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Clin Med-Endocrine > Diabetes Mellitus Type 1 > Flashcards

Diabetes Mellitus Type 1 Flashcards

1
Q

What are the four main types of hormones that the pancreas produces

A

Pancreatic Polypeptide
Insulin
Glucagon
Somatostatin

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2
Q

How does the pancreas function as an exocirne gland?

A

contains digestive enzymes that assist in digestion and absorption of nutrients in the small intestine
Also helps to break down carbs, proteins, lipids into chyme

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3
Q 
What do the following cells secrete?
Alpha
Beta
Delta
Gamma
A

glucagon
insulin
somatostatin
pancreatic polypeptide

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4
Q

How does insulin work when glucose levels are high?

A

works by driving glucose into cells and inhibiting the secretion of glucagon

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5
Q

how does glucagon work when glucose levels are low

A

causes the liver to convert glycogen into glucose

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6
Q

How does insulin work to get glucose into the cell

A

insulin binds to cell membrane receptor which causes activation of GLUT4 a glucose transporter and allows glucose into the cell

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7
Q

What cells does glucose get transported into

A

Liver
Adipose tissue
Muscle

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8
Q

What happens to a patient who has DM?

A

Increase in Blood glucose levels
lack of insulin
Fat,Muscles,Live can not utilize blood glucose for energy
alternate energy sources are broken down for fuel

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9
Q

What are counterregulatory hormones

A

they undo insulins job

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10
Q

what are some counterregulatory hormones

A 
Glucagon
Epinephrine
Norepinephrine
cortisol
Growth hormone
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11
Q

What inhibits the secretion of glucagon

A

high glucose levels and insulin

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12
Q

What stimulates glucagon

A

low glucose

strenuous exercise

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13
Q

What happens in the liver when glucagon is stimulated

A

stimulates glycogenolysis
breakdown of glycogen to glucose
Stimulates glycolysis and lipolysis- break down of lipids/triglycerides stored in fat tissues metabolized into free fatty acids which leads to ketogenic effect that decreases blood pH

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14
Q

In a healthy patient what are their defense mechanism against hypoglycemia

A

pancreas decreases its insulin output
Alpha cells in pancreas secrete counterregulatory hormone, glucagon to signal the liver to release more glucose, promotes glycogenolysis and glycolysis/lipolysis
Adrenal glands secrete epinephrine which act to signal the production of more glucose and refrain certain tissue from using glucose in bloodstream

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15
Q

What happens when epinephrine and glucagon fail to adequately raise blood glucose levels

A

the body releases cortisol and GH which work to increase blood glucose

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16
Q

What effects are seen in a patient with DM

A

After yrs of T1DM many lose these defenses against hypoglycemia
Not able to benefit from reducing bodies own secretion of insulin
Can not longer secrete glucagon
After many instances of hypoglycemia the epi response gets blunted
Results in defective glucose counterregulation and prone to bout of severe hypoglycemia
Causes hypoglycemia unawareness

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17
Q

what is the definition of Type 1 DM

A

chronic state of hyperglycemia due to an absence or deficiency of insulin

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18
Q

what is the definition of Type 2 DM

A

A combination of insulin receptor abnormalities and inadequate insulin secretion to compensate

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19
Q

Who is are the greatest risk for Diabetes

A 
non-hispanic whites
Asian Americans
Hispanic
Non-hispanic blacks
Male-female ratio 1.5to1
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20
Q

when is T1DM most common

A

most common in children and young adults with a peak incidence before puberty 11-13
Can still develop in adults

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21
Q

What increases a patients odds of getting T1DM

A

autoimmune disease

Graves, Hashimoto, Addisons

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22
Q

What types of factors increase the risk of T1DM

A

Environmental factors can cause it to be expressed
Viral-which causes autoimmume response in which the immune attacks virus infected cells along with beta cells
Diet- response to antibodies in cows milk
Chemical/drugs-detroy
Trauma/pancreatitis

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23
Q

The majority of patients have susceptibility gene located on what region of which chromosome?

A

HLA region on chromosome 6

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24
Q

Which is the highest risk for type 1 DM in the US borne by individual who express which allele

A

DR3 and DR4 allele

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25
what do DQ+Dr both code for
antigens expressed on the surface of macrophages and B lymphocytes
26
what are DQ alleles associated with?
increased risk for type 1 DM
27
What causes the destruction of the beta cells in Type 1 DM?
lymphocytic infiltration | loss of the insulin-productin beta cells of the islets of langerhans in the pancreas, leading to insulin deficiency
28
what is type 1a immune mediated destruction of beta cells
T-cell mediated autoimmune attack
29
what happens with beta cell pathophysiology?
as beta mass declines, insulin secretion decreases until the available insulin no longer is adequate to maintain normal blood glucose levels
30
How much os the beta cell need to be destroyed for diabetes to be diagnosed
80-90%
31
How is the pathology of the beta cells reversed
exogenous insulin to reverse this catabolic condition, prevent ketosis, decrease hyperglucagonemia and normalize lipid and protein metabolism
32
when patients are diagnosed with T1DM have which antibodies circulating at diagnosis
Islet cell antibody (ICA) Insulin auto-antibodies (IAA) Antibody to glutamic acid (GAD 65) antibody to tyrosine phosphatases (IA-2 and IA2-B)
33
what happens when glucagon levels are high
breakdown of fats lipolysis leads to ketoacidosis which produces energy for cellular function
34
what are symptoms of diabetic ketoacidosis?
N/V Thirst/polyuria Abdominal pain SOB
35
what are physical exam findings of diabetic ketoacidosis
``` presents in less than 24hrs Tachycardia Dehydration/hypotension Tachypnea/kassmaul respiration/respiratory distress abdominal tenderness lethargy obtundation cerebral edema/ coma ```
36
What events take place in a patient during DKA
there is a lack of insulin which elevated glucagon. There is a osmotic diuresis causes polyuria, dehydration, polydipsia. The body starts lypolysis for fuel which cause ketone bodies to form causing metabolic acidosis. This triggers counter regulatory hormones.
37
what are the classical clinical presentation of T1DM
polyuria, polydipsia, polyphagia, unexplained weightloss
38
what are some other symptoms associated with T1DM other than the polys
Fatigue, Nausea, Blurred vision Paresthesia Hypotension/Orthostatic hypotenstion
39
When can you take a fasting blood glucose level
at least 8 hours after eating
40
when can you take a post prandial blood glucose
2 hours after a meal
41
how many readings of 126mg/dl are needed to be diagnosed as diabetic
2 consecutive positive readings
42
what is the function of the HbA1C do
provides an average blood sugar control over the 120 day period (life cycle of RBC)
43
when do you need to screen for diabetes in patients?
high risk patients with a relative with type 1 DM which will be screened for anti-islet antibodies before ago of 10years
44
According to ADA recommendations when should you test a patients HbA1c
it is used to diagnose type 1DM only when the condition is suspected but the classic symptoms are absent
45
What are microvascular complications with DM
nephropathy neuropathy retinopathy
46
what are the macrovascular complications with DM
coronary artery disease peripheral arterial disease Cerebrovascular accident
47
what types of additional lab studies would you want to order
``` lipid panel Renal function (Bun,Cr, GFR, urinalysis) EKG/carotid ultrasound peripheral pulse podiatric assessment opthalmic assessment ```
48
what are the primary goals of type 1 DM
prevent acute illness Hyper/hypoglycemia prevent long term complication of macro/microvascular
49
what are the types of rapid acting insulin
lispro (humalog) | aspart (Novolog)
50
what are short acting regular insulin
Humulin R | Novolin R
51
What are intermediate acting NPH
Humulin N Novolin N Humulin L Novolin L
52
what are long acting insulin
ultralente | glargine (lantus)
53
What are the benefits of rapid acting insulin?
pts can eat sooner flexible dosing schedule allows patients to adjust their insulin to their eating habits used with long acting or intermediate insulin hypoglycemia is common
54
What is the short acting insulins function
``` used 30 min before meal used in a sliding scale for DM or Hospital patients with out DM for stressful situations, infections, MI, perioperative period Can be given IV diabetic ketoacidosis hyperkalemia ```
55
What is the most common form of insulin treatment for T1DM
intermediate acting insulin give 2x/day given in combo with regular or lispro for tighter glucose control
56
What is the benefit of long acting insulin and when should it be given
no peaks best for basal coverage controls blood sugar levels between meals and sleeping best given at bed time with recurrent uncontrolled fasting hyperglycemia less nocturnal hypoglycemia
57
how many injections will insulin therapy require
3-6x/day requires self monitoring readings preferred regimens ultra-short acting and long acting
58
What are the ADA's recommendations for diet
cholesterol 300mg/day sat fats<10% of total daily calories unsaturated fats of total daily calories
59
what are the important things for T1DM to do with their diet
eat snacks and meals at regular intervals or smaller portions more regularly Avoid dehydration
60
what are the most common lipid abnormalities
hypertriglyceridemia and lover levels of HDL are most common
61
What do children and adolescents with T1DM have a higher risk of what type of other diseases
athersclerosis | heart disease
62
What should diabetics be put on to get their lipids under control
statins
63
how can exercise be helpful treatment for T1DM
improves utilization of carbs and lipids | Might predispose to hypoglycemic episodes
64
how would you council your patients who are T1DM that are going to exercise
start slow and work up to moderate exercise check glucose prior to exercise and every 30 min during exercise may need to reduce insulin before and after exercise
65
What are the surgical interventions for pancreatic transplantation indications
for T1DM only serious and progressive DM complications Old pancreas is left in place because it still makes digestive enzymes A kidney-pancreas transplant is an operation to place both a kidney and pancreas at the same time in someone who has kidney failure related to T1DM
66
Pancreatic islet allo-transplantation?
is a procedure in which islets cells from the pancreas of a deceased organ donor are purified, processed and transferred into another person experimental procedure as of now
67
What is the function of self monitoring glucose levels. | what are the pros and cons
achieve tight glycemic control and to monitor asymptomatic hypoglycemic episodes patient is in control must trust patient
68
what is the threshold for hypoglycemia
50mg/dl dangerous level
69
what are symptoms of hypoglycemia
``` confusion letharhy seizure coma focal neurological symptoms autonomic hyperactivity ```
70
what are treatments for avoid hypoglycemia?
``` decrease insulin or oral hypoglycemic doses increase snacks educate your patient about hypoglycemia Carry packs of sugar/candy Glucagon ```
71
how would you treat a person with extreme hypoglycemia
IV bolus 50% dextrose or 1mg Glucagon IM
72
what is the somogyi effect
nocturnal hypoglycemia followed by rebound am hyperglycemia body responds to the low blood sugar by releasing hormones that raise the blood sugar level, may cause a high sugar level in the morning
73
what can cause the smogyi effect
a person who takes insulin doesn't eat regular bedtime snack, the persons sugar level drops during night hypoinsulinemia
74
what is the dawn phenomenon?
end result of a combination of natural body changes that occur during the sleep cycle to prepare a person to wake up the counterregulator hormones work against insulin during bedtime where insulin may be wearing out which causes hyperglycemia in the morning

Clin Med-Endocrine (8 decks)

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