Glucose Regulation Review for Quiz #2 Flashcards
What is diabetes?
A group of conditions characterized by a high level of blood glucose / blood sugar
What are the different types of diabetes?
Type 1 DM
Type 2 DM
Gestational, diabetes
Pre-diabetes
Type 1 DM definition
Beta cells of the pancreas are destroyed by the immune system by mistake; genetic factors play a role
Insulin production is reduced; less insulin binds to receptors on target cells, which means that less glucose is taken into the cells and more glucose in the blood
What is type 1 DM characterized by?
Early onset, symptoms start suddenly, before the age of 20
INSULIN DEPENDENT
Type 2 DM definition
Pancreas produces enough insulin, but something goes wrong with receptor binding/insulin signaling inside the target cells
The cells are not responsible for insulin, and cannot import glucose
What is type 2 DM characterized by?
Adult onset; symptoms are gradual after age 30
INSULIN RESISTANT
Gestational diabetes
Acquired during pregnancy, and usually resolves after giving birth
Usually occurs in third trimester
Cause is thought to be related to pregnancy hormones that interfere with insulin’s action on insulin receptors
Pre-diabetes
Blood sugar level is at the border line; higher than normal, but lower than diabetics
May or may not progress to diabetes
Insulin
A hormone secreted by beta cells in the center of the Islets of Langerhans that is necessary for glucose intake by target cells
Islets of Langerhans
Clusters of cells in the pancreas that produce hormones of insulin and glucagon
Glucagon
Secreted by alpha cells in the periphery of the Islets of Langerhans
What is the physiology of insulin?
It REDUCES blood glucose levels by binding to insulin receptors embedded in the cell membrane of various insulin-responsive tissues, like muscle cells and adipose tissue
What is the physiology of glucagon?
It RAISES blood glucose levels by getting the liver to generate new molecules of glucose from other molecules, and also break down glycogen into glucose to get dumped into the blood
What is the physiology of Type 1 DM?
Autoimmune destruction that cannot be prevented
The body cannot make enough insulin because of a Type IV hypersensitivity response/cell-mediated immune response
What happens in the Type IV hypersensitivity response / cell mediated immune response in Type 1 DM?
A persons own T cells (part of the immune system) attack the pancreas
This is a genetic abnormality that causes a loss of self tolerance among T cells, which specifically target the beta cell antigens
What are T cells?
Cells that react to antigens (usually small peptides—polysaccharides or lipids; some of the antigens are part of our body cells)
Antigens are foreign substances that induces an immune response in the body
What is self tolerance?
A process the body uses to eliminate T cells
What does losing self tolerance mean?
It means that T cells are allowed to recruit other immune cells and coordinate an attack on the beta cells
What does losing beta cells mean?
Losing beta cells = less insulin = glucose overload in the blood
What is the Human Leukocyte Antigen (HLA) system?
Where a group of genes on chromosome 6 encode the Major Histocompatibility Complex (MHC) — a protein that is important for helping the immune system recognize foreign molecules in maintaining self tolerance
People with type one DM have specific HLA genes in common with each other
What is the genetic clue for Type 1 DM?
HLA – DR3
HLA – DR4
*Note that not everyone with those genes develop diabetes
What are the symptoms of Type 1 DM?
Beta cell destruction starts early and usually 90% of the cells are destroyed before symptoms start to appear
Polyphagia, glycosuria, polyuria, polydipsia,
What is the treatment for type 1 DM?
Lifelong insulin therapy to regulate blood glucose levels and enable cells to use glucose
What is polyphagia?
Extreme hunger
Phagia = eating; poly = a lot
What is glycosuria?
When blood gets filtered through the kidneys, some of it starts to spill into the urine
Glycos = glucose; uria = urine
What is polyuria?
Glucose is osmotically active, so water tends to follow it, increasing the urination
What is polydipsia?
Since there is so much urination people with uncontrolled diabetes become dehydrated and thirsty
Dipsia = thirst
What are the complications of type one diabetes?
Diabetic ketoacidosis, (DKA)
What is diabetic ketoacidosis (DKA)
A complication characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased production of ketones
This condition results from the combination of insulin deficiency, and an increase in hormone release that leads to increased liver and kidney glucose production
Why are ketone bodies important?
They can be used by cells for energy, but they also increase acidity of the blood
Acetoacetic acid — considered a ketoacid because it has a ketone group and a carboxylic acid group
B-hydroxybutyric acid — technically isn’t a keto I said, since its keto group has been reduced to a hydroxyl group
What complications come with the blood becoming more acidic?
Kussmaul respiration: deep labored breathing as a body at times to move carbon dioxide out of the body in effort to reduce its acidity
What does a blood acidity do with hydrogen ions and potassium ions?
Blood acidity = increases H + INSIDE the cell; while K + gets sent into fluid OUTSIDE cells
Hyperkalemia physiology
A mechanism caused by insulin stimulating the sodium potassium ATPase, which helps K + get into cells
Without insulin K + stays in fluid outside of the cells
Overtime, even though the blood K + levels remain high; overall stores of K + in the body (inclusive of K + inside cells) starts to run low
This leads to INCREASED potassium in the fluid outside the cells which quickly makes it into the blood and causes hyperkalemia where K+ is excreted
Hyperkalemia
A potassium level in the blood that’s higher than normal
What are the symptoms of diabetic ketoacidosis (DKA)?
Nausea, vomiting, fruity breath — due to the generation of ketone bodies, Kussmaul respiration
Polyuria, polydipsia, weight, loss, dry skin, sunken eyes, soft, eyeballs, lethargic, coma
What is the treatment for diabetic ketoacidosis?
Fluids for dehydration
Insulin to lower blood glucose
Electrolytes (K +)
What is the physiology of Type 2 diabetes?
Condition in which the body makes insulin, but does not respond to it
Body provides the normal amount of insulin, but the cells don’t move their glucose transporters to their membrane in response, which is needed for glucose to get into the cell
What is the body’s response to Insulin resistance in type 2 DM?
Since the tissues don’t respond as well to normal levels of insulin, the body ends up producing more insulin to get the same effect and move the glucose out of the blood through beta cell hyperplasia and beta cell hypertrophy
These processes happen in attempt to pump out more insulin, which only works for a while will keep insulin levels higher than normal to maintain normal glucose levels
What is beta cell hyperplasia?
where the body increases the number of beta cells in response to insulin resistance
What is beta cell hypertrophy?
Where beta cells grow in size in response to compensating for insulin resistance
What process leads to patients developing hyperglycemia in type 2 diabetes?
When beta cells secrete an increased amount of islet amyloid polypeptides (amylin); overtime amylin builds up and aggregates in the islets and is not sustainable
Overtime does maxed out beta cells, get exhausted, and become dysfunctional, causing them to undergo hyportrophy and hypoplasia
As beta cells are lost and insulin levels decrease, glucose levels in the blood starts to increase causing hyperglycemia.
Hyperplasia
When beta cells die off
Hypotrophy
When beta cells get smaller
What is hyperglycemia?
Occurs with insulin resistance due to an imbalance of glucose intake and production
Higher than normal blood glucose levels
What is hypoglycemia?
Lower than normal levels of blood glucose
What are the symptoms of hyperglycemia?
Polydipsia
Polyuria
Polyphagia
Weight loss
Headache
Fatigue
Vision changes
Numbness and tingling
Abdominal pain
Nausea, vomiting
Slow healing wounds
Recurrent infections
What are the symptoms of hypoglycemia?
Similar to hyperglycemia; confusion
What are the risk factors of type 2 DM?
Obesity, lack of exercise, and hypertension
Genetic factors also play a role ( ex: one twin having diabetes increases the risk for the other twin)
What are the complications of type 2 DM?
Hyperosmolar hyperglycemic state (HHS)
What is the physiology of hyperosmolar hyperglycemic state (HHS)?
When levels of glucose are super high in the blood – hyperosmolar state – water leaves the body cells and enters the blood vessels, leaving the cells relatively dry and shriveled
Blood vessels that are full with water lead to increased urination and total body dehydration
What are the diagnostic tests for DM?
Fasting blood glucose (FBG)/ fasting plasma glucose (FPG)
Casual (random) plasma glucose (RPG)
Oral glucose tolerance test (OGTT)
Glycosylated hemoglobin — hemoglobin A1c (HbA1c)
What is a fasting blood glucose (FBG) test? 
Blood glucose levels are checked while patient is fasting,
no food or fluids for the past 8 hours
What is a casual random plasma glucose (RBG) test?
Blood glucose levels are taking regardless of when the patient last ate
General guideline: taking before a meal (AC), or at bedtime (HS); however, if a patient is NPO or on tube feedings, they must do it every 4-6 hours
What is an oral glucose tolerance test (OGTT)?
It measures the body’s ability to metabolize glucose
Can be used to test for diabetes, pre-diabetes, or gestational diabetes
What are the guidelines for the oral glucose tolerance test (OGTT)?
No food or drink 8 to 12 hours prior to the test
Drink glucose at the time of the test
After two hours, the blood is tested again to see how well the body reacted to the drink and measure if they have diabetes
Hemoglobin A1c test (HbA1c)
Measures the amount of glycosylated hemoglobin — which is analyzed glucose attached to hemoglobin — in the blood
This is checked every 3 months
This test takes an average of a patient’s blood glucose levels at any point of the day without having to fast, so patients prefer it
What is a normal range for a person without diabetes in a Fasting blood glucose test?
<100 mg /dL
What is the prediabetes range for fasting blood glucose test? (Impaired Fasting Glucose)
> 100, but <126 mg / dL
**100–125 mg/dL
What is considered the diabetes range for the fasting glucose test?
≥126 mg/dL
What is the diabetes range for a Random Blood Glucose test?
≥200 mg/dL
What is the normal range for an Oral Glucose Tolerance test?
<140 mg/dL
What is the pre-diabetes range for an Oral Glucose Tolerance test?
140-199 mg /dL
What is the diabetes range for an Oral Glucose Tolerance test?
≥200 mg/dL
What is the normal range for an HbA1c test?
4–5.6%
What is the prediabetes range for an HbA1c test?
5.7–6.4%
What is the diabetes range for an HbA1c test?
≥6.5%
What are the chronic complications of DM?
Retinopathy, cerebral, vascular disease, coronary heart, disease, nephropathy, neuropathy, peripheral vascular disease, ulceration and amputation
What is the treatment for type one DM?
Insulin
What is the treatment for type two DM?
Weight loss
Exercise
Healthy Diet
Antibiotic meds (example: metaformin)
What risk does insulin treatment come with?
Hypoglycemia, especially if injecting insulin without having a meal
Overtime what can high glucose levels damage?
Tiny blood vessels (arterioles, capillaries and venules)
Causes hyaline arteriosclerosis, hypoxia, atherosclerosis, and a potential lead to heart attacks and strokes 
hyaline arteriosclerosis
The walls of the arterioles develop hyaline deposits which are proteins that make the arterioles is hard and inflexible
Hypoxia
A process in capillaries where the basement membrane thickens, which challenges the ability of oxygen to move from the capillary to the tissues
What is the Somogyi effect?
Morning hyperglycemia from the counterregulatory response to nighttime hypoglycemia
Typically happens and type 1 diabetics
What is the dawn phenomenon?
Results from a nighttime release of adrenal hormones that causes blood glucose elevations at about 5 to 6 AM
Type 2 are most likely to experience this
What is ketosis?
Ketones in the urine break down fats for energy when there isn’t enough insulin to use glucose which increases the acidity in the blood
Check urine for ketones when blood sugar is greater than 250 mg/dL
What are the acute complications of diabetes?
Diabetic ketoacidosis (DKA)
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS or HHS)
Hypoglycemia
What is the diagnostic range for diabetic ketoacidosis?
Blood sugar is greater than 250 mg/ dL
Classic symptoms are usually the 3 Ps in type 1 DM
What is the diagnostic range for hyperglycemic – hyperosmolar nonketotic syndrome?
Blood sugar is greater than 600 mg/dL
No ketosis present
What are the causes of hypoglycemia?
Acute complication due to little food intake, such as skipping a meal or too much insulin and diabetes pills
Can occur if you’re more active than usual
What is the treatment of hypoglycemia?
It includes the 15/15 rule or 20/20 rule either give 15 g of simple carbs and recheck blood glucose in 15 minutes; or 20 g of simple carbs for heavier patients and recheck blood glucose in 20 minutes
What is neuroglycopenia?
Damage the brain because a lack of glucose availability due to hypoglycemia
- the brain does not have glucose reserves, so it is imperative that hypoglycemia is treated immediately
What are the symptoms of hypoglycemia?
WASH THIS
shaking, fast heartbeat, sweating, dizziness, anxiety, hunger, blurry vision, weakness or fatigue, headache, irritability
If the hypoglycemic patient is awake and alert, which rule do you use to check their blood sugar?
15/15 or 20/20 rule if their blood sugar is less than 60 or 70 mg/dL
If the hypoglycemic patient is severely lethargic or unconscious what should you do?
Check their blood sugar levels and make sure that they are not below 60 or 70 mg / dL
If it is then administer one amp of D 50 (50% dextrose) intravenously and then immediately recheck the blood sugar
What is metabolic syndrome (syndrome X)?
a condition that is linked to an increased risk of diabetes and heart disease marked by central abdominal obesity, high blood pressure, high triglycerides, low cholesterol, and insulin resistance
Management of diabetes
Diet and exercise
Regular blood glucose monitoring
Why is dieting important for diabetic patients?
Choosing meals can affect their blood sugar levels, so it’s important to choose wisely to maintain normal blood sugar levels and prevent complications
What is a patient teaching in diet for DM?
Carb-counting: patient teaching of how to read nutritional labels and limiting the carbohydrate intake with each meal to maintain normal blood glucose levels
What is self monitoring blood glucose (SMBG)?
Monitoring blood glucose during meals, or before meals, and at bedtime (AC/HS)
How is exercise important in managing diabetes?
Helps regulate blood glucose levels
Increases insulin effectiveness and sensitivity in the body
What effects do alcohol and DM have on blood glucose levels?
They can inhibit glucose production
Alcohol can induce hypoglycemia
What is glycogenesis?
The process by which the body breaks down and converts glucose into glycogen
Stored in the liver
What is glycogenolysis?
The process by which the body breaks down/converts glycogen to glucose
What is gluconeogenesis?
Metabolic process by which the forms glucose from non-carbohydrate sources like amino acids, lactate, and glycerol
What is ketogenesis?
A biochemical process by which the body breaks down fats
What are the macrovascular complications of diabetes
Cardiovascular disease
Cerebrovascular disease
Peripheral vascular disease
What are the microvascular complications of diabetes?
Nephropathy
Neuropathy
Retinopathy
What are the risks associated with cardiovascular disease in DM?
Obesity, hyperlipidemia and hypertension increases the risk for heart disease
What are the risks associated with the cerebrovascular disease in DM?
Hyperlipidemia atherosclerosis, and hypertension increases risk for stroke
Peripheral vascular disease
Poor vascular circulation
Vascular changes = reduce white blood cell activities, leading to decreased immunity
Slow healing wounds, lead to increased risk of amputation
Nephropathy
Kidney dysfunction
Early signs = albumin in urine
Neuropathy
Nerve dysfunction
Early sign = numbness and loss of sensation in lower extremities
What is retinopathy?
Vision problems
Early signs = blurred vision
What does post prandial mean?
After meal
