL-cholesterol
- Insulin resistance
Criteria for T1 or T2 DM
- symptoms of polyuria, polydipsia, & polyphagia plus a casual plasma glucose of greater than 200 mg/dL without regard to time of last meal
- FBG >126 mg/dL
- Two hour glucose > 200 mg/dL during an oral glucose tolerance test
- confirm results by repeat testing on a different day
- HbA1c > 6.5%
- C-peptide-shows how much insulin pancreas is making
Normal blood glucose
FBG <100
2 hr PC <140
Prediabetes
FBG 100-125
2 hr PC >140
Full DM
FBG >126
2 hr PC>200
Nutritional guidelines
insulin to carb ratio: 1 unit insulin for every 12-15 grams of carbs
What are the side effects to artificial sweeteners?
-can change gut bacteria composition
-leads to cravings, overeating, and weight gain
-gas, bloating, diarrhea
-headache/migraines, mood changes
worsen IBS, gut inflammation
Benefit to exercise
- lowers BG by increasing the uptake of glucose by body muscle
- improves insulin utilization
- decreases CV risk factor
Exercise precautions
- avoid exercise if BG > 250 mg/dl & if spilling ketones
- patients on exogenous insulin should eat 15 g of carbs before moderate exercise to prevent hypoglycemia
- if exercising to lose weight or to control, insulin may need to be decreased
Inhaled Insulin
Afrezza
- inhalation powder, approved 2014
- a rapid acting inhaled insulin indicated to improve glycemic control in adult patients with DM
lipoatrophy
dimpling or pitting
lipohypertrophy
raised hard tissue mass, thick
TREMORS
T-tachycardia R-iRRitable E-Extreme hunger M-iMpaired vision O-Out of sorts R-lethaRgic S-Sweating
Rule of 15
Give 15 g fast acting carbs (juice, soda, candies), recheck BG in 15 minutes, If still low give 15 g more of carbs, recheck BG in 15 min, If BG WNL & symptoms resolve, give protein snack & 15 grams of carbs if next meal is >1 hr away
DKA
caused by an absence of or inadequate amount of insulin resulting in abnormal metabolism of carbs, protein, & fat
- BG> 250 mg/dL
- low pH
- low bicarb
- glucose in urine
Hyperglycemia (THIRST)
T-thirst H-Hunger I-itchy/dry skin R-really need to urinate S-Sleepiness T-Throwing up
Dawn Phenomenon
normal blood glucose until starts to rise around 04-08; cortisol, glucagon, & epinephrine are highest in early morning -> causing liver to produce glucose
Insulin Waning
progressive BG increase overnight; may need to change dinner/bedtime insulin
Somogyi effect
night hypoglycemia followed by rebound hyperglycemia
