Exam 3 - diabetes mellitus Flashcards
DM is a dysfunction of:
the endocrine pancreas
What does type 1 DM affect the metabolism of?
fat, protein, and carbohydrates
DM is not one disease, but a what? with what in common?
group of diseases WITH glucose intolerance in common
DM is characterized by:
hyperglycemia
DM can be the result of defects in what?
- insulin secretion
- insulin action
- or both
What type of DM is most common in children?
Type 1 diabetes
Define type 1 diabetes mellitus:
insulin-dependent diabetes mellitus
What type of DM is most common in adult? or has an onset during adulthood?
type 2 diabetes
define type 2 diabetes mellitus:
non-insulin-dependent diabetes mellitus
What is type 2 diabetes associated with?
obesity and insulin resistance
What are four ways to diagnose diabetes mellitus?
- glycosylated hemoglobin HgA1C levels
- more than 1 fasting plasma glucose greater than 140 mg/dl
- 2 hour plasma glucose during oral glucose tolerance testing (OGTT)
- random glucose levels about 200 mg/dl with symptoms
What kind of method is HgA1C?
method to follow plasma glucose over time
What do glucose molecules do with hemoglobin?
glucose molecules join to hemoglobin in 120 day life span of RBCs
What is typical of those with poorly controlled diabetes and HgA1C?
those with poorly controlled diabetes have increased levels of glycosylated hemoglobin
What values will be elevated with DM?
HgA1C, FPG, or OCTT
what are two other risk factors for DM?
- impaired glucose tolerance (IGT)
2. impaired fasting glucose (IFG)
what does impaired glucose tolerance come from?
diminished insulin secretion
what does impaired fasting glucose come from?
from enhanced hepatic glucose output
What happens with the pancreas and beta cells in type 1 DM?
- pancreatic atrophy
2. loss of beta cells
Type 1 diabetes mellitus characterizes what percent of diabetes in western world?
10%
What is Type 1 diabetes the result of?
genetic susceptibility and environmental factors
What is there a strong genetic associated of with type 1 DM?
with HLA class II antigens DR and DQ
What are two genetic susceptibility factors that increase risk of type 1?
- first-degree relative with type 1
2. strongest association with MHC
What are two environmental factors that increase risk of type 1?
- viral infection: H. pylori infection
2. exposure to cow’s milk proteins, relative lack of vitamin D
Define type 1A:
cell-mediated destruction of the B cells
What kind of antigen is associated with type 1A:
leukocyte antigen HLA-Dr4
Define type 1B:
uncommon primary autoimmune condition associated with other autoimmune problems (Hashimoto disease, graves disease, myasthenia gravis)
What kind of antigen is associated with type 1B:
associated with HLA-DR3 in those between 30 to 50 years of age
In type 1 DM, what accumulates in blood? and spills into what?
glucose accumulates in blood and spills into urine as renal threshold exceeded
What occurs in type 1 DM from insulin lack?
protein and fat breakdown
Are type 1 DM manifestations acute or chronic:
acute
What are the 3 P’s associated with type 1 DM?
- polydipsia
- polyuria
- polyphagia
True or false: there is weight gain associated with type 1 DM:
false; weight loss
Wide fluctuations of what occur with type 1 DM:
wide blood sugar
What kind of condition is associated with type 1 DM:
ketoacidosis
define ketoacidosis
increased levels of ketones occur without insulin
Ketones cause a drop in what?
pH (metabolic acidosis)
What occurs from blowing off acetone with ketoacidosis?
fruity breath
There is little to no what in type 1 DM:
little or no insulin secretion
What is the initial symptom of type 1 DM?
diabetic coma
What combination can be used to treat type 1 DM:
insulin, meal planning, exercise, self monitoring of blood glucose
What is a transplant associated with type 1 DM:
- islet cells
2. whole pancreas
Type 2 diabetes mellitus characterizes what percent of diabetes in western world?
90%
What are 5 risk factors of type 2 diabetes mellitus?
- obesity
- hypertension
- physical inactivity
- family history
- metabolic syndrome
type 2 diabetes mellitus affect both:
- adults
2. children
What 3 interactions cause type 2 diabetes mellitus?
- genetic
- epigenetic
- environmental
What 2 factors account for 60-80% of type 2 cases?
- obesity
2. insulin resistance
What occurs with abnormal glucagon secretion in type II cases?
decreased B-cell responsiveness to plasma glucose
What may be due to decreased B-cell mass or abnormal function in type II diabetes?
islet dysfunction
What are 2 major mechanisms of type II diabetes?
- insulin resistance
2. decreased insulin secretion by beta cells
Type 2 diabetes has a strong what?
inheritance pattern
Relatives of type 2 diabetes have a much higher risk of what?
developing it as well
True or false: there is only 1 gene that is found responsible for type 11 diabetes:
false; many different genes associated, but no single gene found responsible
What are 4 clinical manifestations of type 2 diabetes?
- fatigue
- pruritus
- recurrent infections
- visual changes or symptoms of neuropathy
What are 5 treatment options?
- exercise
- diet
- treatment of obesity
- oral hypoglycemia
- bariatric surgery
What are 5 complications of DM?
- hypoglycemia
- diabetic ketoacidosis
- hyperosmolar nonacidotic diabetic coma
- somogyi effect
- dawn phenomenon
What is also called insulin shock or insulin reaction:
hypoglycemia
What is a typical glucose level in newborns with hypoglycemia?
less than 47 mg/dL
what is a typical glucose level in children and adults with hypoglycemia?
less than 70 mg/dL
Which type of diabetes is hypoglycemia more commonly associated with?
type 1 diabetes
What are 5 clinical manifestations of hypoglycemia?
- tachycardia
- palpitations
- diaphoresis
- tremors
- pallor and arousal anxiety
What are 2 treatment options for hypoglycemia?
- oral or IV glucose
2. glucagon: prescribed for emergency use
A neurogenic reaction occurs from what?
from low glucose sensed by hypothalamus (increased hr, palpitations, diaphoresis, tremors, pallor and anxiety)
What is another type of symptom associated with hypoglycemia and cells?
cell malnutrition (headache, dizziness, irritability and fatigue, poor judgment, confusion, visual changes, hunger, seizures and coma, symptoms masked b-blocking drugs)
What is a serious complication of DM?
diabetic ketoacidosis - responsible for many hospital admissions and death
Diabetic ketoacidosis occurs when there is… (2 things)
- relative/absolute insulin deficiency
2. increase i insulin counter regulatory hormones (catecholamines, cortisol, glucagon, and GH)
What 2 things increase with ketoacidosis?
- hepatic glucose production
2. fat mobilization
What 1 thing decreases with ketoacidosis?
peripheral glucose usage
What 4 things precipitate DKA?
- infection, trauma
- surgery, MI
- interruption of insulin
- emotional stress
symptoms of DKA:
- polyuria
- dehydration
- kussmaul respirations
- acetone breath odor
treatment of DKA:
administer insulin to decrease glucose levels, fluids, replacements of electrolytes
What is normal in hyperosmolar non-acidotic diabetic coma? What is abnormal?
ketones; glucose over 600 mg/dl
Due to high BS, glycouria and polyuria cause what in hyperosmolar non-acidotic diabetic coma?
- severe volume depletion
2. intracellular dehydration
blood glucose is high during what time of the day with the somogyi effect?
high in the morning
somogyi effect is common in what 2 things?
- type 1 DM
2. kids
Hypoglycemia at night with the somogyi effect stimulates what?
glucose counteregulation (epinephrine, GH, cortisol, and glucagon release)
Glucose is increased by what 2 things with the somogyi effect?
- gluconeogenesis
2. glycogenolysis
What 2 things are mobilized with the somogyi effect? what is inhibited
fatty acids and proteins; peripheral glucose use is inhibited
define the dawn phenomenon:
early morning rise in glucose, no hypoglycemia at night
What decreases during the night with the dawn phenomenon?
- glucose metabolism by muscle and fat
What are 4 chronic complications of DM?
- diabetic neuropathies
- microvascular disease
- large blood vessel disease
- infections
Can some neuropathies be reversed?
yes; food and wrist drop
What are microvascular problems due to?
basement membrane thickening
What is diabetes the most common cause of?
end stage renal disease
What is the most common cause of death in those with type 11 DM?
CAD
What are infections due to in DM?
- sensory impairment (resulting in injury)
- hypoxia
- increased pathogen growth in presence of high glucose
- reduced blood supply
