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vanessa endocrine ppnp > diabetes pathophysiology > Flashcards

diabetes pathophysiology Flashcards

1
Q

which cells produces insulin

A

beta cells

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2
Q

what is the function of insulin?

A
  1. reduce blood sugar level by increase uptake of glucose by cells and use it
  2. prevent fat and glycogen break down
  3. inhibit glycogenesis and increase protein synthesis
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3
Q

what does the cells use glucose for ?

A

metabolic energy

fat synthesis

glycogen synthesis

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4
Q

what does F cells produce ?

A

pancreatic polypeptide

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5
Q

what does sigma cells produce?

A

Somatostatin

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6
Q

what cells produces glucagon? what is the function of glucagon

A

alpha cells

increase blood sugar level by breaking down glycogen in the liver

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7
Q

what are the signs of hypoglycemia?

A
  1. sleepiness
  2. sweating
  3. pallor
  4. lack of coordination
  5. irritability
  6. hunger
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8
Q

what are the signs of hyperglycemia?

A
  1. glycosuria (glucose in urine)
  2. polyuria (increased urine as urine follow glucose)
  3. polydipsia (increased thirst due to water loss)
  4. polyphagia (hunger and eat more as cells are not utilizing glucose )
  5. weight loss (body cannot use glucose and body break down fat )
  6. malaise and fatigue (decrease of energy)
  7. blurred vision (swelling of lenses from osmotic effect)
  8. tingling pain and sensation (early sign of neuropathy)
  9. slow healing of cuts and bruise
  10. dry mouth
  11. headache
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9
Q

what is type 1 diabetes?

A

it is when beta cells are destroyed and unable to produce insulin

often called childhood diabetes

occurs when 80-90% of beta cells is destroyed

(genetic disposition, with a stressor event causes diabetes)

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10
Q

what are the causes of type 1 diabetes ?

A
  1. genetic factors (if both parent have, 10-20%, in identical twins 50%)
  2. environmental factors (viral infections, chemical toxins that change the structure and destroy beta cells)
  3. autoimmunity where the beta cells are being destroyed (insulitis)
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11
Q

elaborate more on the autoimmunity cause of diabetes

A

insulitis is the destruction of insulin producing cells

it is caused by the infiltration of islets with mononuclear cells containing activated macrophages

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12
Q

what is type 2 diabetes?

A

insulin resistance where target cells become unresponsive to insulin due to defect in insulin receptor function

as blood glucose rise, the pancreas produces more insulin and as it progresses, the insulin producing cells get destroyed

usually asymptomatic

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13
Q

what are the causes of type 2 diabetes?

A
  1. genetic (both parent, 70-100%, identical twin 90%)
  2. insulin resistance
  3. pancreatic beta failure where cells cannot sustain hyperinsulinemia (high insulin)
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14
Q

what is the progression of diabetes for type 2

A

normal glucose tolerance

impaired glucose tolerance

impaired fasting glucose

diabetes Meletus

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15
Q

how to test and diagnose diabetes?

A

when patient has symptoms and when 1 of the test result is high

or two high test

if one high and one normal, the higher test should be repeated

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16
Q

what is the range for fasting plasma glucose test?

A

normal range is 5

diabetes is more than or equal to 7

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17
Q

what is the range for 2 hour fasting glucose test

A

normal 7.8

diabetes more than or equal to 11.1

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18
Q

what is considered as diabetes at random time

A

more than equal to 11.1

and have signs of polyurea, polydipsia, unexplained weight loss

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19
Q

what is hba1c ?

A

it measures the glucose level for the past 3-4 months

value of 6.5% indicates diabetes

20
Q

what does arterial blood gas test show?

A

if patient have diabetic ketoacidosis

21
Q

what are the other diagnostics test to test for diabetes

A
  1. C reactive protein test (for diabetic foot infection)
  2. wound culture
  3. renal test function (check electrolytes level)
  4. liver function test
  5. ophthalmoscopy
22
Q

what are the acute complications of diabetes mellitus ?

A
  1. diabetic ketoacidosis
  2. diabetic nonketotic hyperosmolar coma (HHS)
23
Q

what is diabetic ketoacidosis?

A

it is the body breaking and burning down fat due to the absence or not enough insulin

free fatty acids are converted to ketone bodies by the liver and it leads to metabolic acidosis

the by product of ketone digestion is beta hydrobutyric acid, acetone, autoacetic acid

usually coupled with infection and is life threatening

24
Q

what are the signs of diabetic ketoacidosis?

A
  1. hyperglycemia
  2. dehydration and electrolyte loss (increase urination)
  3. fruity smell
  4. weakness, condusion and loss of consciousness
  5. abdominal pain ( only in DKA)
  6. Kussmaul respirations (compensatory mechanism to increase the O2 )
25
Q

how to diagnose dka?

A
  1. serum glucose more than 13.9
  2. arterial ph less than 7.3
  3. serum bicarbonate less than 18 ( sign of metabolic acidosis)
  4. ketones present in urine
  5. beta hydroxybutyrate found and high (it is by product of ketone digestion
26
Q

what is the treatment of ketoacidosis ?

A
  1. 0.9 normal saline to fix dehydration
  2. remove sugar slowly with insulin (to fix hyperglycemia
27
Q

what is diabetic nonketotic hyperosmolar coma (HHS)?

A

it occurs when the insulin level is too low to prevent hyperglycemia but is high to prevent fat breakdown.

the body try to remove glucose in the urine and when the body loses too much electrolytes, it causes altered sensorium (sense of awareness)

happen in older people 50-70

no known history of diabetes or mild diabetes

28
Q

what are symptoms of HHS?

A

skin appears flushed , dry and warm

high fluid loss

neurological changes

29
Q

what is the treatment for HHS?

A
  1. fluid replacement
  2. correction of electrolyte
  3. insulin administeration
30
Q

what are the different chronic complications of diabetic mellitus ?

A
  1. microvascular (small vessels)
  2. macrovascular ( large vessels)
31
Q

what is the microvascular complication of diabetes?

A
  1. retinopathy (increased pressure on the eye, likely to develop cataracts and glaucoma after about 20 years)
  2. renal disease (more in type 2)
  3. erectile dysfunction
  4. peripheral neuropathy (numbness, paresthesia prickling sensation)
  5. diabetic foot (due to loss of sensation and poor blood supply)
32
Q

how can microvascular complication be classified into?

A
  1. sensorimotor (numbness, paresthesia, feet mostly affected)
  2. autonomic (erectile dysfunction)
  3. mononeuropathy (damage to a single nerve)
33
Q

what is the macrovascular complication in diabetes?

A

it affects the large vessels

  1. lead to stroke
  2. heart disease and hypertension
  3. peripheral vascular disease
34
Q

how to reduce macro vascular complication

A

blood pressure control

cholesterol control

35
Q

how to reduce micro vascular complications ?

A

glycemic control (HBA1c)

36
Q

when to monitor blood glucose?

A
  1. self monitoring when using insulin
  2. when not using insulin, those at risk, pregnant, fasting and with acute illness
37
Q

when to monitor blood ketone level ?

A
  1. during sustained hyperglycemia in patients with type 1 diabetes
  2. during acute illness
  3. preferably done in the morning
38
Q

when to measure hba1c?

A

routinely done for patient with diabetes

  1. every 3-4 months with unstable control
  2. 6 monthly for stable patients and meeting goals
39
Q

how and what is the mechanism of the body secreting insulin?

A
  1. glucose undergoes glycolysis within the cell to release ATP
  2. atp binds to K+ transporter causing them to close
  3. K+ cannot leave the cell = highly positive cell to be formed
  4. depolarization occurs and causes Ca channels to open allowing Ca to enter the cell
  5. presence of Ca triggers exocytosis and release insulin
40
Q

what is the stimulus for secreting insulin in the body?

A
  1. glucose level exceeding 80-120 mg/dL , triggers the uptake of glucose into beta cells in the pancreas
  2. GI hormones like gastrin, secretin, cck GIP
  3. amino acids and fatty acids
  4. parasympathetic nervous system (storing of nutrients )
  5. sympathetic nervous system ( when nervous and need energy)
41
Q

what are the insulin that produces peaks of reaction?

A

bolus insulin

42
Q

what are the insulin that produces the ground level?

A

basal/ backgroud insulin

43
Q

what is the insulin effect on the liver

A
  1. inhibits gucogenogenesis, stimulates the liver to store glucose in the form of glycogen
44
Q

what is the insulin effect on the muscle ?

A

increased facilitated transport of glucose into the cells by increasing the number of glut 4 transporters

stimulates gycolysis

45
Q

what is the effect of insulin in adipose tissue?

A

suppress adipose tissue lipolysis (prevent the breakdown of fats)

vanessa endocrine ppnp (8 decks)

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