Nov. 13, 2019 Flashcards
Mnfts of DM
- The 3 P’s
- Polyuria + frequency
- Polydipsia
- Polyphagia
- Weight loss (type 1)
- Obesity (type 2)
- Complications
Why does polyuria occur?
Because inc OSMOTIC PRESSURE pulls more fluid into vessels
Why is there weight loss in type 1 diabetes?
Because most calories in a person are from carbohydrates, but in type 1 diabetes carbos are excreted in urine
3 examples of ACUTE COMPLICATIONS from DM
- Hypoglycemia
- DKA
- HHS
Why is HYPOGLYCEMIA acutely life threatening?
Because the brain is unable to metabolize anaerobically, and is dependent on glucose for metabolism, therefore if glucose is absent the brain may die w/in min
T or F:
HYPOGLY is usually more of a problem in Type 1 DM
T
What 4 causes of HYPOGLY
- Caused by mismanagement
- Taking too much INSULIN6
- Overexertion
- Missed meal
Altered brain Fx cause what to kick in?
The AUTONOMOUS NERVOUS SYSTEM
What is the Tx for HYPOGLY?
Admin of carbos PO
- Mild = 15g
- Severe ( <2.8) = 20g
When does someone enter a HYPOGLY coma?
When the brain is deprived of glucose
Signs of HYPOGLY coma?
LOC
…duh
What happens to GLUCAGON and EPINEPHRINE after about 5 yr w diabetes
Their responses become dampened
Tx of HYPOGLY coma:
- 1mg GLUCAGON subq or IM
- 50% sol’n of GLUCOSE IV
What does GLUCAGON do?
It breaks down GLYCOGEN in the liver
What is DIABETIC KETOACIDOSIS?
A form of acidosis triggered by KETONE bodies
Does DKA usually occur in type 1 or 2 DM?
Type 1
What are the 3 major problems that result in DKA?
1) HYPERGLY
2) KETOSIS
3) METB ACIDOSIS
What is KETOSIS?
The formation of KETONES
What is broken down to create KETONES?
LIPIDS
Why is DKA METB as opposed to RESP ACIDOSIS?
It involves a fixed acid, making it METB
What is GLUCOGENESIS?
Formation of GLUCOSE from breaking down CARBOS
What is GLUCONEOGENESIS?
Formation of GLUCOSE from non-CARBOS, such as LIPIDS/PROTEINS
Who is most commonly affected by HYPEROSMOLAR HYPERGLYCEMIC STATE (HHS)?
Usually people w type 2 DM or the elderly
Severe infct can lead to what?
HHS
T or F:
HHS leads to acute pancreatitis
F, the other way around
3 causes of HHS
1) Elevated GLUCOSE in fluid
2) Inc CARBO intake
3) Inc INSULIN resistance
Severe HYPERGLY leads to _________
HYPEROSMOLARITY
Why does HYPERGLY lead to HYPEROSMOLARITY?
Because the inc in GLUCOSE in the BVs causes an imbalance in the cell and the V pulls fluid from the interstitial space
What is the link between dehydration and HYPEROSMOL?
The osmotic pressure pulls fluid out of cells and is excreted in the urine
If you have no LIPOLYSIS, you have _______.
INSULIN
If you don’t have LIPOLYSIS, are you at risk for KETOACIDOSIS?
No, KETONES are from lipids being broken down
When do the chronic complications of DIABETES generally mnft?
10-15 years post onset, might be longer if condition is managed well
Altered METB results in an excess of what?
BENIGN METABOLITES
What problem arises d/t altered metb and vasc damage?
Perfusion problems
What is MICROVASCULAR damage affecting?
The CAPILLARIES
3 examples of MICROVASC damage?
1) NEPHROPATHY
2) NEUROPATHY
3) RETINOPATHY
What is MACROVASCULAR damage affecting?
The ARTERIES
MACROVASC contributes to which major conditions?
- ATHERO
- CAD
- MI
- CVA
- PVD
4 complications of VASC damage
this ones fucking loooooooong
1) Def METB
- Abn METABOLITE accum which inflicts injury
2) Impaired perf
- GLUCOSE + PROTEINS = GLYCOSULATED
PROTEINS
- These proteins become dysfxal
- Cause oxidative damage and FREE RADICALS
- They deposit on the endothelium, causing impaired
TRANSCAP EXCHANGE
- Foreign deposits cause PLATELET AGGREGATION
which impairs perf
3) Prolif of ANAEROBIC bacteria
- In deficiency of air
- In DIABETES there is an abundance of HYPOXIC
areas eg the foot
4) Poor healing
- Dec perf
- Can’t bring nutrients to the damaged area
Explain the process of ANEURYSM formation in RETINOPATHY
- Vs in eye are damaged (MICROVASC damage)
- ANEURYSMS form
- If ANEURYSM ruptures, this causes visual impairment
Explain the process of CATARACT formation in RETINOPATHY
- Sorbitol (a sugar alcohol) accumulates in the lens fibrils
- Swelling of lens fibrils occurs when water moves in to maintain osmotic balance
- The excess water causes disruption of fibrils and cataract formation
- Lens becomes opaque, light cannot properly pass through and refract
Explain the process of GLAUCOMA formation in RETINOPATHY
- Glaucoma is caused by damage to the optic nerve d/t increased intraoccular pressure
Is the increased intraoccular pressure in GLAUCOMA caused by VASC?
No, its caused by the pressure from the AQUEOUS HUMOR and VITEOUS HUMOR
What causes NEPHROPATHY?
MICROVASC damage = impaired perf = GLOMERULAR injury = impaired renal Fx = RF?
3 causes of NEUROPATHY?
1) DEMYLINATION
2) NEURAL ISCHEMIC INJURY
3) POOR CONDUCTION
How do CAD, CVA, and PVD relate to DM?
They mobilize LIPIDS = inc LIPIDS = HYPERLIPIDEMIA = ATHERO = major risk factor for MI, CVA, PVD
Is HTN more or less prevalent in DIABETICS?
More prevalent
Are INFCTs more or less prevalent in DIABETICS?
Much more prevalent
What 2 INFCTS are most commonly seen in DIABETICS?
Foot INFCTS and UTIs
Why are INFCTS difficult to manage in DIABETICS?
- Impaired perf (VASC insufficiency)
- Impaired WBC Fx
- Neuropathy (Dec sensation)
What are the Dx tests for DM?
- A detailed Hx (fam, 3 P’s, extreme wt loss or gain)
- Random GLUC test (>11 mmol/L)
- IFG (> or equal to 7)
- IGT (>11 mmol/L)
- HgbA1C (> or equal to 6.5%, 5% is normal)
What are the main Dx for DM?
- Random GLUC test (>11 mmol/L)
- IFG (> or equal to 7)
- IGT (>11 mmol/L)
Tx for DM?
- Lifestyle mod
- GLYCEMIC control
- PO HYPOGLYCEMICS (type 2)
- Inc cell response to I
- Dec hepatic GLUCOGENESIS
- Stim B cells
- Metformin if HgbA1C still >7% after 2-3 months of
lifestyle mods - Metformin +1 if HgbA1C > or equal to 9%
- I for type 1
- PO HYPOGLYCEMICS (type 2)
