type 1 diabetes

Question 1

What is happening in type 1 DM?

Answer 1

total destruction of the pancreatic beta cells

Question 2

What is type 1 DM considered?

Answer 2

an autoimmune disorder

Question 3

What are the two types of type 1 DM?

Answer 3

type 1A (90-95%)
Type B (idopathic, no autoimmune)

Question 4

What is the prevalence of type 1 DM?

Answer 4

accounts for 5-10% of all diabetes

Question 5

What are the sx of short-term acute complications of T1D?

Answer 5

three Ps
- polyuria
- polydipsia
- polyphagia
- may have visual disturbances, fatigue, weakness
- DKA is often the presenting sign

Question 6

What is required for short-term acute complications of T1D?

Answer 6

requires exogenous insulin to stop the catabolic process, lower the blood sugar, & prevent ketosis

Question 7

What is ketosis?

Answer 7

a metabolic state where the body uses free fatty acids for energy instead of glucose

Question 8

What causes T1D?

Answer 8

genetic predisposition
- mutation on human leukocyte antibodies on chromosome 6

Question 9

What triggers T1D?

Answer 9

triggered by illness, viral infection or autoimmune disease

Question 10

T1D is __ - ______________ mediated hypersensitivity to _____ - _____ antibodies

Answer 10

T- lymphocyte; beta-cell

Question 11

What are those with T1D at increased risk for?

Answer 11

increased risk for other diseases, such as celiac disease, rheumatoid arthritis & hypothyroidism

Question 12

What are the clinical manifestations of T1D?

Answer 12

• polydipsia
• polyuria
• polyphagia
• weight loss
• abd pain
• blurred vision (accumulation of aqueous humor in the eye)
• frequent candida infections
• extremely elevated glucose
• ketones in urine
• metabolic acidosis
• often presents in DKA

Question 13

What causes polydipsia in T1D?

Answer 13

• hyperglycemia increases osmotic pressure in extracellular compartments
• results in water shifting out of intracellular space
• cellular dehydration creates sense of thirst

Question 14

What is polyuria?

Answer 14

increased amount & frequency of urination

Question 15

What causes polyuria?

Answer 15

• renal threshold for glucose reabsoprtion is exceeded
• results in glucose remaining in renal tubule
• osmotic gradient develops which pulls water from the tubule cells into urine
• “spilling” glucose in urine = renal threshold is exceeded

Question 16

What is polyphagia?

Answer 16

increased hunger (w/ weightloss in T1D)

Question 17

What causes polyphagia?

Answer 17

insulin deficiency; cells are not recieving glucose which sets compensatory processes into place to incrrease blood glucose levels

Question 18

polyphagia:
What does the liver break glycogen into?

Answer 18

glucose

Question 19

What is the process of fat breakdown called?

Answer 19

lypolysis

Question 20

What does fat breakdown into?

Answer 20

fatty acids and glycerol

Question 21

What are fatty acids converted to in T1D?

Answer 21

converted to ketones in the blood stream

Question 22

What is the process of fatty acids being converted into ketones called?

Answer 22

ketosis

Question 23

Where does glycerol go and what does it make?

Answer 23

glycerol goes to the liver to make glucose

Question 24

What is the process of glycerol being converted to glucose called?

Answer 24

gluconeogenesis

Question 25

When fat has been exhausted what occurs?

Answer 25

muscle breakdown occurs

Question 26

What is muscle brokendown into?

Answer 26

amino acids

Question 27

Where do amino acids go to be converted to glucose?

Answer 27

the liver

Question 28

Why does blurred vision occur T1D?

Answer 28

accumulation of glucose in aqueous fluid in cornea; causes osmolarity change

Question 29

What does the osmolarity change in the eye do?

Answer 29

alters refraction of light entering the eye

Question 30

What is a result of the altered process of aerobic and anaerobic metabolism?

Answer 30

ketones

Question 31

What are ketones a result of?

Answer 31

breakdown of fat into free fatty acids & glycerol for energy

Question 32

What organ converts fatty acids and glycerol into ketones?

Answer 32

the liver

Question 33

What are strong acids that accumulate in the blood and can lead to metabolic acidosis?

Answer 33

ketones

Question 34

__________________ occurs instead of ________ or citric acid cycle when ketones are made

Answer 34

gluconeogenesis; krebs

Question 35

What is considered a hyperglycemic emergency?

Answer 35

diabetic ketoacidosis

Question 36

What causes diabetic ketoacidosis?

Answer 36

markedly decreased or absence in the amount of insulin

Question 37

diabetic ketoacidosis is typically seen in _______ but can occur in ______

Answer 37

T1D; T2D

Question 38

___________ _____________ may be the initial presentation of type 1

Answer 38

diabetic ketoacidosis

Question 39

In what age group does diabetic ketoacidosis usually occur?

Answer 39

occurs most often in younger people but can happen at any age

Question 40

What is diabetic ketoacidosis characterized by? (hint:4)

Answer 40

1. hyperglycemia 2. metabolic acidosis 3. dehydration 4. electrolyte loss

Question 41

diabetic ketoacidosis results from development of ________

Answer 41

ketosis

Question 42

How is diabetic ketoacidosis diagnosed?

Answer 42

- serum glucose >250mg/dl - ketonemia and urine - low pH - low HCO3

Question 43

What are the three main causes of diabetic ketoacidosis?

Answer 43

- infection or illness - lack of insulin - undiagnosed or undertreated diabetes - poor compliance (teens)

Question 44

What are the sx of DKA?

Answer 44

- 3 Ps - weight loss - severe N/V - marked fatigue - extreme dehydration - poor skin turgor - dry mucous membranes - tachycardia - hypotension - acetone breath - kussmaul resp - changes in LOC

Question 45

What is the first step to treat DKA?

Answer 45

fluid replacement!

Question 46

Why do we want to begin with fluid replacement when treating DKA?

Answer 46

- to restore intravascular volume - to clear ketones - to correct electrolyte imbalances

Question 47

What kind of insulin should you give to treat DKA?

Answer 47

regular; IV insulin BG is <250. Then switch to SQ insulin

Question 48

What should you monitor when treating DKA?

Answer 48

- need to monitor for cerebral edema as fluid shifts back to the cells - need to monitor for hypokalemia as insulin shifts potassium back into cells

Question 49

What are the most common electrolyte imbalances seen in DKA?

Answer 49

hyponatremia & hyperkalemia

Question 50

What is the final part of treating DKA after immediate issues are solved?

Answer 50

treating the underlying cause

Question 51

What is hypoglycemia defined as?

Answer 51

defined as BG <70 mg/dl with or w/o sx

Question 52

In what group does hypoglycemia usually occur?

Answer 52

occurs most commonly in patients treated with insulin but can occur from some oral antidiabetic agents

Question 53

What factors can precipitate hypoglycemia in patients on insulin?

Answer 53

- errors in insulin dosing - failure to eat - increased exercise - decreased insulin need after removal of stressful situation - medication changes - alcohol ingestion (decreases liver gluconeogenesis)

Question 54

What are the sx of hypoglycemia?

Answer 54

- sweating - hunger - dizziness - nervousness - tremulousness - irritability - headache - heart palpitations - confusion - disorientation - inability to concentrate - seizures - stupor or LOC - unexplained night sweats cloudy mental state upon arising

Question 55

What are sx of nocturnal hypoglycemia?

Answer 55

- sleep disturbances - vivid dreams - morning headache - chronic fatigue - depression

Question 56

What is the dawn phenonmenon?

Answer 56

increase in fasting blood glucose and/or insulin requirements during the early morning hours

Question 57

What is not triggered by a nocturnal hypoglycemia event?

Answer 57

the dawn phenomenon

Question 58

What causes the dawn phenonmenon?

Answer 58

due to nocturnal elevation of growth hormone which raises BG - slows cells use of glucose

Question 59

What is the somogyi effect?

Answer 59

nocturnal hypoglycemia followed by rebound hyperglycemia

Question 60

What does hypoglycemia trigger during the somogyi effect?

Answer 60

hypoglycemia triggers the release of counter-regulatory hormones: releasing glycogen from the liver; epinephrine, cortisol & growth hormone

Question 61

What does the somogyi effect occur?

Answer 61

occurs due to too much or too little insulin at bedtime or skipped nighttime snack

Question 62

How do you treat the somogyi effect?

Answer 62

decrease insulin dose or changing the time of medication

Question 63

How do you tell the difference between dawn phenomenon and somogyi effect?

Answer 63

check the glucose level in the middle of the night

Question 64

What are the glucose levels at 3am in the dawn phenomenon and somogyi effect?

Answer 64

dawn - normal/ high glucose somogyi - low glucose