Lectures Exam 2 Pt. 1 (Exam 2) Flashcards
What is a relative or absolute deficiency of insulin, causing glucose intolerance? What three things can define who a diabetic is?
- Diabetes
- If the individuals Fasting Sugar levels are > 125 mg/dL.
- A 75 mg Glucose Tolerance Test:: If glucose is > 200 mg/dL after 2 hours.
- A HbA1c > 6.5%: Tests if hemoglobin are glucosylated due to high glucose levels that spill into RBCs and it provides a good estimate of the average level of glucose for this past 3 months. *(< 5.7% is normal).
Diabetes effects what percent of the US population? How many die each year? What % is undiagnosed? What percent are in a pre-diabetic state?
- 8-9% of US population
- 73,000 die/year
- 50% undiagnosed
- 14% (Fasting blood glucose [100-125] or HbAlc is 5.75%-6/4%)
What are the three symptoms of Diabetes?
- Polydipsia (thirst) and Polyphagia (hunger)
- Polyuria (excessive urine)
- Unexplained weight loss
What functions to promote glucose and amino acids through membranes of skeletal/smooth/cardiac muscle cells, fibroblasts, FAT cells (these are particularly important due to disrupted lipid metabolism) ; it is an anabolic hormone (helps control normal growth patterns and tissue development) .Does not affect glucose uptake in: neurons, kidney and red blood cells. And Insulin and C-peptide (are linked in precursor peptide) are secreted from beta cells in islets of Langerhans (pancreas) in response to glucose?**(Re-do slide)
- Insulin Functions
What are the consequences of diabetes (most of which occurs in the liver)?
- Increased lipolysis resulting in blood ketosis and elevated triglycerides
- Increased glycogenolysis and gluconeogenesis
- Anabolic effect (protein catabolism of muscle-can cause wasting)
Describe Type 1 diabetes:
Type 1 (insulin-requiring): Features: young (3-20 yrs old), loss of Islet Beta Cells, 5% of cases, and are typically thin:
• No natural insulin
• Loss of beta cells an autoimmune process-probably triggered by environment such as a viral infection
• Ketoacidosis-dehydration; deep labored breathing (caused by acidosis); nausea, coma; anorexia
• Usually thin (lack growth stimulation due to anabolic effects of insulin—as a growth factor)
• Glucose levels often get up to >500 mg/dl before diagnosed
Describe Type 2 diabetes:
What syndrome is this associated with?
Type II DM, “adult onset”, Non-insulin dependent DM:
Features:
• Insulin levels often normal, problem is resistance of insulin receptors to insulin stimulation
• Correlates with excessive visceral fat: diet controls ~20%
• Correlates with hypertension and risk for atherosclerosis, dyslipidemia—resulting in the metabolic syndrome (see below)
• Some genetics-likely polygenic autosomal
• Most over 30 yrs old, but increasing numbers of younger Type II DM patients due to obesity
• 80-90% of these patients are obese/proper diet and exercise reverse symptoms for many type II diabetics
• Minimal ketones or acidosis, but very high glucose
• Some ethnic groups have higher risk (e.g., Pima Indians, Hispanics, African Americans, etc.)
- Associated with Metabolic Syndrome (also called Metabolic Syndrome X) –not well defined.
What are some features of Metabolic Syndrome which is caused by Type 2 diabetes? What are some Pathogenesis associated with Metabolic Syndrome? What are some major metabolic complications?
- Features:
• Complex interaction between obesity and Insulin resistance
• Type II diabetes-insulin receptors refractory to insulin
• Abnormal lipid metabolism-high triglycerides & LDL, low HDL-
• Excess fat around waist
• Hypertension
• Increased risk for atherosclerosis
• Prothrombin tendency - Pathogenesis:
• Increased visceral adiposity
• Impaired glucose metabolism and insulin sensitivity
• Increased hepatic inflammation and cirrhosis - Major metabolic complications:
• Very high glucose
• Hyperosmolar consequences, including coma
• Brain swelling due to increased osmolarity
What is a type of diabetes due to stress of pregnancy (3-10% of pregnancies), it usually goes away after pregnancy, although type II can develop late; and Can have problems with insufficient placental function and babies that are abnormally large with excessive insulin secretion and early hypoglycemia causing fetal malformations? What effect can this have on the baby?
- Gestational Diabetes
- • Early hypoglycemia in baby if mothers not well controlled
• Fetal malformation if mothers not well controlled (remember insulin is a growth factor)
What are 5 oral problems associated with diabetes?
- Increased gingivitis and periodontitis
- Poor wound healing (issue with oral surgery or implants)
- Abnormal infections such as thrush/candida
- Xerostomia (increased caries)
- Be sure patients are careful to avoid hypoglycemia
Insulin replacement is required for all Type ___ diabetics, and for more serious Type ___ diabetics? What is the most common type of insulin used?
- Type 1 (all), Type 2 (serious)
- U-100
What type of insulin has Rapid onset, early peak action, duration ~4 hours and is Taken immediately before meal?
- Lispro
What are some long term complications from diabetes?
- Ketoacidosis/hyperosmolar coma/urinary tract infections
- Ophthalmic-swelling, cataracts, retinopathy, neuropathy, glaucoma and blindness; results from glucose accumulation in eye-metabolized or sorbitol, trapped in lens of eye and increases osmolaric ophthalamic swelling
- Accelerated atherosclerosis, unhealthy cholesterols and lipid metabolism and negative consequences on heart (e.g., MI), kidneys (e.g., glomerulosclerosis, pyelonephritis, etc.), brain (stokes)
- Peripheral neuropathies –loss of touch and pain in extremities (such as feet); gangrene (frequent feet amputations)
- Autonomic nerve dysfunction: abnormal GI motility; hypotonic bladder, increased UTI
- More prone to infections, slow healing
- Monitor with Hgb Alc test for a 3 month assessment of glucose levels.
- Symptoms worsen with stress, such as infection
- Coronary atherosclerosis with MI—most common cause of death in diabetics.
What type of insulin is Short-Acting helps to delay onset and has a lengthened duration, has a 30 minute onset, peaks after 2-3 hours and persist for 5-8 hours?
- Crystalline Zinc
What type of insulin is Immediate-acting, Absorption and onset are delayed because insulin linked to peptide called PROTAMINE for delayed release after injection, Pharmacokinetic features: onset=2-15 hrs; duration=4-12 hours, Often mixed with other shorter acting insulins (Lispro) for both immediate insulin and sustained insulin needs?
- NPH (neutral protein hagedorn)
