Exam 3 - diabetes mellitus Flashcards

1
Q

DM is a dysfunction of:

A

the endocrine pancreas

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2
Q

What does type 1 DM affect the metabolism of?

A

fat, protein, and carbohydrates

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3
Q

DM is not one disease, but a what? with what in common?

A

group of diseases WITH glucose intolerance in common

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4
Q

DM is characterized by:

A

hyperglycemia

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5
Q

DM can be the result of defects in what?

A
  1. insulin secretion
  2. insulin action
  3. or both
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6
Q

What type of DM is most common in children?

A

Type 1 diabetes

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7
Q

Define type 1 diabetes mellitus:

A

insulin-dependent diabetes mellitus

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8
Q

What type of DM is most common in adult? or has an onset during adulthood?

A

type 2 diabetes

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9
Q

define type 2 diabetes mellitus:

A

non-insulin-dependent diabetes mellitus

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10
Q

What is type 2 diabetes associated with?

A

obesity and insulin resistance

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11
Q

What are four ways to diagnose diabetes mellitus?

A
  1. glycosylated hemoglobin HgA1C levels
  2. more than 1 fasting plasma glucose greater than 140 mg/dl
  3. 2 hour plasma glucose during oral glucose tolerance testing (OGTT)
  4. random glucose levels about 200 mg/dl with symptoms
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12
Q

What kind of method is HgA1C?

A

method to follow plasma glucose over time

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13
Q

What do glucose molecules do with hemoglobin?

A

glucose molecules join to hemoglobin in 120 day life span of RBCs

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14
Q

What is typical of those with poorly controlled diabetes and HgA1C?

A

those with poorly controlled diabetes have increased levels of glycosylated hemoglobin

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15
Q

What values will be elevated with DM?

A

HgA1C, FPG, or OCTT

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16
Q

what are two other risk factors for DM?

A
  1. impaired glucose tolerance (IGT)

2. impaired fasting glucose (IFG)

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17
Q

what does impaired glucose tolerance come from?

A

diminished insulin secretion

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18
Q

what does impaired fasting glucose come from?

A

from enhanced hepatic glucose output

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19
Q

What happens with the pancreas and beta cells in type 1 DM?

A
  1. pancreatic atrophy

2. loss of beta cells

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20
Q

Type 1 diabetes mellitus characterizes what percent of diabetes in western world?

A

10%

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21
Q

What is Type 1 diabetes the result of?

A

genetic susceptibility and environmental factors

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22
Q

What is there a strong genetic associated of with type 1 DM?

A

with HLA class II antigens DR and DQ

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23
Q

What are two genetic susceptibility factors that increase risk of type 1?

A
  1. first-degree relative with type 1

2. strongest association with MHC

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24
Q

What are two environmental factors that increase risk of type 1?

A
  1. viral infection: H. pylori infection

2. exposure to cow’s milk proteins, relative lack of vitamin D

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25
Define type 1A:
cell-mediated destruction of the B cells
26
What kind of antigen is associated with type 1A:
leukocyte antigen HLA-Dr4
27
Define type 1B:
uncommon primary autoimmune condition associated with other autoimmune problems (Hashimoto disease, graves disease, myasthenia gravis)
28
What kind of antigen is associated with type 1B:
associated with HLA-DR3 in those between 30 to 50 years of age
29
In type 1 DM, what accumulates in blood? and spills into what?
glucose accumulates in blood and spills into urine as renal threshold exceeded
30
What occurs in type 1 DM from insulin lack?
protein and fat breakdown
31
Are type 1 DM manifestations acute or chronic:
acute
32
What are the 3 P's associated with type 1 DM?
1. polydipsia 2. polyuria 3. polyphagia
33
True or false: there is weight gain associated with type 1 DM:
false; weight loss
34
Wide fluctuations of what occur with type 1 DM:
wide blood sugar
35
What kind of condition is associated with type 1 DM:
ketoacidosis
36
define ketoacidosis
increased levels of ketones occur without insulin
37
Ketones cause a drop in what?
pH (metabolic acidosis)
38
What occurs from blowing off acetone with ketoacidosis?
fruity breath
39
There is little to no what in type 1 DM:
little or no insulin secretion
40
What is the initial symptom of type 1 DM?
diabetic coma
41
What combination can be used to treat type 1 DM:
insulin, meal planning, exercise, self monitoring of blood glucose
42
What is a transplant associated with type 1 DM:
1. islet cells | 2. whole pancreas
43
Type 2 diabetes mellitus characterizes what percent of diabetes in western world?
90%
44
What are 5 risk factors of type 2 diabetes mellitus?
1. obesity 2. hypertension 3. physical inactivity 4. family history 5. metabolic syndrome
45
type 2 diabetes mellitus affect both:
1. adults | 2. children
46
What 3 interactions cause type 2 diabetes mellitus?
1. genetic 2. epigenetic 3. environmental
47
What 2 factors account for 60-80% of type 2 cases?
1. obesity | 2. insulin resistance
48
What occurs with abnormal glucagon secretion in type II cases?
decreased B-cell responsiveness to plasma glucose
49
What may be due to decreased B-cell mass or abnormal function in type II diabetes?
islet dysfunction
50
What are 2 major mechanisms of type II diabetes?
1. insulin resistance | 2. decreased insulin secretion by beta cells
51
Type 2 diabetes has a strong what?
inheritance pattern
52
Relatives of type 2 diabetes have a much higher risk of what?
developing it as well
53
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
54
What are 4 clinical manifestations of type 2 diabetes?
1. fatigue 2. pruritus 3. recurrent infections 4. visual changes or symptoms of neuropathy
55
What are 5 treatment options?
1. exercise 2. diet 3. treatment of obesity 4. oral hypoglycemia 5. bariatric surgery
56
What are 5 complications of DM?
1. hypoglycemia 2. diabetic ketoacidosis 3. hyperosmolar nonacidotic diabetic coma 4. somogyi effect 5. dawn phenomenon
57
What is also called insulin shock or insulin reaction:
hypoglycemia
58
What is a typical glucose level in newborns with hypoglycemia?
less than 47 mg/dL
59
what is a typical glucose level in children and adults with hypoglycemia?
less than 70 mg/dL
60
Which type of diabetes is hypoglycemia more commonly associated with?
type 1 diabetes
61
What are 5 clinical manifestations of hypoglycemia?
1. tachycardia 2. palpitations 3. diaphoresis 4. tremors 5. pallor and arousal anxiety
62
What are 2 treatment options for hypoglycemia?
1. oral or IV glucose | 2. glucagon: prescribed for emergency use
63
A neurogenic reaction occurs from what?
from low glucose sensed by hypothalamus (increased hr, palpitations, diaphoresis, tremors, pallor and anxiety)
64
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)
65
What is a serious complication of DM?
diabetic ketoacidosis - responsible for many hospital admissions and death
66
Diabetic ketoacidosis occurs when there is... (2 things)
1. relative/absolute insulin deficiency | 2. increase i insulin counter regulatory hormones (catecholamines, cortisol, glucagon, and GH)
67
What 2 things increase with ketoacidosis?
1. hepatic glucose production | 2. fat mobilization
68
What 1 thing decreases with ketoacidosis?
peripheral glucose usage
69
What 4 things precipitate DKA?
1. infection, trauma 2. surgery, MI 3. interruption of insulin 4. emotional stress
70
symptoms of DKA:
1. polyuria 2. dehydration 3. kussmaul respirations 4. acetone breath odor
71
treatment of DKA:
administer insulin to decrease glucose levels, fluids, replacements of electrolytes
72
What is normal in hyperosmolar non-acidotic diabetic coma? What is abnormal?
ketones; glucose over 600 mg/dl
73
Due to high BS, glycouria and polyuria cause what in hyperosmolar non-acidotic diabetic coma?
1. severe volume depletion | 2. intracellular dehydration
74
blood glucose is high during what time of the day with the somogyi effect?
high in the morning
75
somogyi effect is common in what 2 things?
1. type 1 DM | 2. kids
76
Hypoglycemia at night with the somogyi effect stimulates what?
glucose counteregulation (epinephrine, GH, cortisol, and glucagon release)
77
Glucose is increased by what 2 things with the somogyi effect?
1. gluconeogenesis | 2. glycogenolysis
78
What 2 things are mobilized with the somogyi effect? what is inhibited
fatty acids and proteins; peripheral glucose use is inhibited
79
define the dawn phenomenon:
early morning rise in glucose, no hypoglycemia at night
80
What decreases during the night with the dawn phenomenon?
1. glucose metabolism by muscle and fat
81
What are 4 chronic complications of DM?
1. diabetic neuropathies 2. microvascular disease 3. large blood vessel disease 4. infections
82
Can some neuropathies be reversed?
yes; food and wrist drop
83
What are microvascular problems due to?
basement membrane thickening
84
What is diabetes the most common cause of?
end stage renal disease
85
What is the most common cause of death in those with type 11 DM?
CAD
86
What are infections due to in DM?
1. sensory impairment (resulting in injury) 2. hypoxia 3. increased pathogen growth in presence of high glucose 4. reduced blood supply