Insulin and Diabetes Flashcards
What causes DM?
deficit insulin secretion from beta cells in islets of Langerhans
lack response by cells to insulin (insulin resistance)
What does the term ‘insulin deficit; cover?
decreased secretion of insulin
and
insulin resistance
What is insulin?
an anabolic hormone
What does deficient insulin result in?
abnormal, carb, fat, protein metabolism as transported by glucose
amino acids into cells impaired as well due synthesis of protein and glycogen
these metabolic abnormalities affect lipid metabolism
many tissue and organs adversely affected by DM
What cell types are not affected directly by insulin deficit?
insulin not required for transport glucose into brain cells - fortunate as neurons require glucose constantly
digestive tract - not req glucose for absp
exercising skeletal muscle can utilise glucose w/o proportionate amount insulin - significant t- excessive exercisers can deplete blood glucose = hypoglycaemia
-conversely exercise helpful controlling blood glucose levels in presence of insulin deficit
TI
(insulin dependent) (more severe)
child, adolescent
genetic destruction B cells
autoimmune disorder/reaction
acute complication = hypo/ketoacidosis
child, adolescent
genetic destruction B cells
autoimmune disorder/reaction
acute complication = hypo/ketoacidosis
What is TI DM a major factor predisposing to?
strokes
mi
peripheral vascular disease
amputation
kd
blindness
TII
reduced effectiveness/defecit insulin
increased pancreatic B cell production
increased resistance body cells insulin
increase production glucose liver
(or a combination of them all)
overweight, older adult, ^incidence adolescence, african american, hispanic, native americans
Pathophysiology; DM, insulin deficit ;
insulin deficit =
decrease transport and use of glucose in many cells
blood glucose^
excess spills into urine (glucosuria) = osmo pa filtrate^ = polyuria, fluid loss, electrolyte loss
draw H2O cells = dehydration, polydypsia
lack nutrients stimulate polyphagia
Pathophysiology; DM insulin deficit prolonged;
lack glucose = catab of fat,pro = excess fatty acids and their metabolites( ketones +ketoacids in blood)
= ketonuria
as dehydration develops, GFR decreases and so excretes acids is limited =
decompensated metabolic acidosis - life threatening = DKA/Diabetic Coma
SnS:
Hunger
Fatigue
Polyuria
Nocturia
Dry Mouth
Itchy Skin
Blurred Vision
TII - weight gain, ^abdo girth
Dx:
3Ps
as blood glucose^ in early stages, fluid loss significant, and appetite ^
Typically 3Ps herald onset;
Polyuria
Polydipsia
Polyphagia
Dx:
fast blood glucose levels
glucose tolerance test
glucosylated haemoglobin (HbA1)
home BM
urine tests
ABG - ketoacidosis,serum electrolytes
Tx:
- maintain normal blood glucose levels
- measures depend severity
diet and exercise
- complex cars low gi index
- adeq protein
- low cholesterol, low lipid
-fibre
- match needs activity level
insulin replacement
