Module 15

Question 1

Chronic disease characterized by elevated blood levels of glucose

Answer 1

Diabetes

Question 2

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

Answer 2

proximal

saturated

Question 3

High blood sugar in diabetes is due to one of two things? What are they?

Answer 3

Insulin resistance (Type II)
Lack of insulin production (type I)

Question 4

What are the classic signs of diabetes?

Answer 4

Polyuria - excessive urination
Polydipsia - increased thirst
Polyphagia - increased hunger

Question 5

Insulin is a _______ _______ synthesized by the ___ cells of the ______ __ _________ of the pancreas.

Answer 5

peptide hormone
Beta cells
Islets of Langerhans

Question 6

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.

Answer 6

liver, muscle and fat cells
Glycogen
Protein
fatty acids, triglycerides

Question 7

Extracellular _______ is important in the action of insulin as it helps insulin drive glucose into the cell.

Answer 7

Potassium

Question 8

Insulin-dependent DM
non-insulin dependent DM
Diabetes that occurs in pregnancy

Answer 8

Type I
Type II
Gestational diabetes

Question 9

There is a larger proportion of Type ___ diabetics.

Answer 9

II

Question 10

Type I diabetes is usually diagnosed at this age.

Answer 10

Children/adolescents; symptoms may not appear until early adulthood

Question 11

Type 1 diabetes is caused by an _________ reaction where the body’s own immune cells attack and destroy these cells.

Answer 11

autoimmune

Beta cells

Question 12

Type I diabetes is not ________ and is not caused by eating too much sugar.

Answer 12

preventable

Question 13

In type II diabetes, the pancreas makes _______ insulin, however, the insulin produced is ______ to use.
Over the course of the disease, insulin production may ________.

Answer 13

sufficient
resistant
decrease

Question 14

Type II diabetes was typically diagnosed _____ in life, but there is trend towards ______ people getting the disease.

Answer 14

later

younger

Question 15

Diabetes that first starts in pregnancy - women who have never had diabetes before begin to have elevated levels of glucose in pregnancy

Answer 15

Gestational diabetes

Question 16

Usually, gestational diabetes begins at this time point.

Answer 16

Halfway through pregnancy

Question 17

Usually, ______ and ______ are sufficient to keep blood glucose within normal ranges during gestational diabetes.

Answer 17

diet and exercise

Question 18

Pregnant women with gestational diabetes tend to have ______ babies and babies with ________ in the first few days of life.

Answer 18

larger

hypoglycemia

Question 19

After birth, the blood sugar of the mother usually returns to normal, however, what is usually done?

Answer 19

Blood glucose is continually monitored as many patients develop diabetes later (5-10 years) in life.

Question 20

Most common cause of blindness in people under the age of 65.

Answer 20

diabetic retinopathy

Question 21

Describe how diabetes can lead to retinopathy and what should be done.

Answer 21

Hyperglycemia causes damage to retinal capillaries.

Patients should control blood sugar and get an eye exam every year

Question 22

Diabetic nephropathy can lead to chronic ________ disease.

Diabetic nephropathy is characterized by _________, decreased ________ ______ and increased ________ ________.

Answer 22

kidney
proteinuria
glomerular filtration
blood pressure

Question 23

_________ is the earliest sign of diabetic nephropathy.

Answer 23

Proteinuria

Question 24

Leading cause of morbidity and mortality in patients with type 1 diabetes

Answer 24

diabetic nephropathy

Question 25

The drugs are useful in preventing diabetic nephropathy. And experts suggest they should be taken _______ of the patient’s BP.

Answer 25

ARBs
Ace inhibitors
regardless

Question 26

Leading cause of morbidity and mortality in type II diabetics.

Answer 26

CV disease including MI and stroke

Question 27

__________ develops much earlier in (type II) diabetics than in the general population.

Answer 27

Atherosclerosis

Question 28

CVD in diabetics results from a combination of _________ and altered ______ metabolism.

Answer 28

hyperglycemia

lipid

Question 29

Type II diabetics are given these drugs to reduce CV events.

Answer 29

Statins - reduce CV events regardless of LDL cholesterol levelsq

Question 30

Most common cause of hospitalization for diabetic patients.

Answer 30

diabetic foot ulcers

Question 31

Diabetes accounts for approximately half of all lower limb amputations every year due to _______.

Answer 31

infection

Question 32

There are three tests used to diagnose diabetes, what are they?

Answer 32

Fasting plasma glucose test
Casual plasma glucose test
Oral glucose tolerance test

Question 33

Patients fast for at least ___ hours and then have a blood sample drawn to measure blood glucose.

Answer 33

Fasting plasma glucose test

8 hours

Question 34

Preferred test for diagnosing diabetes.

Answer 34

Fasting plasma glucose test

Question 35

Blood can be drawn at any time, no matter what the interval was since the last meal.

Answer 35

Casual plasma glucose test

Question 36

If an initial casual plasma glucose test suggests diabetes (i.e. >11 mmol/L and classic signs (Triad)), what is done?

Answer 36

Follow up with a fasting plasma glucose test

Question 37

Test used when the other tests were unable to definitively diagnose diabetes.

Answer 37

Oral glucose tolerance test

Question 38

Describe the oral glucose tolerance test.

Answer 38

Used when the others were non-definitive.

Give patient a (75g) dose of glucose and measure plasma glucose (2 hours later)

Question 39

Describe glycosylated hemoglobin.

Answer 39

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)

Question 40

What is the most common glycosylated hemoglobin type?

Answer 40

HBA1c

Question 41

Why is glycosylated hemoglobin even measured?

Answer 41

Good indicator of how well a patient is responding to therapy
Try to keep HBA1c below 7% of total HB

Question 42

Additionally, what other values (i.e. other than blood glucose and glycosyalted HB), should be monitored in diabetics, based on the possible diabetic complications?

Answer 42

BP
Lipid levels (LDL, HDL)
Kidney function (urine albumin:creatinine ratio)

Question 43

Describe the weight of type I diabetics.

Describe nutritional intake timing.

Answer 43

Usually thin - the goal is to maintain way

Total caloric intake should be split throughout the day

Question 44

Describe how exercise impacts diabetes.

Answer 44

Increases the cellular response to insulin and increases glucose tolerance
Strenuous exercise, however, may cause hypoglycemia

Question 45

Describe diet and weight in type II diabetics.

Answer 45

Type II diabetics are often obese.
Restricting calories often normalizes insulin release and decrease insulin resistance.
Crucial in treatment plan.