Diabetes (week 5) Flashcards
where does the insulin diabetics inject come from
recombinant DNA technology
what is used for insulin administration in compliant patients
insulin infusion pump
what do insulin infusion pumps do
programmed to release insulin at certain times of the day
what percent of total calories should be carbohydrates in diabetics
55-60%
what percent of total calories should be fat in diabetics
less than 30%
what percent of total calories should be protein in diabetics
15-20%
what must diabetics do when they exercise
must adjust food intake and insulin doses; can become hypoglycemic
what is the main difference between Type I and Type II Diabetes
Type 1= autoimmune; no beta cells; lack of insulin
Type 2= not autoimmune; still have functioning beta cells
speculation about cause of insulin resistance in Type II DM
compounds released from adipose cells will decrease peripheral insulin sensitivity
NIDDM stands for
Non Insulin Dependent Diabetes Mellitus
what is the biggest risk factor for Type II DM
obesity
age of Type II DM
over 40
clinical manifestations of Type II DM
abnormal glucose tolerance
overweight
hyperlipidemic (high LDL)
Tx for Type II DM
EXERCISE
restrict caloric intake
weight loss
dietary counseling
what is gestational diabetes
presence of glucose intolerance during pregnancy; typically during 3rd trimester
blood glucose returns to normal after parturition
Mimics Type II DM
possible causes of gestational diabetes
chorionic somatomaammopropin (produced by placenta)
estrogen
cortisol
weight gain during pregnancy
risk factors for gestational diabetes
family history of diabetes obesity high maternal age parity greater than 5 previous complicated pregnancy glycosuria (presence of glucose in urine)
tx for gestational diabetes
dietary counseling
exercise
monitor blood glucose and urine ketones
glyburide
glyburide
promotes release of insulin
does not cross placenta
teratogenicity
likelihood of a drug to create defects in developing fetus
chronic complications of Diabetes
higher incidence of peripheral vascular disease
cardiac disease
renal disease retinopathy
neuropathy
AGE stands for
advanced glycosylation end-products
normal AGE process
glucose will attach reversibly to proteins, lipids, and nucleic acids without benefit of enzymes;
bad when bound irreversibly????
problem with AGE
- can attach to basement membranes of blood vessels and verves, thickening them and decreasing permeability
- promotes production of free radicals
- inactivates nitric oxide which is a vasodilator, which leads to vasoconstriction and ischemia
- causes damage to nerves
polyol pathway
pathway for glucose metabolism used by tissues that do not need insulin for glucose transport
tissues that utilize polyol pathway
kidnes endothelium of blood vessels retinal tissue eye lens nerves
what happens in the polyol pathway when a person is hyperglycemic
excess glucose shunted to polyol pathway
why is it bad that there is excess glucose shunted to polyol pathway
excessive byproducts (sorbitol, fructose) are produced, causing osmotic injury (lysis)
how does AGE contribute to diabetic neuropathy
causes hypoxia
how does polyol pathway contribute to diabetic neuropathy/retinopathy
sorbitol damages Schwann cells, interferes with ion pumps, and distrupts nerve conduction
how does AGE contribute to microvascular disease
-thickening of basement membrane
interfering with diffusion which interferes with supply of oxygen and nutrients to tissue
-damages endothelial cells, increasing plaque formation
which type of diabetes is more common to die of renal failure
type I
how does AGE lead to nephropathy
alters basement membrane of glomerulus, leading to glomerularsclerosis (thickening of glomerulus)
- will decrease filtration
- glucose toxicity
how does polyol pathway lead to nephropathy
damages tubular cells
how is the development of nephropathy slowed
ACE (angiotensin converting enzyme) inhibitors
control blood glucose
macrovascular disease
includes:
coronary artery disease (CAD)
CVA
peripheral vascular disease (PVD)
which type of diabetes is more common to have macrovascular disease
type II
what is the most common cause of death in NIDDM, especially in women
Coronary artery disease
what does your risk of stroke increase by if you have diabetes
2x (due to increased BP)
what does peripheral vascular disease typically lead to?
amputation
why do diabetics have increased risk of infection
- impaired sensation
- hypoxia (due to decreased BF and decreased release of O2 to tissue)
- pathogens proliferate because of increased glucose
- blood supply is decreased
- WBCs have decreased chemotaxis
