DM Patho (NUR 325) Created by Diana Hallis Flashcards
1
Q
What percentage of the population has diabetes?
A
10%
2
Q
Diabetes is the __ leading cause of death in the United States?
A
7th
3
Q
What is diabetes?
A
A metabolic disorder characterized by hyperglycemia that results from defects in insulin secretion or action
4
Q
Why is diabetes a problem?
A
It can cause extensive long-term damage to multiple organ systems
5
Q
What are simple sugars and complex chemical units?
A
Carbohydrates
6
Q
Where are carbohydrates broken down?
A
duodenum and proximal jejunum
7
Q
Regulating glucose depends on the __
A
Liver
8
Q
When we eat carbs they are broken down into glucose, and our liver does what?
A
extracts glucose from the blood
9
Q
After our liver extracts glucose from the blood it will synthesize it into __
A
glycogen (store it)
10
Q
If our liver detects we need sugar it will __ __
A
breakdown glycogen
11
Q
Breakdown of glycogen aka __
A
glycogenolysis
12
Q
__ __ extract glucose for their energy need
A
Peripheral tissues (all cells)
13
Q
The pancreas controls our body’s fuel supply in connection with the __
A
Liver
14
Q
The pancreas controls how much __ and __ is in the blood
A
glucose and insulin
15
Q
The pancreas has __ and __ functions
A
exocrine and endocrine
16
Q
Exocrine function of the pancreas:
A
pancreatic cells secrete directly into ducts, NOT the bloodstream
17
Q
endocrine function of the pancreas:
A
cells secrete insulin directly into the blood stream
18
Q
Where in the pancreas is insulin secreted?
A
Islet of Langerhans
19
Q
Islet of Langerhans accounts for __% of the pancrease
A
1-2%
20
Q
Islet of Langerhand takes up __ to __% of the pancreatic blood flow
A
15-20%
21
Q
2 types of cells in the Islet of Langerhans are…
A
alpha and beta cells
22
Q
Alpha cells secrete __ in response to low blood sugar
A
glucagon
23
Q
What does glucagon do?
A
Stimulates the liver to release stored glucose into the blood
24
Q
How does the liver release glucose in response to glucagon?
A
Glycogenesis
25
What do beta cells in the Islet of Langerhans do?
produce insulin
26
How does insulin lower blood glucose?
It stimulates the movement of glucose into body tissues
27
Insulin is what stimulates your cells to be able to...
use glucose
28
4 hormones that RAISE blood glucose levels are...
Glucagonepinephrinegrowth hormoneglucocorticoids
29
Where is glucagon released?
Islet of Langerhans in the pancreas
30
Where is epinephrine released?
adrenal medulla and other chromatin tissues
31
Where are glucocorticoids released?
adrenal cortex
32
Where is growth hormone secreted from?
anterior pituitary
33
Insulin will __ blood sugar
decrease
34
Glucagon will __ blood sugar
increase
35
Epinephrine will __ blood sugar
increase
36
Glucocorticoids will __ blood sugar
increase
37
Growth hormone will __ blood sugar
increase
38
Together, insulin, glucagon, epinephrine, glucocorticoids, and growth hormone will create a...
counter-regulatory mechanism
39
Counter-regulatory mechanism prevents __ under the effect of insulin
hypoglycemia
40
Insulin is produced by the __ __
beta cells
41
Insulin stimulates the... (3 things) of glucose
Uptake, utilization, and storage of glucose
42
All cells need glucose, what hormone tells your body to use this glucose?
Insulin
43
Insulin also stimulates the liver to store glucose as __
glycogen (when the cells do not need glucose)
44
Insulin inhibits the breakdown of __ __
adipose tissue
45
Once the liver has been saturated with glycogen, insulin will promote the liver to synthesize __ __
fatty acids
46
In the healthy person, insulin has a __-__ effect
fat-sparing
47
The fat-sparing effect of insulin drives cells to use __ instead of fat for energy
carbohydrates
48
What happens when you don't have enough insulin?
Can't breakdown carbohydrates efficiently
49
If your body cannot breakdown carbohydrates efficiently, this will cause a decrease in __ use by the cells
glucose
50
If cells can't use glucose, __ results.
hyperglycemia
51
When cells can't use glucose, this causes cells to use an alternate source of energy, which is __ __
fatty acids
52
Decrease in insulin leads to impaired __ __
fat metabolism
53
Insulin deficiency increases __
lipolysis
54
Insulin deficiency decreases __
lipogenesis
55
Impaired fat metabolism causes __ __ __ in the blood
free fatty acids
56
Free fatty acids are an alternate energy source for when...
glucose cannot be used
57
Excess free fatty acids is converted to __ and __
cholesterol and phospholipids
58
Free fatty acids will breakdown into __
acetyl-CoA
59
Acetyl-CoA is used by the liver to become __ __
acetoacetic acid
60
Substances that is composed of the acid breakdown product acetoacetic acid are __ __
ketone bodies
61
Short-term complication of impaired fat metabolism is increased __ __
serum ketones
62
Increased serum ketones aka
ketosis
63
Ketosis is measured by __ and __ levels
blood and urine levels
64
Ketosis can cause severe __ __
metabolic acidosis
65
Severe metabolic acidosis can lead to __
coma
66
Long-term complication of impaired fat metabolism
atherosclerosis
67
Why does long-term impaired fat metabolism cause atherosclerosis?
Due to the increased serum lipid levels
68
Insulin deficiency can also lead to __
proteolysis
69
What is proteolysis?
protein breakdown
70
Proteolysis causes the body to store protein ineffectively due to...?
increased protein catabolism and cessation of protein synthesis
71
Proteolysis causes increased in circulating __ __
amino acids
72
During increased circulation of amino acids, cells can then use amino acids as an __ __ when glucose is not available
energy source
73
Protein catabolism = __ __
muscle wasting
74
Protein catabolism also happens in people who are __
starving
75
Why do people who are starving have protein catabolism?
they don't have carbohydrates for an energy source
76
Protein catabolism leads to... (4)
1) Muscle wasting 2) multiple organ dysfunction 3) aminoacidemia 3) increased urea nitrogen (BUN)
77
Protein catabolism is more common in Type __ diabetics
Type 1 diabetics
78
Hyperglycemia increases __ __ pressure
plasma osmotic pressure
79
What is plasma osmotic pressure?
High blood concentration
80
High plasma osmotic pressure causes fluid in the tissues to shift to...
the vascular space to maintain homeostasis
81
When fluid shifts into the vascular space to decrease osmotic pressure, this results in __ __
cellular dehydration
82
Osmotic diuresis will cause __
glycosuria
83
Glycosuria definition
Excretion of sugar in the urine
84
When does glycosuria occur?
When hyperglycemia reaches a point beyond what the kidneys can reabsorb
85
Insulin deficiency leads to... (3 Ps!)
polyuria, polyphagia, polydipsia
86
Polyphagia definition
increased hunger
87
Polydipsia definition
increased thirst
88
Polyuria definition
increased urination
89
Why does insulin deficiency lead to polyphagia?
Catabolism of fat and protein, and also cellular starvation
90
What does insulin deficiency lead to polydipsia?
It's related to increased serum osmolarity
91
Because of vascular osmolarity there is increased water excretion and loss of __
electrolytes such as K+, Na+, Cl-
92
Diabetes is either an __ or __ insulin deficiency
absolute or relative
93
What are the three main types of diabetes?
Type 1, Type 2, and Gestational
94
Prediabetic A1C range
5.7-6.4
95
Diabetic A1C range
6.5 or higher
96
Fasting plasma glucose prediabetic range
100-125
97
Fasting plasma glucose diabetic range
126 or higher
98
Oral glucose tolerance test pre diabetic range
140-199
99
Oral glucose tolerance test diabetic range
200 or higher
100
When is an oral glucose tolerance test used?
to test gestational diabetes
101
Type 1 diabetes is the most common
pediatric chronic disease
102
When is type 1 diabetes usually diagnosed?
around 12 years of age
103
Type 1 diabetes can be __
idiopathic
104
Type 1 diabetes is much less common than...
Type 2 diabetes
105
You can be diagnosed with diabetes as an __
as an adult
106
Type 1 diabetes is considered an __ disease
autoimmune disease
107
With an autoimmune disease, there is a genetic predisposition and some sort of __ __
environmental factor/trigger
108
Sometimes the trigger for type 1 diabetes is thought to be a __
Virus that causes your body to attack the pancreatic beta cells
109
Diabetes type 1 is a slowly progressive T-cell mediated disease where your T-cells destroy...
your own beta cells
110
__ form on beta cells and circulate in the blood and lymphatics
autoantigens
111
Autoantigens activate cellular and humoral immunity which destroy what?
destroy the beta cells
112
When beta cells are destroyed they cannot be __, resulting in.,..
cannot be regenerated, resulting in a complete lack of endogenous insulin
113
Type 1 diabetes represents __ % of all diabetics
5-10% of all diabetics
114
Old names for type 1 diabetes are...
Insulin dependent diabetes, juvenile onset diabetes
115
Type 1 diabetes is often incorrectly diagnosed as...
type 2
116
Type 1 diabetes has a long preclinical period with symptoms showing when....
Insulin is almost gone, which produces the hyperglycemia symptoms
117
The preclinical period of type 1 diabetes typical age range
6-12 years
118
Type 1 diabetes symptoms
Polyuria, polyphagia, polydipsia, weight loss, fatigue, frequent infections, itching, visual changes, parathesia
119
Genetic and __ __ responsible for type 2 diabetes
environmental factors
120
Risk factors for type 2 diabetes (5)
Age, obesity, hypertension, inactivity, family history
121
Type 2 diabetes is most likely due to __ __
Insulin resistance
122
Insulin resistance is where cells....?
don't respond to insulin
123
With type 2 diabetes, in addition to insulin resistance there is also decreased insulin secretion. Why?
due to beta cells being overwhelmed
124
Sub-optimal response of insulin sensitive tissues is most likely the result of what?
Long-term obesity, because insulin is constantly being secreted into the blood stream. Cells become insensitive
125
Non-modifiable risk factors for type 2 diabetes
Family history, age of 45 years or higher, race/ethnicity, previous gestational diabetes
126
Modifiable risk factors for type 2 diabetes
Physical inactivity, obesity, hypertension, hyperlipidemia
127
Insulin is the key to...
letting glucose into the cells
128
Symptoms are not as evident in type 2 as they are in..
type 1
129
Symptoms for type 2 diabetes are usually vague...
nonspecific manifestations of hyperglycemia
130
Symptoms of type 2 diabetes
Fatigue, recurrent infections, visual changes, prolonged wound healing
131
Doctors usually test those at high risk for type 2 diabetes such as
Overweight, hyperlipidemia, hypertension
132
Type 2 diabetes: Causes impaired insulin secretion because of...
B cell exhaustion due to overuse
133
Type 2 diabetes: Peripheral insulin resistance because of...
Increased visceral fat
134
Type 2 diabetes causes increased hepatic production because of...
Impaired suppression of gluconeogensis within the liver
135
Another metabolic complication of type 2 diabetes
Altered production of hormones and cytokines by adipose tissue
136
Characterized by hyperglycemia, acidosis, and ketonuria
diabetic ketoacidosis (DKA)
137
DKA is more common in...
Type 1 diabetics
138
Acidosis can be so severe that they...
go in a coma
139
DKA blood sugars are in the...
400-600 range
140
Extremely high blood sugar (600-800), very thick blood, BUT normal pH
Hyperosmolar hyperglycemic syndrome (HHS)
141
HHS is more common in...
Type 2 diabetics
142
HHS has less profound insulin deficiency than DKA, but
more significant fluid deficiency (osmolarity)
143
Rapid onset, blood sugar less than 55-60
hypoglycemia
144
Hypoglycemia is usually related to...
medications
145
Hypoglycemia is common in...
BOTH types of diabetics
146
Patients whose blood sugar is normally in the 200 range will experience
symptoms of hypoglycemia before getting to 55-60 range
147
Symptoms of hypoglycemia - make sure you know these!
Pallor, sweating, increased heart rate, palpitations, convulsions, coma, tremors, anxiety, restlessness, hunger
148
Acute complications of diabetes (3)
DKA, HHS, hypoglycemia
149
Chronic complications of diabetes are typically associated with...
Poorly controlled diabetes
150
2 types of tissue damaged caused by chronic poorly controlled diabetes
microvascular and macrovascular
151
Damage to capillaries, retinopathies, neuropathies, nephropathies
microvascular tissue damage
152
Damage to large vessels, coronary artery, pheriphal vascular, and cerebrovascular
microvascular tissue damage
153
Microvascular tissue damage: Frequency and severity of lesions are proportional to...
length of time with uncontrolled diabetes or duration of the disease
154
Accompany microvascular disease usually in the eyes, kidneys, and nerves
Hypoxia and ischemia
155
Diabetes can damage capillaries causing...
capillary membrane thickening
156
Microangiopathy
Small vessel disease
157
Microvascular tissue damage can lead to
dead toes, feet, damaged nerves
158
Most common complication of diabetes
Diabetic neuropathy
159
Diabetic neuropathy related to the
metabolic and vascular factors associated with chronic high blood sugar
160
Chronic hyperglycemia can cause diabetic neuropathy by
Ischemia and demyelination of the nerves which causes neural changes and delayed conduction
161
Diabetic neuropathy causes loss of
pain, temperature, and vibration sensations
162
Diabetic neuropathy leads to...
ulcers, infections, and results in amputation
163
Diabetic retinopathy is the
leading cause of blindness worldwide
164
Diabetic retinopathy results from..
relative hypoxemia, damage to retinal blood vessels, red blood cell aggregation, and hypertension
165
Diabetic retinopathy: Small vessels become occlude and cause
infarction
166
Diabetic nephropathy is the most common cause of...
chronic kidney disease and end stage renal disease
167
Why do diabetics get diabetic nephropathy?
The glomerular basement membrane becomes thick and hard and nonfunctional (sclerosed)
168
What percentage of diabetic develop diabetic nephropathy?
50%
169
What do you need to educated diabetic patients to do?
Check their feet, know if they are feeling pain or not, get eyes checked, have kidneys monitored and watch urine output. Are you peeing?
170
Macrovascular problems are more common in...
Type 2 diabetes
171
Example of macrovascular complication of type 2 diabetes
Atherosclerosis
172
Diabetics are at increased risk for __
Infection
173
Atherosclerosis puts type 2 diabetics are higher risk for
Infection, strokes, CAD, PAD
174
Macrovascular complications in diabetes are thought to b caused from... (4)
Oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased cytokine production
175
When you have hyperglycemia your body starts to do a lot of other things such as...
Oxidative stress, inflammation, contributes to the development to atherosclerosis
176
Diabetics have diminished __ __ of infection
warning signs of infection
177
Because of the vascular damage many diabetics have, when there is an infection
WBCs can't get there to heal it
178
Bacteria grow more rapidly in diabetics because
Bacteria use glucose to grow, so they can proliferate quicker
179
Sometimes in response to diabetes, WBCs become __ and __
become abnormal and ineffective
