Lecture 7, 8, 9 (Disorders of Glucose Metabolism) Flashcards
What is Type I Diabetes Mellitus?
A syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance with inadequate insulin secretion to compensate for the resistance.
What type of cell is destructed in Type I Diabetes Mellitus?
Pancreatic islet B cells typically due to an auto-immune process.
What is Type 2 Diabetes Mellitus?
A more prevalent form of diabetes that results from insulin resistance with a defect in compensatory insulin secretion.
In what population does Type I Diabetes typically occur?
Children and young adults.
What are the clinical features of Type I Diabetes Mellitus? (5 major- 8 listed)
(1) Polyuria and thirst
(2) Weakness or fatigue
(3) Polyphagia with weight loss
(4) Recurrent blurred vision
(5) Nocturnal enuresis
(6) Recurrent blurred vision
(7) Vulvovaginitis or pruritis
(8) Peripheral neuropathy
Normal Glucose Tolerance: Fasting plasma glucose mg/dL
<100
Normal Glucose Tolerance: Two hours after glucose load mg/dL
<140
Normal Glucose Tolerance: HbA1c (%)
<5.7
Impaired Glucose Tolerance (Hyperglycemic): Fasting plasma glucose mg/dL
100-125
Impaired Glucose Tolerance (Hyperglycemic): Two hours after glucose load mg/dL
> 140-199
Impaired Glucose Tolerance (Hyperglycemic): HbA1c (%)
<5.7
Diabetes Mellitus: Fasting plasma glucose mg/dL
> 126
Diabetes Mellitus: Two hours after glucose load mg/dL
> 200
Diabetes Mellitus: HbA1c (%)
> 6.5
What is the most common complication that occurs in patients with diabetes who are treated with insulin?
Hypoglycemia
What is hypoglycemia?
Low plasma glucose levels (<60 mg/dL)
What are hypoglycemic S&S? (10)
(1) Headache
(2) Impaired vision
(3) Hunger
(4) Irritability
(5) Weakness/fatigue
(6) Sweating
(7) Dizziness
(8) Fast heartbeat
(9) Shaking
(10) Anxiety
How would you manage hypoglycemia?
(1) Eat or drink 15 grams of fast-acting, low-fat carbohydrate right away
(2) Check again in 15 minutes; if blood glucose is still low (<80), have 15 more grams
(3) Snack if meal time is more than 30-60 minutes away
What are medical complications that you can get with poorly treated diabetes?
(1) Retinopathy
(2) Nephropathy
(3) Neuropathy- peripheral and autonomic
(4) Disorders of the skin
(5) Disorders of the foot
/What is Diabetic Ketoacidosis (DKA)?
May be the initial manifestation of Type 1 Diabetes or may result from increased insulin requirements in type 1 diabetes patients during the course of infection, trauma, myocardial infarction, or surgery
What are the lab values associated with DKA? (6)
(1) Hyperglycemia 200-800 mg/dL
(2) Acidosis with blood pH <15 mEq/L (elevated anion gap)
(4) Serum (and urine) positive for ketones
(5) Profound hypovolemia
(6) Electrolyte loss: hypokalemia
What are the S&S of DKA? (6)
(1) Polyuria
(2) Polydipsia
(3) Abdominal Pain
(4) Nausea
(5) Hyperventilation- Kussmaul’s breathing
(6) Breath can smell sweet 2/2 to ketones
What is the pathogenesis of DKA?
(1) Results from insulin deficiency
(2) Results in excess release of free fatty acids from adipose tissue
(3) Free fatty acids are substrate for production of ketones in the liver (beta-hydroxy-butyrate, acetoacetate, acetone)
(4) Increased hepatic glucose production from lactate from muscle breakdown
What is the treatment of DKA?
Therapeutic goals are to restore plasma volume and tissue perfusion, reduce blood glucose and osmolality toward normal, correct acidosis, replenish electrolyte losses, and identify and treat precipitating factors
(1) Fluid replacement
(2) Insulin replacement
(3) Potassium, sodium bicarbonate, phosphate
