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Pathophysiology > exam 2: diabetic mellitus > Flashcards

exam 2: diabetic mellitus Flashcards

1
Q

what hormone is secreted by alpha cells of the pancreas?

A

glucagon

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2
Q

what effect does glucagon have on insulin?

A

antagonist to the effect of insulin

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3
Q

what stimulates glucagon production? what inhibits it?

A

-stimulated by low glucose levels and sympathetic simulation
-increases blood glucose concentration by stimulating glycogenolysis, gluconeogenesis and lipolysis
-inhibited by high glucose levels

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4
Q

what hormone is secreted by beta cells of the pancreas?

A

insulin and amylin

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5
Q

what is insulin?

A

an anabolic hormone from precursor proinsulin which is formed from preproinsulin

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6
Q

what is a c peptide preproinsulin

A

used as an indirect measurement of serum insulin synthesis

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7
Q

what is a key component in maintaining normal cellular function

A

sensitivity of insulin receptor

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8
Q

what is a primary stimulus of insulin?

A

increase in blood levels of glucose and by PNS usually before eating a meal

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9
Q

what is the main function of insulin?

A

stimulate protein and fat synthesis and decrease the blood glucose levels

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10
Q

what is an amylin

A

an amyloid polypeptide co-secreted with insulin by beta cells in response to nutrient stimuli

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11
Q

how does amylin work with blood glucose

A

regulates blood glucose concentration by delaying gastric emptying and suppressing glucagon secretion after meals

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12
Q

what effect does amylin have with reducing blood glucose

A

has a satiety effect to reduce food intake and to prevent hyperglycemia

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13
Q

what hormone is secreted by delta cells of the pancreas?

A

gastrin and somatostatin

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14
Q

how does gastrin affect the blood glucose

A

it stimulates the secretion of gastric acid

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15
Q

how does somatostatin affect the blood glucose

A

essential in carbohydrate, fat, and protein metabolism
- involved in regulating alpha and beta cell function within the islets by inhibiting secretion of insulin, glucagon, and pancreatic polypeptide

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16
Q

what hormone do F (pp) cells of the pancreas secrete

A

pancreatic polypeptide

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17
Q

how does the pancreatic polypeptide affect the blood glucose

A

by inhibiting gallbladder contraction and exocrine pancreatic secretion

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18
Q

what is type 1 DM

A

it is a primary beta-cell defect or failure leading to severe insulin deficiency or no insulin secretion at all

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19
Q

what is the etiology of type 1 DM

A

autoimmune; genetic and environmental factors, resulting in gradual process of autoimmune destruction in genetically susceptible individuals

20
Q

describe the pathophysiology of type 1 DM

A

genetic predisposition and environmental factors lead to autoantigens forming insulin-producing cells to circulate in the blood stream, which activates cellular immunity and humoral immunity toward beta cells leading to the destruction of beta cells with decreased insulin secretion

21
Q

what is type 2 DM

A

insulin resistance with inadequate insulin secretion

22
Q

what is the etiology of type 2 DM

A

genetic susceptibility (polygenic) combined with environmental determinants and defects in beta cell function combined with insulin resistance

23
Q

describe the pathophysiology of type 2 DM

A

genetic factors and environment factors (obesity) alters insulin receptors leading to
- insulin resistance: leads to increased insulin > prediabetic
-decreased beta cell mass/function: leads to decreased insulin > hyperglycemic

24
Q

describe metaBBOLic syndrome

A

B: BP meds leading to increase BP (>130 systolic)
B: increase fasting blood glucose (>1000
O: obesity based on waist size
L: high cholesterol levels

25
Q

the body works to get rid of high blood glucose in hyperglycemia by:

A

polyuria: frequent urination
polydypsia: increased thirst
polyphagia: increased hunger

26
Q

what causes hyperglycemia:

A

sepsis
stress
skip insulin
steroids

27
Q

what are presenting symptoms of hyperglycemia

A

extreme thirst, polyuria, fruity breath odor, kussmaul breathing (deep, rapid, labored, distressed, dyspneic), rapid and thready pulse, dry mucous membrane, poor skin turgor, bl glucose >250 mg/dL

28
Q

what is the treatment of hyperglycemia

A

fluid, insulin, and electrolyte replacment

29
Q

what are symptoms of hypoglycemia (insulin shock)

A

headache, lightheadedness
nervousness, apprehension
tremor
excess perspiration; cold, clammy skin
tachycardia
slurred speech
memory lapse, confusion, seizures
bl glucose <60 mg/dL

simple nursing:
H- headache
I- irritable
W- weakness
A- anxiety and trembling (pallor)
S- sweating (diaphoresis)
H- hunger

30
Q

what causes hypoglycemia

A

exercise
alcohol (decreases sugar synthesis)
insulin peak times

31
Q

what are treatments for hypoglycemia

A

A-Awake
A-Ask to eat

S-Sleep
S-Stab (with IV D50- dextrose)
- reassess sugar Q15 after

immediate replacement of glucose either PO or IV

prevention is achieved with individualized management of medications and diet, monitoring blood glucose levels, and education

32
Q

what is diabetic ketoacidosis

A

aka diabetic coma syndrome
-absolute or relative deficiency of insulin and an increase in the insulin counter regulatory hormones of catecholamines—cortisol, glucagon, and growth hormone.

33
Q

what are presenting symptoms of DKA

A

malaise, dry mouth, headache, polyuria, polydipsia, weight loss, n/v, pruritus, abdominal pain, lethargy, SOB, Kussmaul respirations, fruity or acetone odor to breath

34
Q

how it DKA managed

A

with a combination of fluids, insulin and electrolyte replacement

35
Q

what is the relationship of retinopathy to DM and its associated symptoms:

A

it is a microvascular complication

-progresses from no visual changes to loss of visual acuity and blindess
- worsened by hyperosmolar lens edema and cataract formation

36
Q

what is the relationship of nephropathy to DM and its associated symptoms:

A

it is a microvascular complication

-microalbuminuria and HTN slowly progressing to end-stage kidney failure

37
Q

what is the relationship of neuropathy to DM and its associated symptoms:

A

it is a microvascular complication

-sensorimotor polyneuropathy progressing to distal paresthesias and muscle wasting
-postural hypotension, gastroparesis, urinary retention and erectile dysfunction

38
Q

what is the relationship of skin and foot lesions to DM and its associated symptoms:

A

it is a microvascular complication

-pressure ulcers and delayed wound healing; abscess formation; necrosis and gangrene of toes and feet; infection and osteomyelitis

39
Q

what is the relationship of cardiovascular system to DM and its associated symptoms:

A

it is a macrovascular complication

-HTN, CAD, cardiomyopathy, HF

40
Q

what is the relationship of cerebrovascular system to DM and its associated symptoms:

A

it is a macrovascular complication

-increased risk for ischemic and thrombotic stroke

41
Q

what is the relationship of peripheral vascular system to DM and its associated symptoms:

A

it is a macrovascular complication

-increased claudication, nonhealing ulcers, gangrene

42
Q

SIMPLE NURSING INFO:
what diet should be avoided if a client has DM

A

simple sugars (soda, candy, white bread/white rice, juice)

43
Q

SIMPLE NURSING INFO:
what diet should be encouraged if a client has DM

A

good carbohydrates:
high in fibers; brown- bean, rice, bread peanut butter; and whole- wheat, grain and milk

WHY?? since it is high in fat (lipid), it will slow down sugar absorption
AKA low-glycemic index food

44
Q

SIMPLE NURSING INFO:
what precautions should be made for a client who has DM on their feet

A

keep clean, dry and injury free

F: no Flip Flops, high heels, nylon
O: no Otc corn removal
O: no Overly hot baths, pads, etc
T: no Toe injuries (daily inspection)

45
Q

SIMPLE NURSING INFO:
how do you draw up insulin

A

clear to cloudy

46
Q

SIMPLE NURSING INFO:
how do you properly administer insulin injections

A

-rotate every 2-3 weeks (best on abdomen near belly button)
-never aspirate as it can cause swelling and scar tissue
-never massage or add heat after subq

47
Q

SIMPLE NURSING INFO:
if a client is experiencing DKA in Type 1 DM and is nauseous, what is an acceptable approach

A

can give insulin without food but must monitor glucose closely

Pathophysiology (6 decks)

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