endocrine diabetes and diabetes problems Flashcards
What is diabetes mellitus (DM)?
A chronic, multisystem disease characterized by poor insulin production, impaired insulin utilization, or both.
What are three major complications associated with DM?
Adult blindness, end-stage renal disease (ESRD), and non-traumatic lower limb amputations.
How does DM contribute to cardiovascular issues?
It is a major contributing factor to heart disease and stroke.
What are the four diagnostic criteria for DM?
- HgbA1C ≥ 6.5%
- Fasting plasma glucose ≥ 126 mg/dL
- 2-hour plasma glucose ≥ 200 mg/dL during an oral glucose tolerance test
- Random plasma glucose ≥ 200 mg/dL in a patient with hyperglycemia symptoms.
What does the HgbA1C test measure?
The percentage of hemoglobin with glucose attached, reflecting blood sugar control over the previous 2-3 months.
Why is HgbA1C important in diabetes management?
It helps assess long-term glucose control and determines if treatment is effective or needs adjustment.
What are the normal glucose levels?
74-106 mg/dL.
At what glucose level is considered low?
Below 74 mg/dL.
At what glucose level is considered high?
Above 106 mg/dL.
What are the four types of diabetes mellitus (DM)?
- Type 1 Diabetes Mellitus (T1DM)
- Type 2 Diabetes Mellitus (T2DM)
- Gestational Diabetes Mellitus (GDM)
- Other specific types (such as those due to genetic defects, diseases of the exocrine pancreas, and drug-induced diabetes).
What is Type 1 Diabetes Mellitus (T1DM)?
An autoimmune disorder where the body develops antibodies against insulin and/or pancreatic beta cells, leading to no insulin production.
What happens when insulin production stops in T1DM?
Glucose remains in the blood, causing cell, tissue, and organ death, which can ultimately be fatal if untreated.
When is T1DM typically diagnosed?
Usually before 40 years of age, though the onset is gradual.
What are two risk factors for developing T1DM?
Genetic predisposition and exposure to viruses.
What is a life-threatening complication of rapid T1DM onset?
Diabetic ketoacidosis (DKA).
What is the classic triad of symptoms in T1DM?
Polydipsia (excessive thirst), polyuria (frequent urination), and polyphagia (excessive hunger).
Why do individuals with T1DM experience polyphagia?
The body believes it is not receiving enough sugar because glucose cannot enter cells without insulin.
What other symptoms are common in T1DM?
Weakness, fatigue, weight loss, and electrolyte abnormalities.
What is Type 2 Diabetes Mellitus (T2DM)?
A condition characterized by inadequate insulin secretion, insulin resistance, and other contributing factors.
What are some common risk factors for T2DM?
Overweight/obesity, older age, family history of T2DM, and being part of non-white ethnic groups.
How does T2DM commonly co-occur with other health issues?
It often co-occurs with high cholesterol and hypertension.
What is the trend regarding T2DM incidence in children?
The incidence is growing due to the increasing prevalence of childhood obesity.
What are the classic symptoms of T2DM?
Polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger).
What additional symptoms might indicate T2DM?
Weakness and fatigue, recurrent infections, prolonged wound healing, vision changes, and signs of renal failure.
What is metabolic syndrome?
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).
How many factors must an individual have to be diagnosed with metabolic syndrome?
An individual must have at least 3 of the 5 specified factors.
What is gestational diabetes mellitus (GDM)?
Diabetes diagnosed for the first time during pregnancy, caused by hormonal changes that block the action of insulin, leading to hyperglycemia.
When does GDM typically develop during pregnancy?
Usually in the third trimester.
What is a common risk associated with GDM for delivery?
Higher risk for cesarean sections due to increased baby size.
How does a baby’s pancreas respond to excess maternal glucose in GDM?
The baby’s pancreas increases insulin production, which can lead to hypoglycemia after birth.
What are some risks for babies born to mothers with GDM?
Higher risk for perinatal death, birth injuries, and neonatal complications.
What are common risk factors for developing GDM?
Obesity, advanced maternal age, and family history of diabetes.
What are some manifestations of GDM?
Polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (excessive hunger), fatigue, recurrent infections, weight loss despite increased appetite, and nausea/vomiting.
What are other types of diabetes mellitus?
Diabetes resulting from injury, interference, or destruction of pancreatic cells due to diseases or medications.
What diseases can lead to secondary diabetes?
Cushing syndrome, hyperthyroidism, pancreatitis, cystic fibrosis, and hemochromatosis.
How can parenteral nutrition affect diabetes?
It can interfere with insulin production and glucose metabolism, potentially leading to diabetes.
What are some medications that can induce diabetes?
Corticosteroids, thiazide diuretics, Dilantin (phenytoin), and atypical antipsychotics.
What is the mechanism by which these diseases and medications lead to diabetes?
They cause damage to pancreatic cells or alter insulin secretion and utilization, leading to hyperglycemia.
What is diabetic ketoacidosis (DKA)?
A life-threatening condition caused by a profound deficiency of insulin, leading to hyperglycemia, ketosis, acidosis, hyperkalemia, and severe dehydration.
In which types of diabetes is DKA most common?
Primarily in Type I diabetics, but it can also occur in Type II diabetics during periods of physiological stress.
What are some common etiologies of DKA?
Infections, inadequate insulin dosage, undiagnosed Type I diabetes, poor self-management, and neglect.
What causes the life-threatening condition of DKA?
- Absolute or relative deficiency of insulin.
- Increase in counterregulatory hormones (glucagon, catecholamines, cortisol, and growth hormone) that worsen hyperglycemia.
How does glucagon contribute to DKA?
It signals the liver to release stored glucose (glycogen), exacerbating hyperglycemia.
What role do catecholamines play in DKA?
They stimulate glucagon secretion and interfere with glucose disposal by tissues.
How does cortisol affect glucose levels in DKA?
It acts on the liver, muscle, and adipose tissue to release more sugar.
What is the classic triad of manifestations in DKA?
Polyuria, polydipsia, and polyphagia.
What are some specific signs of DKA?
Hyperglycemia, sweet fruity odor (acetone breath), ketonuria, Kussmaul respirations, nausea/vomiting, lethargy, weakness, confusion, signs of dehydration, tachycardia, and hypotension.
How is DKA diagnosed?
Blood glucose > 250 mg/dL, arterial blood gas (ABG) pH < 7.3, serum bicarbonate level < 16 mEq/L, and ketonuria.
What is hyperosmolar hyperglycemic syndrome (HHS)?
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.
What is the primary risk factor for HHS?
Individuals over 60 years old with Type II diabetes.
What are some common precipitating factors for HHS?
Infections, other illnesses, sepsis, and newly diagnosed Type II diabetes.
How do the manifestations of HHS differ from DKA?
HHS produces fewer symptoms in the early stages, so hyperglycemia may go unnoticed until it becomes severe.
What are some serious consequences of HHS?
Severe hyperglycemia leads to increased serum osmolality and severe neurological manifestations.
How is HHS diagnosed?
Serum glucose > 600 mg/dL, high serum osmolality, and minimal ketones in blood and urine.
What is a key difference in hyperglycemia levels between DKA and HHS?
DKA presents with severe hyperglycemia, while HHS presents with severe hyperglycemia and elevated osmolality.
What type of metabolic imbalance is associated with DKA?
Metabolic acidosis with a pH < 7.3.
What is the ketone level in DKA compared to HHS?
DKA shows ketonemia (elevated beta-hydroxybutyrate), while HHS has minimal or negative ketonemia.
How does volume depletion differ between DKA and HHS?
HHS involves profound volume depletion, whereas DKA may involve less severe volume depletion.
Which demographic is more affected by DKA?
Young individuals and those with Type 1 diabetes mellitus (T1DM).
Which demographic is more affected by HHS?
Elderly individuals, often with Type 2 diabetes mellitus (T2DM), with about 20% having no prior history of T2DM.
How does the presentation of DKA differ from HHS?
DKA typically has an acute presentation, while HHS has a longer, protracted course of illness.
What is hypoglycemia?
A condition characterized by low blood sugar levels, defined as <74 mg/dL.
What are common precipitating factors for hypoglycemia?
Mismatched food intake with the peak action of insulin or other agents, or poor food intake.
What are some common manifestations of hypoglycemia?
Tremors, palpitations, diaphoresis (sweating), anxiety/irritability, hunger, pallor, dyspashia , visual disturbances, confusion, changes in level of consciousness (LOC), coma, and death.
How is hypoglycemia diagnosed?
Through history and physical examination (H&P) and blood glucose check.
What is angiopathy in the context of diabetes?
Damage to blood vessels that can lead to various complications.
What is diabetic retinopathy?
A complication that affects the eyes, leading to vision issues due to damage to the retina.
What is nephropathy in diabetes?
Damage to the nephrons, which can lead to kidney dysfunction and potentially kidney failure.
What does neuropathy refer to in diabetic patients?
Damage to the nerves, which can cause pain, tingling, and loss of sensation, especially in the extremities.
What are diabetic wounds?
Non-healing wounds that occur due to neuropathy and poor circulation, often leading to serious infections.
Why are amputations a concern for diabetic patients?
Due to the complications of diabetic wounds and infections, which can lead to tissue death and necessitate amputation.
How can diabetes affect mental health?
Chronic complications can lead to depression and anxiety in diabetic patients.
