Endocrine - Diabetic complications

Question 1

Four counter-regulatory hormones that increase glucose? When do these increase?

Answer 1

• Glucagon
• Growth hormone
• Epinephrine
• Cortisol
• Increase during uncontrolled diabetes and stress

Question 2

*______ -Hyperglycemia inappropriately activates this enzyme in certain tissues. What does things does this contribute too?

Answer 2

• Protein Kinase C (PKC)

* Microvascular, macrovascular, and neurological complications

Question 3

_____Pathway-
Glucose is converted to _____-> _____; with hyperglycemia there is an accumulation these, which causes an increase in _____ which attracts ____ and leads to _____.

Answer 3

• Polyol Pathway
• Sorbitol ->Fuctose
• Increase in intracellular osmotic pressure
• Attracts fluid
• Leade to tissue damage

Question 4

Persistent hyperglycemia leads to ________ of glucose to collagen and protein in blood vessel walls and interstitial tissue.
Known as______.

Answer 4

• IRREVERSIBLE BINDING

* Advanced Glycosylation End-products (AGEs )

Question 5

4 common causes of hypoglycemia

Answer 5

• Exercise
• Deficient food intake or absorption
• Medication - insulin excess/oral diabetics
• Alcohol

Question 6

Distal Symmetric Polyneuropathy aka _____ is _____.
*Sensory alterations: Paresthesias- _______. Starts at ____ moves up _____
Dysthesias- _________
Anesthesia- _______
*Motor alterations: ____ r/t intrinsic muscles

Answer 6

• Peripheral Neuorpathy
• Distal
• Tingling, burning, numbing- starts at toes and moves up legs
• Stinging/stabbing pain
• Loss of sensation
• Foot deformities

Question 7

loss of warning signs of hypoglycemia

Answer 7

Defective counter-regulation (Autonomic neuropathy)

Question 8

Focal neuropathy - Sudden diplopia, ptosis, eye pain

Answer 8

Cranial Nerve Palsies 3 & 6

Question 9

pain, asymmetric weakness, wasting of iliopsoas, quadriceps, adductor muscles

Answer 9

Amyotrophy

Question 10

____Cream is a ____ inhibitor used for ____?

Answer 10

• Capscasin
• Substance P
• DPN

Question 11

3 classes of Meds used to treat Diabetic Neuropathy? 4 examples

Answer 11

TCA, Anticonvulsants, SNRI,

• TCA - amitriptyline
• Anticonvulsants - Gabapentin, Pregabalin
• SNRI - Duloxetine

Question 12

Diabetic Microvascular disease results in Hypoxia and ischemia of various organs, especially the ____ and ____.

Answer 12

• Retina

* Kidney

Question 13

Retinopathy - retinal ____, RBC _____

Answer 13

*Retinal ischemia
*RBC aggregation
*

Question 14

neovascularization and fibrosis in retina and optic disc, traction may cause retinal detachment, hemorrhage in vitreous humor, etc. what stage of retinopathy is this?

Answer 14

Proliferative

Question 15

Treatmetns for diabetic retinopathy?

Answer 15

Laser coagulation, vitrectomy

Question 16

most common cause of end-stage renal disease (ESRD).

Answer 16

Nephropathy

Question 17

1st manifestation of renal disease

Answer 17

Microabluminuria/proteinuria

Question 18

(later) decrease in oncotic pressure, fluid overload, anasara (generalized body edema).

Answer 18

hypoproteinemia

Question 19

Uremia GFR drops below ___ml/min..leads to?

Answer 19

• 10

* Uncontrolled hypertesnion

Question 20

____(Protective cholesterol) tend to be ____in diabetics

Answer 20

• HDLS

* Low

Question 21

ADA recommendations for BP and LDL cholesterol?

Answer 21

BP- lower than 130/80 mm Hg LDL- lower than 100 mg/dl

Question 22

in PAD

• Lesions begin as ulcers, progress to?

Answer 22

osteomyelitis or gangrene and eventually amputation