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Anatomy and Physiology > Diabetes - Pathophysiology and Pharmacology > Flashcards

Diabetes - Pathophysiology and Pharmacology Flashcards

1
Q

What are the nonmodifiable risks of developing diabetes?

A

Genetics (family)
Age
Gender
Post menopausal

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2
Q

What are the modifiable risks of developing diabetes?

A 
Smoking
Hypertension
Dyslipidaemia
Obesity
Physical inactivity
Excess alcohol
Stress
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3
Q

What is diabetes mellitus and its symptoms?

A

A disorder of the pancreas

Inadequate insulin for carbohydrate metabolism

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4
Q

What is diabetes insipidus (rare) and its symptoms?

A

Disorder of the endocrine system

Inadequate anti-diuretic hormone (ADH)

Blood glucose levels are normal

Excessive thirst

Excessive production of dilute urine

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5
Q

What is the reason for diabetes mellitus resulting to inadequate insulin for carbohydrate metabolism?

A

Glucose absorbed from the gastrointestinal tract cannot be metabolised or stored and so reaches higher than normal levels in the bloodstream

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6
Q

How big is the pancreas in length?

A

12-15cm long

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7
Q

Where does the pancreas lie in the body?

A

lies in the epigastric and left of the hypochondriac region

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8
Q

Where does the head of the pancreas lie?

A

It curves into the shape of the duodenum

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9
Q

Where does the body of the pancreas lie?

A

Behind the stomach

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10
Q

Where does the tail of the pancreas lie?

A

In front of left kidney

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11
Q

What space is the pancreas located in?

A

Retroperitoneal space

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12
Q

What is unique about the pancreas?

A

It is both endocrine and exocrine

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13
Q

What is the exocrine function of the pancreas?

A

Digestive enzymes released into duodenum via ducts

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14
Q

What is the endocrine function of the pancreas?

A

Insulin and glucagon directly into the bloodstream

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15
Q

What are the three cells that the Islets of Langerhaans contains?

A

Alpha cells
Beta cells
Delta cells
F cells

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16
Q

What is the role of alpha cells?

A

(Unaffected in diabetics) Secretes the hormone glucagon which raises blood glucose levels

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17
Q

What is the role of the beta cells?

A

Secretes the hormone insulin which lowers blood glucose levels

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18
Q

What is the role of the delta cells?

A

Secretes growth hormone inhibiting cells (GHIH) or somatostatin, which inhibits secretion of insulin and glucagon

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19
Q

What is the role of the F cells?

A

Secretes pancreatic polypeptide which regulates digestive enzymes

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20
Q

What is the process called where glucose is regulated?

A

Negative feedback

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21
Q

What are the effects of glucagon release?

A

Stimulates the liver to breakdown glycogen to be released into the blood as glucose

Activates gluconeogenesis which is the conversion of amino acids into glucose

Breakdown stored fat (triglyceride) into fatty acids for use as fuel by cells

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22
Q

What is gluconeogenesis?

A

Conversion of amino acids into glucose

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23
Q

What are the effects of insulin release?

A

Conversion of glucose into glycogen for storage in the liver and muscles (glycogenesis)

Accelerates the transport of glucose from blood into cells (especially skeletal muscle)

Allows entry of amino acids into cells and synthesises proteins

Converts glucose into fatty acids (lipogenesis)

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24
Q

What is glycogenesis?

A

Conversion of glucose into glycogen for storage in the liver and muscles

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25
Q

What is glycogenolysis?

A

Breakdown of glycogen into glucose

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26
Q

How does the binding of insulin result to glucose entering the cell?

A

Insulin binds to complimentary receptor on cell

Opens channel for glucose to enter through

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27
Q

What are the different type of Mellitus?

A 
Type 1 (IDDM)
Type 2 (NIDDM)
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28
Q

What is Diabetes Mellitus Type 1 (Insulin Dependent Diabetes Mellitus)?

A

More common in children and young adults
Sudden onset
Deficiency/absence of insulin
Treated with insulin

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29
Q

What is Diabetes Mellitus Type 2 (Non-insulin Dependent Diabetes Mellitus)?

A

More common in the elderly, late onset
Normally obese
Diet controlled with tablets (can be insulin)

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30
Q

How would you treat Type 1 diabetes?

A

Absolute deficiency of insulin

Regular injections required to prevent death

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31
Q

What causes Type 1 diabetes?

A

Autoimmune genetic disorder where pancreatic beta cells are destroyed

32
Q

What is the metabolism of untreated Type 1 (IDDM)?

A

Insulin not present to aid entry of glucose into cells

Cells instead use fatty acids to produce adenosine triphosphate (ATP)

By-products of fatty acid catabolism are organic acids called ketones

Ketone bodies form acidosis which lower pH of the blood and result in death

By-product of ketones is acetone smell on breath

33
Q

What is ketones?

A

By-products of fatty acid catabolism of organic acids

34
Q

What are some common types of insulin?

A 
Human Actrapid
Human Insulatard ge
Human Mixtard 30 ge
Human Monotard
Human Ultratard
Human Velosulin
Humulin 1
Humulin Lente
Humulin M1
Humulin S
Humulin Zn
Hypurin
Human Actrapid Penfill (pen)
Human Insulatard Penfill (pen)
Human Mixtard 10 Penfill (pen)
35
Q

What is the cause of Type 2 diabetes?

A

Cells in the body are less sensitive to insulin probably through downregulation of insulin receptors

36
Q

What are the three oral hypoglycaemic agents?

A

Biguanides
Sulfonylureas
Alpha-Biguanides

37
Q

What is the role of the oral agent Biguanides?

A

Stops the liver making extra sugar when it is not needed

Increases uptake of glucose by cells

38
Q

What is the role of the oral agent Sulfonylureas?

A

Helps pancreas make extra insulin

39
Q

What is the role of the oral agent Alpha-Biguanides?

A

These are inhibitors that slow the digestion of starches

40
Q

What is the role of the drug called Sulphonylureas?

A

Helps pancreas produce more insulin

41
Q

What are the four Sulphonylureas that helps with increased production of insulin?

A

Gliclazide
Glibenclamide
Tolbutamide
Chlorpropamide

42
Q

What is the only form of Biguanide available?

A

Metformin

43
Q

When is the use of Biguanide contraindicated?

A

Renal impairment

Risk of lactic acidosis in hepatic/respiratory and cardiac failure

44
Q

What are some causes of hypoglycaemia?

A 
Overdose of insulin
Not enough food or delay in food intake
Overdose of medication
Too much exercise
Alcohol
Pregnancy
Gastrointestinal disturbances (D&V)
Recent illness
45
Q

What are some causes of hyperglycaemia?

A

Undiagnosed diabetes
Incorrect medication
Inadequate adjustment to dose of insulin during illness

46
Q

What are the symptoms of hyperglycaemia?

A

Polyuria
Polydipsia
Polyphagia

47
Q

What is polyuria?

A

Excessive urine

48
Q

What is polydipsia?

A

Excessive thirst

49
Q

What is polyphagia?

A

Excessive eating

50
Q

What is the onset of hypoglycaemia?

A

Sudden and rapid - minutes

51
Q

What is the onset of hyperglycaemia?

A

Gradual - hours or days

52
Q

What happens to the skin in response to hypoglycaemia?

A

Profuse sweating/pale

53
Q

What happens to the skin in response to hyperglycaemia?

A

Dry and flushed

54
Q

What are the resps like for hypoglycaemia?

A

Normal to shallow

55
Q

What are the resps like for hyperglycaemia?

A

Deep and sighing (Kaussmauls)

56
Q

What is Kaussmauls?

A

Deep, laboured breathing often associated with metabolic acidosis, particularly diabetic ketoacidosis but also kidney failure

Refers to high pressure in the jugular vein when a person inhales

57
Q

What is the pulse like for someone with hypoglycaemia?

A

Fast and full

58
Q

What is the pulse like for someone with hyperglycaemia?

A

Fast and weak

59
Q

What would the BP be like for someone with hypoglycaemia?

A

Normal

60
Q

What would the BP be like for someone with hyperglycaemia?

A

Low

61
Q

What is normal blood sugar levels?

A

4-7mmol/l but 4-5.4mmol/l is without food consumption

62
Q

What is the breath like for hypoglycaemia?

A

No odour

63
Q

What is the breath like for hyperglycaemia?

A

Sweet/fruity

64
Q

What is the food intake like for hypoglycaemia?

A

Low

65
Q

What is the food intake like for hyperglycaemia?

A

High

66
Q

What is the insulin level like for hypoglycaemia?

A

Excessive

67
Q

What is the insulin level like for hyperglycaemia?

A

Insufficient

68
Q

What are the symptoms for hypoglycaemia?

A 
Hunger
Headache
Dizzy
Confused
Seizures
Aggressive
69
Q

What are the symptoms of hyperglycaemia?

A 
Pain
Nausea
Fever
Vomiting
Thirst
Drowsiness
Low BP
70
Q

How would you pre-hospitally manage hypoglycaemia?

A 
ABCs
Oxygen (if hypoxemic)
Administer Hypostop (if conscious)
Recovery positon
Monitor blood glucose
IM glucagon
Reassurance
Consider paramedic assistance for IV glucose
71
Q

How would you pre-hospitally manage hyperglycaemia?

A 
ABCs
Oxygen (if hypoxemic)
Recovery position
Monitor blood glucose
Reassurance
Consider paramedic assistance for IV fluid if hypoperfused
72
Q

On what circumstances should a hypoglycaemic patient be transported to hospital?

A

Elderly

Are taking oral hypoglycaemic agents, as hypoglycaemia may occur

Have no history and 1st hypo episode

Have blood glucose level greater than 5mmol/l after treatment

Have not returned to normal mental state within 10 minutes of IV glucose (paramedic intervention)

Have been treated with glucagon

Have any additional disorders or complicating factors eg. chest pain, arrhythmias, alcohol, dyspnoea

Exhibits signs of infection (urinary, upper resp tract) and/or unwell

73
Q

What are some long term complications of diabetes?

A

Cardiovascular problems
Infection
Renal failure
Optical

74
Q

What cardiovascular problems can arise from diabetes?

A

Atheroma leading to Peripheral Vascular Disease and MI

Thickening of arteries leading to retinopathy, renal failure and peripheral neuropathy

75
Q

Why would renal failure arise from diabetes?

A

Due to vascular changes

Excessive glucose damages renal blood vessels because its not reabsorbed by the tubules

The remaining glucose raises osmotic pressure, reducing water reabsorption, increased urine volume, electrolyte imbalance, polyuria, hypovolaemia, extreme thirst and polydipsia

76
Q

Why would an infection arise due to diabetes?

A

Phagocytic activity may be depressed by insufficient intracellular glucose

Complications occur in areas affected by neuropathy:
Feet when sensation and blood supply impaired
Boils
Carbuncles
Vaginal candidiasis (thrush)
Pyelonephritis (bacterial infection of the kidney)

77
Q

How would optical issues arise due to diabetes?

A

Loss of vision due to cataracts as excessive glucose attaches to lens proteins causing cloudiness or damage to blood vessels in the retina

Anatomy and Physiology (26 decks)

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