Exam 2: Diabetes Flashcards
What are the theoretical causes of Diabetes Mellitus?
Genetic, Autoimmune destruction of the pancreas and environmental.
Which Diabetes Mellitus type is more common? Type 1 or Type 2?
Type 2
Where is insulin being produced?
By the Beta cells of the pancreas or called Islets of Langerhans.
How many units of insulin do normal pancreas secrete daily?
40 to 50 units
What is a normal range of glucose?
70 to 120 mg/dL
What are the four functions of insulin?
1) Transport of glucose from blood into cells
2) Convert Glucose to glycogen for storage for future carbohydrate use.
3) Enhance Fat deposition and increase protein synthesis
4) Inhibit gluconeogenesis
What occurs for Type 1 Diabetes Mellitus?
It is an autoimmune destruction of Beta Cells. It leads to eventual cease of insulin production.
Autoantibodies can be present in the body for months to years before symptoms appear.
At what age does Type 1 DM occur and what age is most common to have it?
Peak Onset 11 to 13 years.
Most DM type 1 are <40 years old.
What are the clinical manifestations of Type 1 Diabetes Mellitus?
Polydipsia Polyuria Polyphagia Weight loss Weakness Fatigue.
Do Type 1 DM patients require exogenous insulin?
Yes. They need it to sustain life.
What causes the 3P’s of DM Type 1?
High levels of glucose in the blood pulls water away from the cells (dehydration causing polydipsia). No insulin production means there are no insulin to transfer the glucose to the cells (hunger causing polyphagia) and High glucose in the blood causes a diuretic effect (polyuria).
What are the criteria for Prediabetes?
FBG 100-125 mg/dL
2-hr OGTT 140-199 mg/dL
What is the major risk factor for DM Type 2?
Obesity, especially abdominal and visceral obesity.
Does childhood obesity cause an increase of DM 2 incidence in children?
True.
What are the modifiable risk factors for Type 2 Diabetes Mellitus?
Overweight
Smoking
Sedentary lifestyle
Hypertension
How do people get diagnosed for Metabolic Syndrome?
Patient has to have 3 out of the five listed signs in order to be diagnosed.
1) Increased Blood glucose
2) Abdominal obesity
3) Increased BP
4) Increased triglycerides
5) Decreased HDL
What are the risk factors for DM Type 2?
Overweight Older age Family history Smoking Ethnicity Sedentary Lifestyle Baby > 9lb Gestational DM Hypertension Metabolic Syndrome.
What are the four major metabolic abnormalities for Type 2 DM?
1) Pancreas has decreased ability to produce insulin
2) Excess glucose production from liver.
3) Altered hormones’ and adipokines production which leads to altered glucose and fat metabolism.
4) Insulin resistance => Hyperglycemia => Hyperinsulinemia => Beta cell exhaustion
Is the onset of Type 2 Diabetes Mellitus gradual or immediate?
Gradual. It is diagnosed with routine blood work. Patients may go years with hyperglycemia without any symptoms.
What are the clinical manifestations of Type 2 Diabetes Mellitus?
1) Classical symptoms of DM Type 1 (not common)
2) Recurrent infections
3) Recurrent vaginal yeast/candidal infections
4) Prolonged wound healing
5) Visual Changes
How often should people get screenings for Diabetes Mellitus?
High risk individuals should be screened yearly.
For others, every 3 years after age 45.
What is the diagnostic criteria for Diabetes Melliuts?
Hgb A1C >= 6.5%
FBG >= 126 mg/dL
Two-hour OGTT level >= 200 mg/dL
What should normal A1C range be?
4-6 mg/dL
What is a good range A1C for diabetic patients?
<6.5-7 mg/dL
What are the goals of diabetes management?
1) Reduce symptoms
2) Promote Well-being
3) Prevent acute complications
4) Delay long-term complications
What are the goals of Patient teaching?
1) Nutrition therapy
2) Exercise
3) Glucose monitoring and medication
4) Sick Day guidelines
5) Foot care guidelines
What are the four types of Insulin?
Rapid-acting
Short-acting
Intermediate acting
Long-acting
Name, Clarity, Onset, Duration, Injection When? For Rapid acting?
Names: Lispro and Aspart Clear Onset: 10-30 mins Duration: 3-5 hours Injected 0-15 minutes before meal.
Name, Clarity, Onset, Duration, Injection When? For Short-acting (regular) insulin?
Name: Regular Clear Onset: 30-60 mins Duration: 5-8 hours Injected 30-45mins before meal
Name, Clarity, Onset, Duration, Injection When? For Intermediate-acting insulin?
Name: NPH Cloudy Onset: 1.5-4 hours Duration: 12-18 hours Injected BID (breakfast and Dinner)
Name, Clarity, Onset, Duration, Injection When? For Long-acting insulin
Name: Glargine and Detemir
Clear (DO NOT MIX WITH OTHER INSULIN)
Onset: 1-4 hours (has no peak)
Duration: 24+ hours, continuous and steady.
Injected once daily at either bedtime or morning
When you mix two insulins, which do you draw up first? The cloudy or clear insulin?
Clear insulin first. Then cloudy.
Can you mix Glargine or detemir with Lispro or aspart?
No. You do not mix long-acting insulin with any other insulin
