OTH: Endocrine/Metabolic through DM Flashcards
1
Q
___ and ___ glands along with NS, make up central network that controls other glands in the body
A
Hypothalamus and pituitary
2
Q
Endocrine fxn closely linked with ___ system
A
Immune
3
Q
Hypothalamus controls release of ____ hormones, includes what? (4)
A
Pituitary
- Corticotropin-releasing hormone (CRT)
- Throtroponin-releasing hormone (TRH)
- Growth hormone-releasing hormone (GHRH)
- Somatostatin
4
Q
Anterior pituitary controls release of ? (5)
A
- GH
- Adenocorticotropic hormone (ACTH)
- Follicle-stimulating hormone (FSH)
- Leutinizing hormone (LH)
- Glucocorticoids (cortisol)
5
Q
Posterior pituitary controls release of ?
A
- Antidiuretic hormone (ADH)
2. Oxytocin
6
Q
Adrenal cortex— release of (4)
A
- Mineral corticosteroids (aldosterone)
- Glucocorticoids (cortisol)
- Adrenal androgens (DHEA)
- Androstenedione
7
Q
Adrenal medulla— release of ?
A
Epinephrine, norepinephrine
8
Q
Thyroid gland — release of ? Thyroid C cells control release of ?
A
Triiodothyronine and thyroxine
Thyroid C control release of calcitonin
9
Q
Parathyroid gland — release of ?
A
Parathyroid hormone (PTH)
10
Q
Pancreatic islet cells — release of ?
A
- Insulin
- Glucagon
- Somatostatin
11
Q
Kidney — release of ?
A
1,25-dihydroxy-Vitamin D
12
Q
Ovaries — release of ?
A
Estrogen and progesterone
13
Q
Testes — release of ?
A
Androgens (testosterone)
14
Q
4 hormones released by islets of langerhans in pancreas ?
A
- Insulin
- Glucagon
- Amylin
- Somatostatin
15
Q
Allows uptake of glucose from bloodstream, suppresses hepatic glucose production, ____ glucose levels
A
Insulin
LOWERS
16
Q
Stimulates hepatic glucose production to ___ glucose levels; especially in fasting state
A
Glucagon
RAISES
17
Q
Insulin is secreted by _ cells
A
Beta
18
Q
Glucagon is secreted by _ cells
A
Alpha
19
Q
Modulates rate of nutrient delivery (gastric emptying); suppresses release of glucagon
A
Amylin
20
Q
Amylin is secreted by _ cells
A
Beta
21
Q
Acts locally to DECREASE secretion of insulin and glycogen; decrease motility of stomach, duodenum, gallbladder, decrease secretion and absorption by delta cells
A
Somatostatin
22
Q
Cluster of risk factors that increase likelihood of developing heart disease, stroke, DMT2 is called
A
Metabolic syndrome (syndrome X)
23
Q
Have to have 3+ of following criteria for metabolic syndrome:
- Abdominal obesity: large waist size (men ?, women ?)
- Cholesterol: elevated triglycerides ( __ mg/dL or on ___ meds)
- Cholesterol: low HDL (men?, women?)
- High BP (SBP ___ and/or DBP ___)
- Blood sugar (FPG ____ mg/dL)
A
- Men 40+“, women 30+”
- 150 mg/dL, cholesterol meds
- Men <40, women <50
- SBP 135+, DBP 85+
- 100+
24
Q
Incidence of metabolic syndrome? Demographic?
A
1/4 adults, older adults/may run in families
25
Complex disorder of carb/fat/protein metabolism caused by deficiency or absence of insulin secretion by B cells of pancreas OR defects in insulin receptors
DM
26
DM causes abnormally ___ levels of sugar or glucose in blood
HIGH
27
D1DM aka ? (2)
INSULIN-DEPENDENT
| JUVENILE ONSET
28
T1DM: decrease in size and number of ___ cells, absolute deficiency of ___ ___
Islet, insulin secretion
29
T1DM: long preclinical period with abrupt onset of sx around ____, requires ___ delivery, prone to ____
Puberty
Insulin
Ketoacidosis
30
T2DM: from inadequate ____ and ___. Is aka _______
Utilization of insulin, Beta cell destruction
| INSULIN RESISTANCE
31
How many DM cases are T1 vs T2?
T1: 1% population, about 10% of all people with DM
T2: 90-95% of DM cases
32
T2DM:
1. ____ onset
2. Insulin dependent?
3. Ketoacidosis?
4. Insulin resistance in ___ and ___ tissue
5. Progressive ___ in pancreatic insulin production
6. Excessive __ __ production
7. Inappropriate ___ secretion
1. Gradual
2. Not insulin dependent
3. Not prone to ketoacidosis
4. Muscle, adipose
5. Decrease
6. Hepatic glucose
7. Glucagon
33
```
T2DM:
Risk factors-
1. ___ and older adults, increased incidence with ___ kids
2. Family hx
3. Lack of ___
4. Unhealthy ___
```
1. Obesity, obese
2. —
3. Physical activity
4. Eating habits
34
Secondary DM: associated with other conditions such as ____ disease, or removal of ___ tissue, endocrine system disease (____, ___ syndrome, ____), drugs, chemical agents
Pancreatic, pancreatic
| Acromegaly, Cushing’s pheochromocytoma
35
Gestational DM: glucose intolerance (___ blood sugar) associated with pregnancy; most likely in ___ trimester. affects approx __% of pregnancies
High
3rd
4%
36
Prediabetes: impaired __ __ with abnormal response to oral glucose test. ___% will convert to T2DM in 10 years
Glucose tolerance
| 10-15%
37
S/Sx DM:
1. ___ blood sugar (____)
2. ___ sugar in urine (____)
3. Excess excretion of urine (____)
4. Excess thirst (____), dry mouth
5. Excess ___ (____), especially after eating
6. Unexplained __ __
7. Fatigue
8. Blurred vision, headaches
1. Increased, hyperglycemia
2. Increased, glycosuria
3. Polyuria
4. Polydipsia
5. Hunger, Polyphasia
6. Wt loss
38
```
Complications of DM:
Microvascular disease (3)
```
1. Retinopathy
2. Renal disease
3. Polyneuropathy
39
Complications of DM:
| Macrovascular disease ... leads to what?
Dyslipidemia (acceleration atherosclerosis) —> CVA, MI, PAD
40
```
Complications of DM:
Integ impairments (4)
```
1. Degenerative CT changes
2. Slow healing
3. Anhidrosis
4. Increased risk ulcers and infections
41
```
Complications of DM:
MSK impairments (5)
```
1. Jt stiffness/contracture risk
2. Increased adhesive capsulitis
3. Tenosynovitis
4. Plantar fasciitis
5. Increased risk osteoporosis
42
```
Complications of DM:
NM Impairments (4)
```
1. Diabetic polyneuropathy
2. Diabetic autonomic neuropathy (DAN)
3. Mononeuropathies
4. Entrapment neuropathies
43
Diabetic polyneuropathy: direction of impairment?
Distal to proximal, symmetrical
44
Diabetic autonomic neuropathy: what are CV symptoms? (6)
Resting tachycardia, exercise intolerance, abnormal HR/BP, CO responses, EXERCISE-INDUCED HYPOGLYCEMIA, postural hypotension
45
Diabetic autonomic neuropathy: integ symptoms? (4)
1. Anhidrosis
2. Abnormal sweating
3. Dry skin
4. Heat intolerance
46
Diabetic autonomic neuropathy: GI symptoms? (4)
Gastroparesis, GERD, diarrhea, constipation
47
Diabetic autonomic neuropathy: Metabolic symptoms?
Abnormal or delayed response to hypoglycemia
48
Focal nerve damage resulting from vasculitis with ischemia and infarction (DM)
Mononeuropathies
49
Repetitive trauma to superficial nerve
Entrapment neuropathy
50
Kidney impairments from DM?
Kidney failure
51
Vision impairments from DM?
Diabetic retinopathy from chronic hyperglycemia, diabetic macular edema
52
Liver impairments from DM?
Fatty liver disease (steatosis)
53
Dx criteria for DM:
1. Sx of DM + casual plasma glucose concentration of ____ mg/dL
2. FPG __ mg/dL (fasting = ? Hrs no food)
3. 2 hr postload glucose ___ during oral glucose tolerance test
1. 200+
2. 126+ (8+ hrs)
3. 200+
54
Medical goals/interventions for DM:
1. Maintain __ __ homeostasis
2. Dietary control
3. Oral ___ agents to decrease blood glucose (DMT_)
4. Insulin to lower blood glucose via injections/pump/intraperitoneal dialysis for pts with ___ ___ (DMT_ or more sever DMT_).
5. Maintain normal lipid levels
6. Control HTN
7. Exercise
1. Glucose/insulin
2. —
3. Hypoglycemic, T2
4. Renal failure (T1, T2)
55
DM: PT outcomes include improved ___ tolerance, increased ___ sensitivity, decreased glycosylated hemoglobin, ___ insulin requirements, improved lipid profiles, BP reduction, ___ management, increased physical work capacity
Glucose, insulin, decreased, weight
56
DM: exercise testing recommended ___ exercise due to increased __ risk
Prior to
| CV
57
DM ExRx:
| FITT for CV Training
F: 3-7 days/wk
I: 50-80% VO2max or HRR corresponding to RPE 12-16
T: 20-60 min
T: rhythmic, large muscle activity, biking, treadmill/overground walking
58
DM ExRx:
FIT for Resistance Training
Minimize what?
F: 2-3 days/wk
I: 60-80% 1RM, 2-3 sets 8-12 reps
T: multi-joint major muscles
Minimize sustained hard gripping/Valsalva
59
Aside from CV and resistance, DM ExRx should also include ?
Flexibility, balance
60
RED FLAGS: DM ExRx Pxns
| Monitor glucose when?
Prior to and following exercise
61
RED FLAGS: DM ExRx Pxns
| What is the most common problem for pts with DM who exercise?
Hypoglycemia
62
RED FLAGS: DM ExRx Pxns
DO NOT EXERCISE if blood glucose < ____ mg/dL
What should you do?
70
Provide carb snack initially (15g)
15g/every hr of intense exercise
63
RED FLAGS: DM ExRx Pxns
Hypoglycemia associated with exercise may last as long as ___ after exercise. To prevent post-exercise hypoglycemia, monitor ____ levels and ingest __ as needed.
48 hrs
Blood glucose
Carbohydrates
64
RED FLAGS: DM ExRx Pxns
| DO NOT EXERCISE IF BLOOD GLUCOSE > ___ mg/dL or poorly controlled (___ present with urine test)
300
| Ketones
65
RED FLAGS: DM ExRx Pxns
1. DO NOT exercise without eating at least ___ hrs before exercise
2. DO NOT exercise without ___ ___
3. DO NOT exercise ___
4. DO NOT inject short-acting insulin in ___ muscles or sites close to ___ muscles because insulin absorbed ___. Where is preferred injection site?
1. 2 hrs
2. Adequate hydration
3. Alone
4. Exercising, exercising, faster — abdomen preferred
66
RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
CV Disease: ___ — may see chronotropic incompetence, blunted __ and __ response, anhidrosis. ___ may be used to regulate intensity
HTN
HR, SBP
RPE
67
RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Retinopathy: avoid activities that dramatically increase SBP > ___ mmHg or pounding/jarring activities
170
68
RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Neuropathy/nephropathy: limit __ if severe
Weight bearing
69
RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Autonomic neuropathy is associated with ___ and ___
Sudden death, silent ischemia
70
RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Nephropathy: limit exercise to ___ intensities, discourage __ activity
Low-moderate, strenuous
71
RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Do not exercise in extreme temperatures due to impaired ___
Thermoregulation
72
response to hypoglycemia?
It pt awake, provide sugar (juice, candy, glucose tab)
| If unresponsive, seek immediate medical attention- glucagon injection or IV glucose required
73
Response to hyperglycemia?
Seek immediate medical tx
74
Hypoglycemia or hyperglycemia?
| Shakiness/trembling
Early stage Hypo
75
Hypoglycemia or hyperglycemia?
| Sweating, fainting, feeling faint
Early stage Hypo
76
Hypoglycemia or hyperglycemia?
| Tachycardia/palpitations, excessive hunger, poor coordination, unsteady gait
Early stage Hypo
77
Hypoglycemia or hyperglycemia?
| Nervousness/irritability
Late stage hypo
78
Hypoglycemia or hyperglycemia?
| Headache, slurred speech, blurred/double vision
Late stage hypo
79
Hypoglycemia or hyperglycemia?
| Drowsiness, inability to concentrate, confusion, loss of consciousness/coma
Late stage hypo
80
Hypoglycemia or hyperglycemia?
| Weakness, flushed, signs of dehydration
Hyper
81
Hypoglycemia or hyperglycemia?
| Dulled senses, confusion, decreased reflexes, paresthesias
Hyper
82
Hypoglycemia or hyperglycemia?
| Increased thirst, dry mouth, decreased appetite, nausea/vom, abdominal tenderness
Hyper
83
Hypoglycemia or hyperglycemia?
| Frequent/scant urination, deep, rapid respirations, rapid weak pulse
Hyper
84
Hypoglycemia or hyperglycemia?
| Fruity odor to breath, coma
Hyper
85
Hypoglycemia onset is ___
Rapid, minutes
86
Hyperglycemia onset is
Gradual (days)
87
Do not exercise pt with DM between ____ hours after insulin injection
2-4 hrs
88
Decrease insulin dose by ___% before anticipated exercise
30-35%
89
Reduce post-exercise insulin dose by up to ___%
30%
90
Short-acting or continuous subcutaneous insulin infusion may have to be eliminated ___ __ or ___ exercise
Immediately before, after
91
Best time to exercise person with DM is __ after meal, increase __ __ at least ___ hours before and after exercise
1 hour after
| Complex CHO 24 hrs
