Exam 2: Diabetes

Question 1

What are the theoretical causes of Diabetes Mellitus?

Answer 1

Genetic, Autoimmune destruction of the pancreas and environmental.

Question 2

Which Diabetes Mellitus type is more common? Type 1 or Type 2?

Answer 2

Type 2

Question 3

Where is insulin being produced?

Answer 3

By the Beta cells of the pancreas or called Islets of Langerhans.

Question 4

How many units of insulin do normal pancreas secrete daily?

Answer 4

40 to 50 units

Question 5

What is a normal range of glucose?

Answer 5

70 to 120 mg/dL

Question 6

What are the four functions of insulin?

Answer 6

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

Question 7

What occurs for Type 1 Diabetes Mellitus?

Answer 7

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.

Question 8

At what age does Type 1 DM occur and what age is most common to have it?

Answer 8

Peak Onset 11 to 13 years.

Most DM type 1 are <40 years old.

Question 9

What are the clinical manifestations of Type 1 Diabetes Mellitus?

Answer 9

Polydipsia
Polyuria
Polyphagia 
Weight loss
Weakness
Fatigue.

Question 10

Do Type 1 DM patients require exogenous insulin?

Answer 10

Yes. They need it to sustain life.

Question 11

What causes the 3P’s of DM Type 1?

Answer 11

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).

Question 12

What are the criteria for Prediabetes?

Answer 12

FBG 100-125 mg/dL

2-hr OGTT 140-199 mg/dL

Question 13

What is the major risk factor for DM Type 2?

Answer 13

Obesity, especially abdominal and visceral obesity.

Question 14

Does childhood obesity cause an increase of DM 2 incidence in children?

Answer 14

True.

Question 15

What are the modifiable risk factors for Type 2 Diabetes Mellitus?

Answer 15

Overweight
Smoking
Sedentary lifestyle
Hypertension

Question 16

How do people get diagnosed for Metabolic Syndrome?

Answer 16

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

Question 17

What are the risk factors for DM Type 2?

Answer 17

Overweight
Older age
Family history 
Smoking 
Ethnicity 
Sedentary Lifestyle 
Baby > 9lb 
Gestational DM 
Hypertension 
Metabolic Syndrome.

Question 18

What are the four major metabolic abnormalities for Type 2 DM?

Answer 18

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

Question 19

Is the onset of Type 2 Diabetes Mellitus gradual or immediate?

Answer 19

Gradual. It is diagnosed with routine blood work. Patients may go years with hyperglycemia without any symptoms.

Question 20

What are the clinical manifestations of Type 2 Diabetes Mellitus?

Answer 20

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

Question 21

How often should people get screenings for Diabetes Mellitus?

Answer 21

High risk individuals should be screened yearly.

For others, every 3 years after age 45.

Question 22

What is the diagnostic criteria for Diabetes Melliuts?

Answer 22

Hgb A1C >= 6.5%

FBG >= 126 mg/dL

Two-hour OGTT level >= 200 mg/dL

Question 23

What should normal A1C range be?

Answer 23

4-6 mg/dL

Question 24

What is a good range A1C for diabetic patients?

Answer 24

<6.5-7 mg/dL

Question 25

What are the goals of diabetes management?

Answer 25

1) Reduce symptoms
2) Promote Well-being
3) Prevent acute complications
4) Delay long-term complications

Question 26

What are the goals of Patient teaching?

Answer 26

1) Nutrition therapy
2) Exercise
3) Glucose monitoring and medication
4) Sick Day guidelines
5) Foot care guidelines

Question 27

What are the four types of Insulin?

Answer 27

Rapid-acting
Short-acting
Intermediate acting
Long-acting

Question 28

Name, Clarity, Onset, Duration, Injection When? For Rapid acting?

Answer 28

Names: Lispro and Aspart 
Clear 
Onset: 10-30 mins 
Duration: 3-5 hours 
Injected 0-15 minutes before meal.

Question 29

Name, Clarity, Onset, Duration, Injection When? For Short-acting (regular) insulin?

Answer 29

Name: Regular 
Clear 
Onset: 30-60 mins
Duration: 5-8 hours 
Injected 30-45mins before meal

Question 30

Name, Clarity, Onset, Duration, Injection When? For Intermediate-acting insulin?

Answer 30

Name: NPH  
Cloudy 
Onset: 1.5-4 hours 
Duration: 12-18 hours 
Injected BID (breakfast and Dinner)

Question 31

Name, Clarity, Onset, Duration, Injection When? For Long-acting insulin

Answer 31

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

Question 32

When you mix two insulins, which do you draw up first? The cloudy or clear insulin?

Answer 32

Clear insulin first. Then cloudy.

Question 33

Can you mix Glargine or detemir with Lispro or aspart?

Answer 33

No. You do not mix long-acting insulin with any other insulin