Lecture 7, 8, 9 (Disorders of Glucose Metabolism)

Question 1

What is Type I Diabetes Mellitus?

Answer 1

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.

Question 2

What type of cell is destructed in Type I Diabetes Mellitus?

Answer 2

Pancreatic islet B cells typically due to an auto-immune process.

Question 3

What is Type 2 Diabetes Mellitus?

Answer 3

A more prevalent form of diabetes that results from insulin resistance with a defect in compensatory insulin secretion.

Question 4

In what population does Type I Diabetes typically occur?

Answer 4

Children and young adults.

Question 5

What are the clinical features of Type I Diabetes Mellitus? (5 major- 8 listed)

Answer 5

(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

Question 6

Normal Glucose Tolerance: Fasting plasma glucose mg/dL

Answer 6

<100

Question 7

Normal Glucose Tolerance: Two hours after glucose load mg/dL

Answer 7

<140

Question 8

Normal Glucose Tolerance: HbA1c (%)

Answer 8

<5.7

Question 9

Impaired Glucose Tolerance (Hyperglycemic): Fasting plasma glucose mg/dL

Answer 9

100-125

Question 10

Impaired Glucose Tolerance (Hyperglycemic): Two hours after glucose load mg/dL

Answer 10

> 140-199

Question 11

Impaired Glucose Tolerance (Hyperglycemic): HbA1c (%)

Answer 11

<5.7

Question 12

Diabetes Mellitus: Fasting plasma glucose mg/dL

Answer 12

> 126

Question 13

Diabetes Mellitus: Two hours after glucose load mg/dL

Answer 13

> 200

Question 14

Diabetes Mellitus: HbA1c (%)

Answer 14

> 6.5

Question 15

What is the most common complication that occurs in patients with diabetes who are treated with insulin?

Answer 15

Hypoglycemia

Question 16

What is hypoglycemia?

Answer 16

Low plasma glucose levels (<60 mg/dL)

Question 17

What are hypoglycemic S&S? (10)

Answer 17

(1) Headache
(2) Impaired vision
(3) Hunger
(4) Irritability
(5) Weakness/fatigue
(6) Sweating
(7) Dizziness
(8) Fast heartbeat
(9) Shaking
(10) Anxiety

Question 18

How would you manage hypoglycemia?

Answer 18

(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

Question 19

What are medical complications that you can get with poorly treated diabetes?

Answer 19

(1) Retinopathy
(2) Nephropathy
(3) Neuropathy- peripheral and autonomic
(4) Disorders of the skin
(5) Disorders of the foot

Question 20

/What is Diabetic Ketoacidosis (DKA)?

Answer 20

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

Question 21

What are the lab values associated with DKA? (6)

Answer 21

(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

Question 22

What are the S&S of DKA? (6)

Answer 22

(1) Polyuria
(2) Polydipsia
(3) Abdominal Pain
(4) Nausea
(5) Hyperventilation- Kussmaul’s breathing
(6) Breath can smell sweet 2/2 to ketones

Question 23

What is the pathogenesis of DKA?

Answer 23

(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

Question 24

What is the treatment of DKA?

Answer 24

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

Question 25

What is Hyperglycemia Hyperosmolar State? (HHS)

Answer 25

Severe hyperglycemia in the absence of significant ketosis, with hyperosmolality and dehydration.

Question 26

What is the clinical presentation of HHS? (5)

Answer 26

(1) Hyperglycemia >600 mg/dL
(2) Serum osmolality >310 mosm/kg
(3) No acidosis; blood pH above 7.3
(4) Serum bicarb >15 mEq/L
(5) Normal anion gap (<14 mEq/L)