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KN JD NPTE: OTHER SYSTEMS > OTH: Endocrine/Metabolic through DM > Flashcards

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

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2
Q

Endocrine fxn closely linked with ___ system

A

Immune

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3
Q

Hypothalamus controls release of ____ hormones, includes what? (4)

A

Pituitary

  1. Corticotropin-releasing hormone (CRT)
  2. Throtroponin-releasing hormone (TRH)
  3. Growth hormone-releasing hormone (GHRH)
  4. Somatostatin
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4
Q

Anterior pituitary controls release of ? (5)

A
  1. GH
  2. Adenocorticotropic hormone (ACTH)
  3. Follicle-stimulating hormone (FSH)
  4. Leutinizing hormone (LH)
  5. Glucocorticoids (cortisol)
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5
Q

Posterior pituitary controls release of ?

A
  1. Antidiuretic hormone (ADH)

2. Oxytocin

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6
Q

Adrenal cortex— release of (4)

A
  1. Mineral corticosteroids (aldosterone)
  2. Glucocorticoids (cortisol)
  3. Adrenal androgens (DHEA)
  4. Androstenedione
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7
Q

Adrenal medulla— release of ?

A

Epinephrine, norepinephrine

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8
Q

Thyroid gland — release of ? Thyroid C cells control release of ?

A

Triiodothyronine and thyroxine

Thyroid C control release of calcitonin

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9
Q

Parathyroid gland — release of ?

A

Parathyroid hormone (PTH)

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10
Q

Pancreatic islet cells — release of ?

A
  1. Insulin
  2. Glucagon
  3. Somatostatin
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11
Q

Kidney — release of ?

A

1,25-dihydroxy-Vitamin D

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12
Q

Ovaries — release of ?

A

Estrogen and progesterone

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13
Q

Testes — release of ?

A

Androgens (testosterone)

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14
Q

4 hormones released by islets of langerhans in pancreas ?

A
  1. Insulin
  2. Glucagon
  3. Amylin
  4. Somatostatin
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15
Q

Allows uptake of glucose from bloodstream, suppresses hepatic glucose production, ____ glucose levels

A

Insulin

LOWERS

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16
Q

Stimulates hepatic glucose production to ___ glucose levels; especially in fasting state

A

Glucagon

RAISES

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17
Q

Insulin is secreted by _ cells

A

Beta

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18
Q

Glucagon is secreted by _ cells

A

Alpha

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19
Q

Modulates rate of nutrient delivery (gastric emptying); suppresses release of glucagon

A

Amylin

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20
Q

Amylin is secreted by _ cells

A

Beta

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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

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22
Q

Cluster of risk factors that increase likelihood of developing heart disease, stroke, DMT2 is called

A

Metabolic syndrome (syndrome X)

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23
Q

Have to have 3+ of following criteria for metabolic syndrome:

  1. Abdominal obesity: large waist size (men ?, women ?)
  2. Cholesterol: elevated triglycerides ( __ mg/dL or on ___ meds)
  3. Cholesterol: low HDL (men?, women?)
  4. High BP (SBP ___ and/or DBP ___)
  5. Blood sugar (FPG ____ mg/dL)
A
  1. Men 40+“, women 30+”
  2. 150 mg/dL, cholesterol meds
  3. Men <40, women <50
  4. SBP 135+, DBP 85+
  5. 100+
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24
Q

Incidence of metabolic syndrome? Demographic?

A

1/4 adults, older adults/may run in families

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25
Q

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

A

DM

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26
Q

DM causes abnormally ___ levels of sugar or glucose in blood

A

HIGH

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27
Q

D1DM aka ? (2)

A

INSULIN-DEPENDENT

JUVENILE ONSET

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28
Q

T1DM: decrease in size and number of ___ cells, absolute deficiency of ___ ___

A

Islet, insulin secretion

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29
Q

T1DM: long preclinical period with abrupt onset of sx around ____, requires ___ delivery, prone to ____

A

Puberty
Insulin
Ketoacidosis

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30
Q

T2DM: from inadequate ____ and ___. Is aka _______

A

Utilization of insulin, Beta cell destruction

INSULIN RESISTANCE

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31
Q

How many DM cases are T1 vs T2?

A

T1: 1% population, about 10% of all people with DM
T2: 90-95% of DM cases

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32
Q

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
A
  1. Gradual
  2. Not insulin dependent
  3. Not prone to ketoacidosis
  4. Muscle, adipose
  5. Decrease
  6. Hepatic glucose
  7. Glucagon
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33
Q 
T2DM:
Risk factors-
1. \_\_\_ and older adults, increased incidence with \_\_\_ kids
2. Family hx
3. Lack of \_\_\_
4. Unhealthy \_\_\_
A
  1. Obesity, obese
  2. —
  3. Physical activity
  4. Eating habits
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34
Q

Secondary DM: associated with other conditions such as ____ disease, or removal of ___ tissue, endocrine system disease (____, ___ syndrome, ____), drugs, chemical agents

A

Pancreatic, pancreatic

Acromegaly, Cushing’s pheochromocytoma

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35
Q

Gestational DM: glucose intolerance (___ blood sugar) associated with pregnancy; most likely in ___ trimester. affects approx __% of pregnancies

A

High
3rd
4%

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36
Q

Prediabetes: impaired __ __ with abnormal response to oral glucose test. ___% will convert to T2DM in 10 years

A

Glucose tolerance

10-15%

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37
Q

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
A
  1. Increased, hyperglycemia
  2. Increased, glycosuria
  3. Polyuria
  4. Polydipsia
  5. Hunger, Polyphasia
  6. Wt loss
38
Q 
Complications of DM:
Microvascular disease (3)
A
  1. Retinopathy
  2. Renal disease
  3. Polyneuropathy
39
Q

Complications of DM:

Macrovascular disease … leads to what?

A

Dyslipidemia (acceleration atherosclerosis) —> CVA, MI, PAD

40
Q 
Complications of DM:
Integ impairments (4)
A
  1. Degenerative CT changes
  2. Slow healing
  3. Anhidrosis
  4. Increased risk ulcers and infections
41
Q 
Complications of DM:
MSK impairments (5)
A
  1. Jt stiffness/contracture risk
  2. Increased adhesive capsulitis
  3. Tenosynovitis
  4. Plantar fasciitis
  5. Increased risk osteoporosis
42
Q 
Complications of DM:
NM Impairments (4)
A
  1. Diabetic polyneuropathy
  2. Diabetic autonomic neuropathy (DAN)
  3. Mononeuropathies
  4. Entrapment neuropathies
43
Q

Diabetic polyneuropathy: direction of impairment?

A

Distal to proximal, symmetrical

44
Q

Diabetic autonomic neuropathy: what are CV symptoms? (6)

A

Resting tachycardia, exercise intolerance, abnormal HR/BP, CO responses, EXERCISE-INDUCED HYPOGLYCEMIA, postural hypotension

45
Q

Diabetic autonomic neuropathy: integ symptoms? (4)

A
  1. Anhidrosis
  2. Abnormal sweating
  3. Dry skin
  4. Heat intolerance
46
Q

Diabetic autonomic neuropathy: GI symptoms? (4)

A

Gastroparesis, GERD, diarrhea, constipation

47
Q

Diabetic autonomic neuropathy: Metabolic symptoms?

A

Abnormal or delayed response to hypoglycemia

48
Q

Focal nerve damage resulting from vasculitis with ischemia and infarction (DM)

A

Mononeuropathies

49
Q

Repetitive trauma to superficial nerve

A

Entrapment neuropathy

50
Q

Kidney impairments from DM?

A

Kidney failure

51
Q

Vision impairments from DM?

A

Diabetic retinopathy from chronic hyperglycemia, diabetic macular edema

52
Q

Liver impairments from DM?

A

Fatty liver disease (steatosis)

53
Q

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
A
  1. 200+
  2. 126+ (8+ hrs)
  3. 200+
54
Q

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
A
  1. Glucose/insulin
  2. —
  3. Hypoglycemic, T2
  4. Renal failure (T1, T2)
55
Q

DM: PT outcomes include improved ___ tolerance, increased ___ sensitivity, decreased glycosylated hemoglobin, ___ insulin requirements, improved lipid profiles, BP reduction, ___ management, increased physical work capacity

A

Glucose, insulin, decreased, weight

56
Q

DM: exercise testing recommended ___ exercise due to increased __ risk

A

Prior to

CV

57
Q

DM ExRx:

FITT for CV Training

A

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
Q

DM ExRx:
FIT for Resistance Training
Minimize what?

A

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
Q

Aside from CV and resistance, DM ExRx should also include ?

A

Flexibility, balance

60
Q

RED FLAGS: DM ExRx Pxns

Monitor glucose when?

A

Prior to and following exercise

61
Q

RED FLAGS: DM ExRx Pxns

What is the most common problem for pts with DM who exercise?

A

Hypoglycemia

62
Q

RED FLAGS: DM ExRx Pxns
DO NOT EXERCISE if blood glucose < ____ mg/dL
What should you do?

A

70
Provide carb snack initially (15g)
15g/every hr of intense exercise

63
Q

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.

A

48 hrs
Blood glucose
Carbohydrates

64
Q

RED FLAGS: DM ExRx Pxns

DO NOT EXERCISE IF BLOOD GLUCOSE > ___ mg/dL or poorly controlled (___ present with urine test)

A

300

Ketones

65
Q

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?
A
  1. 2 hrs
  2. Adequate hydration
  3. Alone
  4. Exercising, exercising, faster — abdomen preferred
66
Q

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

A

HTN
HR, SBP
RPE

67
Q

RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Retinopathy: avoid activities that dramatically increase SBP > ___ mmHg or pounding/jarring activities

68
Q

RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Neuropathy/nephropathy: limit __ if severe

A

Weight bearing

69
Q

RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Autonomic neuropathy is associated with ___ and ___

A

Sudden death, silent ischemia

70
Q

RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Nephropathy: limit exercise to ___ intensities, discourage __ activity

A

Low-moderate, strenuous

71
Q

RED FLAGS: DM ExRx Pxns
DO NOT exercise with poorly controlled complications
Do not exercise in extreme temperatures due to impaired ___

A

Thermoregulation

72
Q

response to hypoglycemia?

A

It pt awake, provide sugar (juice, candy, glucose tab)

If unresponsive, seek immediate medical attention- glucagon injection or IV glucose required

73
Q

Response to hyperglycemia?

A

Seek immediate medical tx

74
Q

Hypoglycemia or hyperglycemia?

Shakiness/trembling

A

Early stage Hypo

75
Q

Hypoglycemia or hyperglycemia?

Sweating, fainting, feeling faint

A

Early stage Hypo

76
Q

Hypoglycemia or hyperglycemia?

Tachycardia/palpitations, excessive hunger, poor coordination, unsteady gait

A

Early stage Hypo

77
Q

Hypoglycemia or hyperglycemia?

Nervousness/irritability

A

Late stage hypo

78
Q

Hypoglycemia or hyperglycemia?

Headache, slurred speech, blurred/double vision

A

Late stage hypo

79
Q

Hypoglycemia or hyperglycemia?

Drowsiness, inability to concentrate, confusion, loss of consciousness/coma

A

Late stage hypo

80
Q

Hypoglycemia or hyperglycemia?

Weakness, flushed, signs of dehydration

81
Q

Hypoglycemia or hyperglycemia?

Dulled senses, confusion, decreased reflexes, paresthesias

82
Q

Hypoglycemia or hyperglycemia?

Increased thirst, dry mouth, decreased appetite, nausea/vom, abdominal tenderness

83
Q

Hypoglycemia or hyperglycemia?

Frequent/scant urination, deep, rapid respirations, rapid weak pulse

84
Q

Hypoglycemia or hyperglycemia?

Fruity odor to breath, coma

85
Q

Hypoglycemia onset is ___

A

Rapid, minutes

86
Q

Hyperglycemia onset is

A

Gradual (days)

87
Q

Do not exercise pt with DM between ____ hours after insulin injection

88
Q

Decrease insulin dose by ___% before anticipated exercise

89
Q

Reduce post-exercise insulin dose by up to ___%

90
Q

Short-acting or continuous subcutaneous insulin infusion may have to be eliminated ___ __ or ___ exercise

A

Immediately before, after

91
Q

Best time to exercise person with DM is __ after meal, increase __ __ at least ___ hours before and after exercise

A

1 hour after

Complex CHO 24 hrs

KN JD NPTE: OTHER SYSTEMS (12 decks)

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