diabetes, metabolic syndrome, PAD

Question 1

T1DM

Answer 1

• B cells of pancreas that produce insulin are destroyed
• Insulin dependence
• Commonly detected before 30 y/o

Question 2

T2DM

Answer 2

Rise in blood glucose
o Insufficient insulin action (insulin resistance)
o Declining insulin production

Leads to B cell failure > insulin dependence > requires insulin injections

Question 3

hypoglycemia

Answer 3

• Pancreas alpha cells releases glucagon in response to hypoglycemia
• Glucagon stimulates release of glucose to plasma from liver
• Plasma glucose returns to normal levels

Question 4

hyperglycemia

Answer 4

• Pancreas b cells release insulin
• Insulin stimulates glucose uptake by cells
• Plasma glucose returns to normal levels

Question 5

criteria for diabetes diagnosis

Answer 5

Fasting plasma glucose >125 mg/dL (FPG)

2-hour plasma glucose >/= 200 mg/dL OGTT

A1C >/= 6.5%

Classic diabetes symptoms + random plasma glucose >/= 200 mg/dL

Question 6

complications of DM

Answer 6

CVD
retinopathy
nephropathy
neuropathy
osteopathy
immune dysfunction

Question 7

charcot’s disease

Answer 7

 Progressive degeneration of weight bearing joints
 Increase risk of skin breakdown

Question 8

coronary artery disease

Answer 8

 Major cause of death in both types of DM
 More diffuse atherosclerosis
 Increase HTN, CHF, CVA risk
 Increase incidence of dysrhythmias

Question 9

increased infection risk

Answer 9

o Skin barrier disruption
o Decreased function of macrophages (impaired immunity)
o Hyperglycemia promotes bacterial growth and proliferation

Question 10

diabetic ketoacidosis (DKA)

Answer 10

• Occurs in Type 1 > Type 2 (shortage of insulin)
• Lack of insulin and increased glucagon
• Body burns fatty acids and produces ketones
• Ketones lead to acidosis

Question 11

DKA s/s

Answer 11

o Respiratory compensation (kussmaul breathing)
o Nausea/vomiting
o Abdominal pain
o Osmotic diuresis

*often precipitated by acute illness

Question 12

osmotic diuresis

Answer 12

High glucose concentrations in the nephrons draw water into nephrons by osmosis

results in
* Polydipsia (excessive thirst)
* Polyuria
* Excessive fluid loss  dehydration (hypotension)

Question 13

hypoglycemia and exercise

Answer 13

 Monitor BG before and after
 May require lower insulin dose pre-activity or increased carb intake prior or during activity
 BG >100 mg/dL prior to exercise then supplement with carb snack

Question 14

hyperglycemia and exercise

Answer 14

• Postpone exercise if BG >250 mg/dL (avoid mod-vig)
• Glucagon release + exercise + hyperglycemia may result in ketoacidosis