Module 15 Flashcards
Chronic disease characterized by elevated blood levels of glucose
Diabetes
Normally, blood glucose is efficiently reasborbed in the ________ tubule, so it is not found in the urine.
However, in diabetes, blood glucose rises so high that the transporters that reasborb it are ________ and significant amounts of glucose are found in the urine
proximal
saturated
High blood sugar in diabetes is due to one of two things? What are they?
Insulin resistance (Type II) Lack of insulin production (type I)
What are the classic signs of diabetes?
Polyuria - excessive urination
Polydipsia - increased thirst
Polyphagia - increased hunger
Insulin is a _______ _______ synthesized by the ___ cells of the ______ __ _________ of the pancreas.
peptide hormone
Beta cells
Islets of Langerhans
When insulin is secreted, it causes glucose uptake into these cells.
In the liver and muscle, glucose is converted to ________.
In muscle cells, glucose uptake promotes _______ synthesis.
In fat cells, insulin causes increased synthesis of ______ _____, resulting in increased _________ synthesis.
liver, muscle and fat cells
Glycogen
Protein
fatty acids, triglycerides
Extracellular _______ is important in the action of insulin as it helps insulin drive glucose into the cell.
Potassium
Insulin-dependent DM
non-insulin dependent DM
Diabetes that occurs in pregnancy
Type I
Type II
Gestational diabetes
There is a larger proportion of Type ___ diabetics.
II
Type I diabetes is usually diagnosed at this age.
Children/adolescents; symptoms may not appear until early adulthood
Type 1 diabetes is caused by an _________ reaction where the body’s own immune cells attack and destroy these cells.
autoimmune
Beta cells
Type I diabetes is not ________ and is not caused by eating too much sugar.
preventable
In type II diabetes, the pancreas makes _______ insulin, however, the insulin produced is ______ to use.
Over the course of the disease, insulin production may ________.
sufficient
resistant
decrease
Type II diabetes was typically diagnosed _____ in life, but there is trend towards ______ people getting the disease.
later
younger
Diabetes that first starts in pregnancy - women who have never had diabetes before begin to have elevated levels of glucose in pregnancy
Gestational diabetes
Usually, gestational diabetes begins at this time point.
Halfway through pregnancy
Usually, ______ and ______ are sufficient to keep blood glucose within normal ranges during gestational diabetes.
diet and exercise
Pregnant women with gestational diabetes tend to have ______ babies and babies with ________ in the first few days of life.
larger
hypoglycemia
After birth, the blood sugar of the mother usually returns to normal, however, what is usually done?
Blood glucose is continually monitored as many patients develop diabetes later (5-10 years) in life.
Most common cause of blindness in people under the age of 65.
diabetic retinopathy
Describe how diabetes can lead to retinopathy and what should be done.
Hyperglycemia causes damage to retinal capillaries.
Patients should control blood sugar and get an eye exam every year
Diabetic nephropathy can lead to chronic ________ disease.
Diabetic nephropathy is characterized by _________, decreased ________ ______ and increased ________ ________.
kidney
proteinuria
glomerular filtration
blood pressure
_________ is the earliest sign of diabetic nephropathy.
Proteinuria
Leading cause of morbidity and mortality in patients with type 1 diabetes
diabetic nephropathy
The drugs are useful in preventing diabetic nephropathy. And experts suggest they should be taken _______ of the patient’s BP.
ARBs
Ace inhibitors
regardless
Leading cause of morbidity and mortality in type II diabetics.
CV disease including MI and stroke
__________ develops much earlier in (type II) diabetics than in the general population.
Atherosclerosis
CVD in diabetics results from a combination of _________ and altered ______ metabolism.
hyperglycemia
lipid
Type II diabetics are given these drugs to reduce CV events.
Statins - reduce CV events regardless of LDL cholesterol levelsq
Most common cause of hospitalization for diabetic patients.
diabetic foot ulcers
Diabetes accounts for approximately half of all lower limb amputations every year due to _______.
infection
There are three tests used to diagnose diabetes, what are they?
Fasting plasma glucose test
Casual plasma glucose test
Oral glucose tolerance test
Patients fast for at least ___ hours and then have a blood sample drawn to measure blood glucose.
Fasting plasma glucose test
8 hours
Preferred test for diagnosing diabetes.
Fasting plasma glucose test
Blood can be drawn at any time, no matter what the interval was since the last meal.
Casual plasma glucose test
If an initial casual plasma glucose test suggests diabetes (i.e. >11 mmol/L and classic signs (Triad)), what is done?
Follow up with a fasting plasma glucose test
Test used when the other tests were unable to definitively diagnose diabetes.
Oral glucose tolerance test
Describe the oral glucose tolerance test.
Used when the others were non-definitive.
Give patient a (75g) dose of glucose and measure plasma glucose (2 hours later)
Describe glycosylated hemoglobin.
Not typically used in diagnosis
Reflects the average blood glucose levels over the previous 2-3 months
The product of glucose and HB interaction –> glycosylated derivatives (mostly HBA1c)
What is the most common glycosylated hemoglobin type?
HBA1c
Why is glycosylated hemoglobin even measured?
Good indicator of how well a patient is responding to therapy
Try to keep HBA1c below 7% of total HB
Additionally, what other values (i.e. other than blood glucose and glycosyalted HB), should be monitored in diabetics, based on the possible diabetic complications?
BP Lipid levels (LDL, HDL) Kidney function (urine albumin:creatinine ratio)
Describe the weight of type I diabetics.
Describe nutritional intake timing.
Usually thin - the goal is to maintain way
Total caloric intake should be split throughout the day
Describe how exercise impacts diabetes.
Increases the cellular response to insulin and increases glucose tolerance
Strenuous exercise, however, may cause hypoglycemia
Describe diet and weight in type II diabetics.
Type II diabetics are often obese.
Restricting calories often normalizes insulin release and decrease insulin resistance.
Crucial in treatment plan.
