Exam 3: Diabetes basics Flashcards
Define T1DM
pancreatic beta cell destruction and eventually absolute insulin deficiency (production or secretion). Considered autoimmune. Not preventable
T1DM etiology
idiopathic autoimmunity
circulating autoantibodies
immune mediated
T1DM Pathophysiology
Autoimmune disease in which body attacks the beta cells of the pancrease resulting in the lack of insulin production. Without insulin it won’t act as a key to open up cells to uptake blood glucose causing hyperglycemia
T1DM Complications
Ketoacidosis
Macrovascular diseases
* Coronary heart disease
* Peripheral vascular disease
* Cerebrovascular disease Microvascular diseases
* Retinopathy
* Nephropathy Neuropathy
explain why Ketoacidosis (DKA)
occur
Ketoacidosis in type 1 diabetes (T1DM) occurs because of a severe insulin deficiency, which prevents glucose from entering cells for energy. As a result, the body starts breaking down fat for fuel, producing ketones as a byproduct. When ketones accumulate in the blood faster than they can be used or eliminated, they cause the blood to become acidic, leading to diabetic ketoacidosis (DKA). This condition is often triggered by factors like infection, insufficient insulin administration, or stress, and is a medical emergency requiring prompt treatment
T1DM symptoms
hyperglycemia (insulin deficiency)
polydipsia (excessive thirst)
polyuria (frequent urination)
polyphagia (excessive hunger)
weight loss
Why does hyperglycemia occur in T1DM
absolute lack of insulin, a hormone that is essential for helping glucose enter cells for energy. Without enough insulin, glucose builds up in the bloodstream instead of being utilized by the body’s cells, resulting in high blood sugar levels.
Why does polyuria occur in T1DM
occurs due to the body’s attempt to excrete excess glucose through urine. When blood sugar levels become very high (hyperglycemia), the kidneys are unable to reabsorb all the glucose, leading to glucose spilling into the urine. The presence of glucose in the urine increases the osmotic pressure, drawing more water into the urine, which results in frequent urination
Why does polyphagia occur in T1DM
due to the body’s inability to effectively use glucose for energy. In T1DM, insulin production is either absent or insufficient, which means glucose cannot enter cells to be used as fuel. As a result, the body begins to break down fat and muscle for energy, leading to increased hunger as the body signals that it needs more fuel to meet its energy demands
Why does polydipsia occur in T1DM
body’s attempt to dilute the excess glucose in the bloodstream. When blood sugar levels rise significantly, the kidneys filter out the excess glucose into the urine, which increases urine volume (polyuria). This causes dehydration, and as a result, the body triggers the sensation of thirst to compensate for the fluid loss and restore proper hydration levels
Why does weightloss occur in T1DM
body cannot properly use glucose for fuel and instead starts breaking down fat and muscle tissue for energy, leading to weight loss. Additionally, excessive glucose in the bloodstream is excreted in the urine (polyuria), which causes fluid loss and contributes to dehydration, further exacerbating weight loss. This weight loss can occur even though the individual may be eating more (polyphagia), as the calories from food are not being utilized effectively.
Diabetes diagnostic criteria: FPG
Fasting Plasma Glucose FPG: ≥126mg/dL
Diabetes diagnostic criteria: CPG
Casual Plasma Glucose CPG: ≥ 200 mg/dL (random)
Diabetes diagnostic criteria: 2hPG
2hPG ≥ 200 mg/dL (2h after oral gluc tolerance)
Diabetes diagnostic criteria: A1c
A1C greater than or equal to 6.5% (long term blood sugar control)
Define A1c
glycosylated hemoglobin amount of glucose attached to the hemoglobin protein in RBC
as blood glucose inc amount of gluc attached to hemo inc estimate 3m time frame
Define T2DM
insulin resistance and insulin deficiency. Preventable
Etiology T2DM
genetic factors
intake of excessive calories
risk factors
physical inactivity
environmental factors
T2DM risk factors
obesity (modifiable)
physical inactivity
prediabetes
metabolic syndrome
older age
ethnicity
gestational diabetes
Pathophysiology T2DM
Insulin resistance by peripheral tissues (muscle and fat cells), impaired insulin secretion, Increased hepatic glucose, Increased lipolysis and elevated free fatty acids, worsening insulin resistance.
Chronic inflammation, renal glucose reabsorption,
T2DM complication
CVD
dyslipidemia
hypertension
T2DM symptoms
hyperglycemia
* Abnormal patterns of insulin secretion and action
* Decreased cellular uptake of glucose
increased postprandial glucose
* Increased release of glucose by liver (gluconeogenesis) resulting in fasting hyperglycemia
* Central obesity
Weight gain
define GDM
occurs during pregnancy and is characterized by elevated blood glucose levels that are not due to pre-existing diabetes.
GDM risk factors
obesity
Family history DM PCOS-impaired lifestyle factors
Advanced maternal age prior history of GM ethnic groups
GDM complications
Preterm Birth
Inc risk for T2DM for mom and bb
Higher birth weight- more glucose to baby and baby produce more insulin promote fat store and and protein synthesis
neonatal hypoglycemia difficult delivery or C-section
GDM behavioral mod management
exercise
GDM medications
insulin analogs
metformin
GDM screening timeframe postpartum
- screening for DM 4-12 weeks postpartum and at least every 3 years
GDM diagnosis
OGTT
GDM diagnosis OGTT time frame
24-28wks
GDM diagnosis OGTT value
1-hour oral glucose tolerance test value ≥ 180 mg/dL
GDM how many kcal from CHO
40%
GDM nutrition management
SFM
- one CHO svg at breakfast - no milk, fruit or dry cereal
- avoid added sugars and fruit juices
- limit refined cHO white bread, pasta…
- avoid sacchrain
GDM breastfeeding yes or no, why?
breastfeeind reduce risk developing T2 in both
PreDM complications
Higher risk for Type 2(asymptomatic)
PreDM diagnosis
Impaired glucose tolerance use 2hPG Impaired Fasting Glucose use PG or A1c
PreDM diagnosis 2hPG
140 - 199mg/dL
PreDM diagnosis FPG
100 - 125 mg/dL
PreDM diagnosis A1c
5.7% to 6.4%
PreDM management
7 - 10% weight loss is typically sufficient for a individual with prediabetes
