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Patho > DM > Flashcards

DM Flashcards

1
Q

What organ controls the body’s fuel supply in response to hormones from the pancreas

A

liver

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2
Q

What is the only hormone that lowers glucose?

A

insulin??

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3
Q

Ingested glucose is stored in the liver as _________ and is released as needed in between meals.

A

glycogen

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4
Q

Liver can also make new glucose as needed and this is called

A

glucogenisis

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5
Q

Common metabolic disorders are characterized by

A

-Hyperglycemia resulting from imbalances between insulin secretion and cellular responsiveness to insulin
-Results in an inability to transport glucose into cells
-Body cells are starved, so fat and protein breakdown is increased to be used as cellular energy

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6
Q

Prediabetes

A

elevated glucose, but does not meet diagnostic criteria

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7
Q

Type I DM

A

insufficient insulin production – autoimmune destruction of beta cells
-There is a rare idiopathic form with no autoantibodies

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8
Q

Type II DM

A

insulin resistance and progressive decline in insulin secretion

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9
Q

Gestational DM

A

develops during pregnancy because of increased weight gain and change in hormones. 50% of time they go on to develop type 2 DM but they initially had some insulin resistance even if they didn’t recognize it

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10
Q

DM is more prevalent among which population?

A

Native Americans/Alaska Natives, African Americans, Latinx Americans

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11
Q

The highest prevalence of Type I DM is among which population?

A

White Americans

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12
Q

Type 2 rates are increasing within _______ with obesity epidemic

A

children

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13
Q

DM is a significant risk factor in

A

CAD, stroke, leading cause of blindness, chronic kidney disease, lower extremity amputation

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14
Q

Dx of DM

A
  1. Fasting (8 hours) glucose > 126 mg/dl
    - <100 normal
    - 100-125 “impaired fasting glucose”
    - Oral glucose tolerance test > 200 mg/dl 2 hours after glucose ingestion
  2. Hemoglobin A1C > 6.5%

-Measures the quantity of a subtype of hemoglobin that is bound to glucose molecules (glycated)
- Hgb contains no glucose when it leaves the bone marrow
- When serum glucose levels are increased, more glucose will bind
Therefore, levels reflect glucose control over the past 3 months (lifespan of a RBC)

  1. Glucose in the urine reflects increased levels of blood glucose because the renal threshold for reabsorption has been exceeded
  2. Increased urine ketones also reflect the body’s increased use of non-glucose energy sources
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15
Q

What does Hemoglobin A1C measure?

A

Measures the quantity of a subtype of hemoglobin that is bound to glucose molecules (glycated)
Hgb contains no glucose when it leaves the bone marrow
When serum glucose levels are increased, more glucose will bind
Therefore, levels reflect glucose control over the past 3 months (lifespan of a RBC)

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16
Q

T1 DM occurs primarily in which population?

A

younger people, but the rate of beta cell destruction can be variable, so it can be diagnosed later

17
Q

What is T1 DM characterized by?

A

AN ABSOLUTE LACK OF INSULIN, elevated blood glucose, and breakdown of fats and proteins
* Prone to the development of ketoacidosis – fatty acids are converted to ketones by the liver

18
Q

What is the treatment for T1 DM

A

Insulin

19
Q

What is Type 2 DM and what is it often associated with?

A

hyperglycemia with INSULIN DEFICIENCY due to beta cell dysfunction
associated with obesity and has a strong genetic component

20
Q

What is Type 2 DM caused by?

A

-Insulin resistance
-Deranged secretion of insulin by the beta cells
-Increased glucose production by the liver

21
Q

What is insulin resistance?

A

Decreased ability of insulin to act effectively on target tissues (muscle, liver, fat)

22
Q

What is insulin resistance caused by?

A

genetic susceptibility and obesity.

-Initially stimulates an increase insulin secretion as the beta cells attempt to maintain a normal blood glucose level
-Over time increased demand can lead to beta-cell exhaustion and failure
-Results in increased glucose level and increased glucose production by the liver (because the cells aren’t receiving glucose, so the liver thinks it needs to make more)

23
Q

What is metabolic syndrome and what increases the risk for developing it?

A

-central obesity
-Increased adipose tissue makes vascular perfusion more challenging and chronic underperfusion/tissue hypoxia leads to macrophage response to cellular damage, thus an increased inflammatory state

24
Q

In metabolic syndrome, evidence suggests that insulin resistance contributes to more than just hyperglycemia which is

A

Obesity, elevated triglycerides, low levels of HDL, HTN, systemic inflammation, abnormal function of the vascular endothelium (leading to things like CAD/PAD)

25
Q

When does Gestational Diabetes typically occur?

A

2nd and 3rd trimesters

26
Q

What does Gestational Diabetes increase the risk of?

A

-pregnancy complications, mortality, and fetal abnormality (large size, glucose regulating issues)
-Placenta makes glucose

27
Q

Weight gain during pregnancy can lead to

A

insulin resistance(especially in people who had some degree of insulin resistance to begin with)

28
Q

What are the clinical manifestations of DM?

A

Primarily driven by hyperglycemia and glucosuria

  1. Polyuria - peeing out glucose/extra water
    Glucose is very osmotically active – excess glucose that can’t be reabsorbed by the kidney is excreted and water follows
  2. Polydipsia (1. bc they are peeing so much they are thirsty 2. osmotic- if vessels are full of sugar, you are gonna lose water from cells out into vasculature so cells are dry and brain tells you to drink more water) its peeing too much and osmotic depletion from cells
    Due to resulting dehydration, and also osmotic loss of water from body cells (due to increased serum glucose. Hypothalmic thirst center detects the cell dehyration)
  3. Polyphagia
    More common in type 1 due to cellular starvation and depletion of fats, proteins
  4. Weight loss
    In Type 1
29
Q

DM complications: Diabetic Ketoacidosis

A

-Most commonly occurs in Type 1
-Lack of insulin causes fatty acids to be used as fuel – produces ketones
-Ketones are acidic and result in metabolic acidosis and changes in pH
-Glucose levels are typically very high and water losses great

30
Q

What is the primary tx of Diabetic Ketoacidosis?

A

fluids

31
Q

DM complications: Hypoglycemia

A

Blood glucose <70
Most commonly seen in people on insulin
Rarely seen in Type 2 DM, but some medications can cause hypoglycemia
Because the brain relies so heavily on glucose, often see altered mental status

32
Q

Somogyi effect and Dawn Phenomenon are both

A

early morning elevations of glucose

33
Q

Chronic complications of DM: Microvascular complications

A
  • Neuropathies, nephropathies, retinopathies, CAD, CVA, PAD
  • Related to the production of advanced glycation end products (reflected in the hemoglobin A1C). Causes damage to endothelial cells.
    -In type 2 DM things are compounded by other issues caused by metabolic syndrome (like chronic inflammation)
34
Q

Chronic complications of DM: Increased risk of infections

A

-Suboptimal vascular response
-Hyperglycemia may influence the growth of microorganisms

35
Q

What occurs during the somogyi effect?

A

Insulin induced hypoglycemia leads to release of things like glucagon, GH, cortisol that raise blood sugar – this causes blood glucose to become elevated which may prompt increased insulin doses to be given (even though the inciting factor was hypoglycemia)

The hypoglycemia often occurs at night and isn’t detected, then the compensatory increase in glucose is seen in the morning

36
Q

What occurs during the dawn phenomenon?

A

Increased blood glucose in the morning that is not triggered by hypoglycemia

Caused by circadian variations in hormone secretion with glucagon secretion to release energy stores to prepare for daily activities

37
Q

What are the two types of complications related to counter regulatory mechanisms?

A
  1. somogyi effect
  2. dawn phenomenon

Patho (16 decks)

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