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pathophysiology > endocrine diabetes and diabetes problems > Flashcards

endocrine diabetes and diabetes problems Flashcards

1
Q

What is diabetes mellitus (DM)?

A

A chronic, multisystem disease characterized by poor insulin production, impaired insulin utilization, or both.

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2
Q

What are three major complications associated with DM?

A

Adult blindness, end-stage renal disease (ESRD), and non-traumatic lower limb amputations.

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3
Q

How does DM contribute to cardiovascular issues?

A

It is a major contributing factor to heart disease and stroke.

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4
Q

What are the four diagnostic criteria for DM?

A
  1. HgbA1C ≥ 6.5%
  2. Fasting plasma glucose ≥ 126 mg/dL
  3. 2-hour plasma glucose ≥ 200 mg/dL during an oral glucose tolerance test
  4. Random plasma glucose ≥ 200 mg/dL in a patient with hyperglycemia symptoms.
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5
Q

What does the HgbA1C test measure?

A

The percentage of hemoglobin with glucose attached, reflecting blood sugar control over the previous 2-3 months.

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6
Q

Why is HgbA1C important in diabetes management?

A

It helps assess long-term glucose control and determines if treatment is effective or needs adjustment.

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7
Q

What are the normal glucose levels?

A

74-106 mg/dL.

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8
Q

At what glucose level is considered low?

A

Below 74 mg/dL.

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9
Q

At what glucose level is considered high?

A

Above 106 mg/dL.

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10
Q

What are the four types of diabetes mellitus (DM)?

A
  1. Type 1 Diabetes Mellitus (T1DM)
  2. Type 2 Diabetes Mellitus (T2DM)
  3. Gestational Diabetes Mellitus (GDM)
  4. Other specific types (such as those due to genetic defects, diseases of the exocrine pancreas, and drug-induced diabetes).
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11
Q

What is Type 1 Diabetes Mellitus (T1DM)?

A

An autoimmune disorder where the body develops antibodies against insulin and/or pancreatic beta cells, leading to no insulin production.

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12
Q

What happens when insulin production stops in T1DM?

A

Glucose remains in the blood, causing cell, tissue, and organ death, which can ultimately be fatal if untreated.

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13
Q

When is T1DM typically diagnosed?

A

Usually before 40 years of age, though the onset is gradual.

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14
Q

What are two risk factors for developing T1DM?

A

Genetic predisposition and exposure to viruses.

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15
Q

What is a life-threatening complication of rapid T1DM onset?

A

Diabetic ketoacidosis (DKA).

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16
Q

What is the classic triad of symptoms in T1DM?

A

Polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger).

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17
Q

Why do individuals with T1DM experience polyphagia?

A

The body believes it is not receiving enough sugar because glucose cannot enter cells without insulin.

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18
Q

What other symptoms are common in T1DM?

A

Weakness, fatigue, weight loss, and electrolyte abnormalities.

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19
Q

What is Type 2 Diabetes Mellitus (T2DM)?

A

A condition characterized by inadequate insulin secretion, insulin resistance, and other contributing factors.

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20
Q

What are some common risk factors for T2DM?

A

Overweight/obesity, older age, family history of T2DM, and being part of non-white ethnic groups.

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21
Q

How does T2DM commonly co-occur with other health issues?

A

It often co-occurs with high cholesterol and hypertension.

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22
Q

What is the trend regarding T2DM incidence in children?

A

The incidence is growing due to the increasing prevalence of childhood obesity.

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23
Q

What are the classic symptoms of T2DM?

A

Polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger).

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24
Q

What additional symptoms might indicate T2DM?

A

Weakness and fatigue, recurrent infections, prolonged wound healing, vision changes, and signs of renal failure.

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25
Q

What is metabolic syndrome?

A

A cluster of conditions increasing the risk for T2DM, characterized by having 3 of the following 5 factors: hyperglycemia, abdominal obesity, hypertension, high triglyceride levels, and low levels of high-density lipoproteins (HDLs).

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26
Q

How many factors must an individual have to be diagnosed with metabolic syndrome?

A

An individual must have at least 3 of the 5 specified factors.

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27
Q

What is gestational diabetes mellitus (GDM)?

A

Diabetes diagnosed for the first time during pregnancy, caused by hormonal changes that block the action of insulin, leading to hyperglycemia.

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28
Q

When does GDM typically develop during pregnancy?

A

Usually in the third trimester.

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29
Q

What is a common risk associated with GDM for delivery?

A

Higher risk for cesarean sections due to increased baby size.

30
Q

How does a baby’s pancreas respond to excess maternal glucose in GDM?

A

The baby’s pancreas increases insulin production, which can lead to hypoglycemia after birth.

31
Q

What are some risks for babies born to mothers with GDM?

A

Higher risk for perinatal death, birth injuries, and neonatal complications.

32
Q

What are common risk factors for developing GDM?

A

Obesity, advanced maternal age, and family history of diabetes.

33
Q

What are some manifestations of GDM?

A

Polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (excessive hunger), fatigue, recurrent infections, weight loss despite increased appetite, and nausea/vomiting.

34
Q

What are other types of diabetes mellitus?

A

Diabetes resulting from injury, interference, or destruction of pancreatic cells due to diseases or medications.

35
Q

What diseases can lead to secondary diabetes?

A

Cushing syndrome, hyperthyroidism, pancreatitis, cystic fibrosis, and hemochromatosis.

36
Q

How can parenteral nutrition affect diabetes?

A

It can interfere with insulin production and glucose metabolism, potentially leading to diabetes.

37
Q

What are some medications that can induce diabetes?

A

Corticosteroids, thiazide diuretics, Dilantin (phenytoin), and atypical antipsychotics.

38
Q

What is the mechanism by which these diseases and medications lead to diabetes?

A

They cause damage to pancreatic cells or alter insulin secretion and utilization, leading to hyperglycemia.

39
Q

What is diabetic ketoacidosis (DKA)?

A

A life-threatening condition caused by a profound deficiency of insulin, leading to hyperglycemia, ketosis, acidosis, hyperkalemia, and severe dehydration.

40
Q

In which types of diabetes is DKA most common?

A

Primarily in Type I diabetics, but it can also occur in Type II diabetics during periods of physiological stress.

41
Q

What are some common etiologies of DKA?

A

Infections, inadequate insulin dosage, undiagnosed Type I diabetes, poor self-management, and neglect.

42
Q

What causes the life-threatening condition of DKA?

A
  1. Absolute or relative deficiency of insulin.
  2. Increase in counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone) that worsen hyperglycemia.
43
Q

How does glucagon contribute to DKA?

A

It signals the liver to release stored glucose (glycogen), exacerbating hyperglycemia.

44
Q

What role do catecholamines play in DKA?

A

They stimulate glucagon secretion and interfere with glucose disposal by tissues.

45
Q

How does cortisol affect glucose levels in DKA?

A

It acts on the liver, muscle, and adipose tissue to release more sugar.

46
Q

What is the classic triad of manifestations in DKA?

A

Polyuria, polydipsia, and polyphagia.

47
Q

What are some specific signs of DKA?

A

Hyperglycemia, sweet fruity odor (acetone breath), ketonuria, Kussmaul respirations, nausea/vomiting, lethargy, weakness, confusion, signs of dehydration, tachycardia, and hypotension.

48
Q

How is DKA diagnosed?

A

Blood glucose > 250 mg/dL, arterial blood gas (ABG) pH < 7.3, serum bicarbonate level < 16 mEq/L, and ketonuria.

49
Q

What is hyperosmolar hyperglycemic syndrome (HHS)?

A

A life-threatening syndrome related to a deficiency of insulin (not enough to cause DKA), resulting in severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

50
Q

What is the primary risk factor for HHS?

A

Individuals over 60 years old with Type II diabetes.

51
Q

What are some common precipitating factors for HHS?

A

Infections, other illnesses, sepsis, and newly diagnosed Type II diabetes.

52
Q

How do the manifestations of HHS differ from DKA?

A

HHS produces fewer symptoms in the early stages, so hyperglycemia may go unnoticed until it becomes severe.

53
Q

What are some serious consequences of HHS?

A

Severe hyperglycemia leads to increased serum osmolality and severe neurological manifestations.

54
Q

How is HHS diagnosed?

A

Serum glucose > 600 mg/dL, high serum osmolality, and minimal ketones in blood and urine.

55
Q

What is a key difference in hyperglycemia levels between DKA and HHS?

A

DKA presents with severe hyperglycemia, while HHS presents with severe hyperglycemia and elevated osmolality.

56
Q

What type of metabolic imbalance is associated with DKA?

A

Metabolic acidosis with a pH < 7.3.

57
Q

What is the ketone level in DKA compared to HHS?

A

DKA shows ketonemia (elevated beta-hydroxybutyrate), while HHS has minimal or negative ketonemia.

58
Q

How does volume depletion differ between DKA and HHS?

A

HHS involves profound volume depletion, whereas DKA may involve less severe volume depletion.

59
Q

Which demographic is more affected by DKA?

A

Young individuals and those with Type 1 diabetes mellitus (T1DM).

60
Q

Which demographic is more affected by HHS?

A

Elderly individuals, often with Type 2 diabetes mellitus (T2DM), with about 20% having no prior history of T2DM.

61
Q

How does the presentation of DKA differ from HHS?

A

DKA typically has an acute presentation, while HHS has a longer, protracted course of illness.

62
Q

What is hypoglycemia?

A

A condition characterized by low blood sugar levels, defined as <74 mg/dL.

63
Q

What are common precipitating factors for hypoglycemia?

A

Mismatched food intake with the peak action of insulin or other agents, or poor food intake.

64
Q

What are some common manifestations of hypoglycemia?

A

Tremors, palpitations, diaphoresis (sweating), anxiety/irritability, hunger, pallor, dyspashia , visual disturbances, confusion, changes in level of consciousness (LOC), coma, and death.

65
Q

How is hypoglycemia diagnosed?

A

Through history and physical examination (H&P) and blood glucose check.

66
Q

What is angiopathy in the context of diabetes?

A

Damage to blood vessels that can lead to various complications.

67
Q

What is diabetic retinopathy?

A

A complication that affects the eyes, leading to vision issues due to damage to the retina.

68
Q

What is nephropathy in diabetes?

A

Damage to the nephrons, which can lead to kidney dysfunction and potentially kidney failure.

69
Q

What does neuropathy refer to in diabetic patients?

A

Damage to the nerves, which can cause pain, tingling, and loss of sensation, especially in the extremities.

70
Q

What are diabetic wounds?

A

Non-healing wounds that occur due to neuropathy and poor circulation, often leading to serious infections.

71
Q

Why are amputations a concern for diabetic patients?

A

Due to the complications of diabetic wounds and infections, which can lead to tissue death and necessitate amputation.

72
Q

How can diabetes affect mental health?

A

Chronic complications can lead to depression and anxiety in diabetic patients.

pathophysiology (56 decks)

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