Diabetes Part 2

Question 1

Classic triad of Type 1 diabetes?

Answer 1

Lots of piss, thirsty, and eat a lot.

Question 2

Severe clinical sign/symptom of type 1?

Answer 2

Diabetic ketoacidosis

Question 3

What was her take home message for the question of….does my child have type 1 or type 2?

Answer 3

Autoantibodies are present over 90% of the time with white kids
Less than half of the time with blacks or Hispanics

Question 4

What is the most common precipitating factor of diabetic ketoacidosis? What are two infections causing it as well?

Answer 4

Not taking your insulin.

Pneumonia and UTI

Question 5

What is the clinical triad of DKA?

Answer 5

Hyperglycemia, ketones in the blood, and metabolic acidosis

Question 6

What is the first major problem with DKA the books talks about?

Answer 6

Epinephrine is involved. Epi inhibits insulin effect and stimulates glucagon release and effect, severe hyperglycemia. As a result, there is no utilization of glucose and it is excreted as an osmotic diuretic causing dehydration.

Question 7

What is the second major problem going on in DKA?

Answer 7

Because insulin is not present, fat is broken down. The FFA are converted in the liver to ketone bodies. At first, the body is not utilizes the ketone bodies as fast as they are being formed, so they too act as an osmotic diuretic. Eventually, there is sufficiency dehydration to where the kidneys do not excrete the ketone bodies, which are acids, and there is metabolic ketoacidosis.

Question 8

3 presenting signs/symptoms of DKA?

Answer 8

NV, tachycardia and kussmaul respirations.

Question 9

What is the purpose of kussmaul breathing?

Answer 9

It is a compensatory Respiratory alkalosis for the metabolic acidosis

Question 10

What 3 things do we give to treat DKA?

Answer 10

Insulin, fluids and potassium

Question 11

What is Hyperglycemic hyperosmotic Syndrome?

Answer 11

This is the condition type 2 patients can get. These guys get severely dehydrated because they are not taking in enough fluids to compensate for the fluid loss due to their diabetes.

Question 12

3 clinical signs of HHS?

Answer 12

Glucose over 600, severe dehydration, and hyperosmolarity

Question 13

What is the pH and bicarb of DKA and HHS?

Answer 13

Less than 7.3 and less than 18

Over 7.3 and over 18

Question 14

What is the osmolarity and hyperglycemia of DKA and HHS?

Answer 14

Less than 320 and over 250

Over 320 and over 600

Question 15

What is the most common acute metabolic complication in either type 1 and type 2 diabetes?

Answer 15

Hypoglycemia

Question 16

What 3 conditions have increased risk because of chronic high blood glucose?

Answer 16

Stroke, MI, and lower extremity gangrene.

Question 17

What is the most common cause of death in diabetics?

Answer 17

MI

Question 18

The effects of microvascular disease resulting from diabetes are most profound in what 3 areas of the body, leading to what 3 conditions?

Answer 18

Retina, kidney, and nerves

Retinopathy, nephropathy and neuropathy

Question 19

What is the recommended A1c for diabetics?

Answer 19

Less than 7

Question 20

Big picture, what is the patho for long term complications of diabetes?

Answer 20

Glucotoxicity

Question 21

What are the 4 mechanisms that are causing damage because of too much glucose?

Answer 21

Cytokines and growth factors
ROS
Procoagulant activity
Proliferation of smooth muscle and matrix

Question 22

What are the precursor agents leading to the 4 mechanisms of damage?

Answer 22

AGEs

Question 23

What is the signaling pathway by which this activation takes place?

Answer 23

Protein kinase C and DAG