Diabetes Pt 1 Flashcards
what leads to the metabolic derangements associated with type 1
loss of insulin (auto immune destruction)
describe type 1 dieabetes
Beta cell destruction (leads to insulin deficiency) Immune mediated (autoimmune) Idiopathic
what is insulin normally secreted by
Beta cells
what increases glucose transport into tissue and the liver
insulin
Must be present for muscle and fat tissues to use glucose
for energy
insulin
what does insulin regulate
glucose metabolism- to produce energy for
cellular functions
mechanism by which insulin promotes fat storage
*Insulin promotes glucose into fat cells where it is broken down
*One of breakdown products is A-glycerophosphate,
combines with fatty acids which ultimately forms
triglycerides
when insulin is lacking what happens to fat
fat is released into the bloodstream
as free fatty acids.
when insulin is lacking what happens to protein
causes protein breakdown into amino acids
what does insulin potentiate the effect of
growth hormone
describe insulin’s role in protein metabolism
insulin increases body protein by increasing transport of amino acids into cells
major stimulus of insulin secretion
glucose
hormones that raise blood glucose levels
Cortisol, Glucagon, Growth hormone, Epinephrine, Estrogen, Progesterone
factors that inhibit insulin secretion
hypoxia, hypothermia, stimulation of alpha adrenergic 2 receptors
macrovascular complications of diabetes
Cardiovascular &
Cerebrovascular
microvascular complications of diabetes
Retinopathy (vision problems)
Nephropathy (kidney dysfunction)
Neuropathy (nerve dysfunction)
Male erectile dysfunction
no matter what type of diabetes the main feature is
hyperglycemia
by the time type 1 symptoms appear what has occured
80% of beta cells are already gone
what does idiopathic (type 1) mean
permanent insulin deficiency
insulin dependent diabetes mellitus
IDDM
what percent of those with diabetes are type 1
10%
what type of insulin is required for type 1
exogenous insulin
what is type 1 associated with
high incidence of complications
usually has sudden onset
manifestations of type 1
- Polyuria
- Polydipsia
- Polyphagia
- Hyperglycemia
- Glucosuria
what is type 2 characterized by
hyperglycemia and insulin resistance
what does type 2 result from
increased production of glucose by liver and
decreased uptake of glucose in liver, muscle and fat cells
what is insulin resistance
higher than usual concentrations of
insulin are required
general characteristics of type 2
- Occurs at any age
- Gradual onset
- Less severe symptoms initially
- Easier to control
- More MIs and strokes
- 90% of those with diabetes are Type 2
- multifactorial
risk factors associated with type 2
Family history
- Obesity
- Inactivity
- Race/ethnicity
- History of gestational DM
- HTN
- Metabolic Syndrome
what is pre diabetes
at risk for developing diabetes, HD, stroke
what is an impaired plasma glucose
2hr plasma glucose greater than 200
during an oral GTT
what is prediabetes characterized by
HgA1C levels ( 6.5% or greater) FBS: FBS greater than 126mg/dl
normal HgA1C level
normal 4-6%
how does diabetes confirmation testing work
Fasting Blood Sugar
- No calories for 8 hours
- Normal 100 mg/dl or less
- Significant >100 but < 126 = impaired
how is DM diagnosed
Two separate tests greater that 126 mg/dL
Or Casual BG of > 200 mg/dl with symptoms
what is an oral glucose tolerance test
- Most sensitive but has issues – cost, inconvenience, timely
- Standard for DM
- Diagnosis is made if 75 g for 2 hr test or 100 g for 3 hr test
values of OGTT
- Normal < 140 mg/dl
- Significant >140 but <200
- Diagnostic >200 mg/dl
describe HbA1c
Shows average blood glucose levels during the previous
120 days (usually followed not more than 90 days at a
time)
what is HbA1c used for other than diagnosis
to monitor control of DM
values of HbA1c
*Normal 4-6%, level of 6.5% is enough to make a
diagnosis of diabetes, 5.7% to 6.49% is a high risk
how to check effective control of DM
HbA1C <7, test urine for ketones and glucose
Self Monitoring Blood Glucose (SMBG) for type 1
3-4x day for type 1
multiple pump injections
Self Monitoring Blood Glucose (SMBG) for type 2
post prandial BG
the length of time after given before insulin hits bloodstream and begins to lower blood glucose.
onset
is the time during which insulin is at its maximum effectiveness at lowering blood glucose.
peak
length of time insulin continues to lower blood glucose
duration
can insulin be given orally
no
types of rapid acting insulin
Humalog (lispro)
Novolog (aspart)
Apidra (glulisin)
types of intermediate acting insulin
NPH (N)
Lente (L)
types of short acting insulin
Regular (R) humulin or novolin
Velosulin (for use in the insulin pump)
types of long acting insulin
Ultralente (U)
Lantus
Levemir (detemir)
types of pre mixed insulin
Humulin 70/30
Novolin 70/30
Novolog 70/30
Humulin 50/50
advantage of premixed insulin
fast and long acting is combined in one injection
rapid acting onset, peak, duration
onset: 15 min
peak: 1-1 1/2 hr
duration: 3-4 hr
short acting onset, peak, duration
onset: 30 min- 1 hr
peak: 2-3 hr
duration: 4-6 hr
NPH peak, onset, duration
onset: 2 hr
peak: 6-8 hr
duration: 12-16 hr
detemir onset, peak, duration
onset: none
peak: none
duration: 17-24 hr
long onset, peak, duration
onset: none
peak: none
duration: 24 hr
mixed onset, peak, duration
onset: 30 min
peak: 4-8 hr
duration: 24 hr