Unit 4 Flashcards
Define glycogenolysis
Breakdown of glycogen by the liver to make glucose.
True or False
Diabetes is a disorder where there is only a problem with metabolizing carbohydrates (like sugar) correctly and that is why it is called ‘sugar diabetes’ by some people.
False
Diabetes is a disorder not only of problems metabolizing carbohydrates correctly, but also fats and proteins.
Define glycogenesis
The creation of glycogen for the storage of excess glucose. This is done by the liver.
Define gluconeogenesis
The creation of glucose from non-carbohydrate sources like amino acids.
Define glucagon
Hormone excreted by the pancreas to trigger the liver to release glucose into the bloodstream.
Insulin is ______ steroid as it makes the body build up from the use of foodstuffs that are ingested.
an anabolic
If the blood sugar is high in the bloodstream, the pancreas releases __________ from the __________ cells in a pulse like fashion. The liver produces ________ from the excess glucose that is not needed immediately by cells. As a result of this process, blood sugar falls.
Insulin, beta, glycogen
Which of the following can cause a goiter?
Thyroid cancer, normal thyroid function, hypothyroidism, hyperthyroidism
Goiters can be present when there is hypo-, hyper-or euthryoid states. They can also be present with thyroid cancer, which I didn’t mention in the recording.
What is the most common cause of hypothyroidism in the U.S.?
Hashimoto’s thyroiditis
Hasimoto’s thyroiditis, an autoimmune disorder is the most common cause of hypothyroidism.
The thyroid is important for the metabolism in the body. Patients with hypothyroidism experience a ______ metabolism and patients with hyperthyroidism experienced a
_______ metabolism.
decreased, increased
Hyper or Hypothyroidism?
Tachycardia
Hyper
Hyper or Hypothyroidism?
intolerance to heat
Hyper
Hyper or Hypothyroidism?
brittle nails and hair
Hypo
Hyper or Hypothyroidism?
constipation
Hypo
Hyper or Hypothyroidism?
Rough and dry skin
Hypo
Hyper or Hypothyroidism?
Cardiac dysrhythmias (like afib)
Hyper
A patient has thyroid storm. What would nurse expect related to this condition.
Anxiety and nervousness, high heart rate and palpitations, and high levels of T3 and T4 and low levels of TSH
Thyroid storm is extreme situation of hyperthyroidism so the symptoms of hyperthyroidism would be present.
Which statement below indicates an understanding of how the thyroid regulation occurs in the body?
Most of thyroid hormones are bound to protein and only a small amount is unbound and active.
Both T3 and T 4 are mostly (99.5%) bound to protein. Only the amount that is not bound is protein is active in the body. There is only a small amount that is active and that has a metabolic effect on cells.
A hemoglobin A1C tells the provider the average blood glucose reading over the last _________ (time frame).
3 to 4 months
Blood test depicting Hgb and RBC exposure to glucose over the previous 3 to 4 months
In prolonged hyperglycemia, hemoglobin that travels on the RBC becomes irreversibly combine with glucose (termed glycosylation) for life of the RBC.
Which of the following are abnormal findings and can be used when diagnosing diabetes?
Hemoglobin A1C of 8% and random blood sugar of 280 mg/dL`
An individual who is diagnosed with gestational diabetes has a very high chance (80-90%) of developing ________ later in life.
T2DM
What type of Diabetes?
Is diagnosed during pregnancy
gestational
What type of Diabetes?
caused by chronic steroid use
secondary
What type of Diabetes?
caused by a genetic predisposition where there is an environmental trigger that stimulates an autoimmune response
T1DM
What type of Diabetes?
The pancreas makes insulin but there is insulin resistance at the cellular level
T2DM
What type of Diabetes?
Individual is most likely to be very sick when diagnosed.
T1DM
What type of Diabetes?
Patients tend to be overweight. Initial treatment includes weight loss and exercise.
T2DM
What type of Diabetes?
Patients have to be treated with insulin
T2DM
What type of Diabetes?
Patients tend to get diagnosed during their yearly physical exam
T2DM
What type of Diabetes?
Caused by pancreatic diseases
Secondary
What type of Diabetes?
Used to be called juvenile diabetes
T1DM
What characteristics are most likely in a patient who is newly diagnosed with Type 1 DM?
Young individual who comes to the hospital acutely ill.
Patients dx with T1DM are usually less than 30 years in age and the symptoms come on very quickly and are very debilitating that they seek healthcare attention. Lethargy, fatigue, weight loss, muscle weakness, 3 P’s, blurred vision.
In patients with T1DM, there is an ________________________ insulin deficiency.
absolute
Which statement best describes one aspect of the patho that occurs in T1DM?
There is inhibition of glucose uptake at the GLUT-4 receptors since there is no insulin binding.
There is a whole series of events that occur with DKA, one of which is the inability of cells to take in glucose because there is no insulin present. The cells are starving as result of this.
What three components are essential for Diabetic Ketoacidosis?
Ketosis, metabolic acidosis, hyperglycemia
Hyperosmolarity occurs and so does Kussmaul breathing, but they are not part of the 3 essential components.
Why does polyuria occur?
Osmotic diuresis
Hyperglycemia leads to spilling of glucose into the urine. More glucose in the urine pulls fluid and electrolytes into the urine increasing the urinary output (polyuria). All of this is described in the word osmotic diuresis.
What is a likely contributing cause to T1DM?
Viral infection and autoimmune disorder
T1DM is an autoimmune disorder that seems to occur in individuals with a genetic predisposition and the occurrence of some environmental trigger like viral infection or exposure to a toxin.
Which of the following represent typical symptoms for an individual who is presenting with new onset type 1 diabetes (not in DKA)?
10lb weight loss over the last month, eating all the time, lethargy and low energy
What are two pathological changes that happen in someone with Type 2 DM?
Increased production of glucose by the liver and insulin resistance at target cells
T2DM is all about “relative” insulin deficiency. It is a problem with insulin resistance and increased production of glucose by the liver (glycogenolysis).
How does someone with T2DM typically present to the healthcare provider and eventually become diagnosed?
Asymptomatic and picked up on routine yearly lab work.
T2DM usually has an insidious onset whereby patients are often asymptomatic or only recall symptoms when asked specifically about certain things.
Which statement is most accurate about T2DM?
Weight loss can make a big impact on T2DM and can be completely managed by diet and exercise.
Obesity has a significant impact on T2DM. Weight loss improve cell sensitivity to insulin and can get patients off of medications and avoid long-term complications. T2DM is NOT because of eating too much sugar in particular, but poor diets have an impact.
A patient with T2DM is admitted with HHNK. What finding will NOT be present in this patient?
metabolic acidosis
Someone with HHNK still have hyperglycemia and dehydration. There is no ketosis or metabolic acidosis. They are still very sick and need ICU care. Dehydration can result in Altered mental status, renal failure, hypotension and tachycardia.
The nurse is reading the patient’s chart and sees a diagnosis of “Metabolic Syndrome”. What does this mean related to diabetes?
The patient has a fasting blood sugar over 100
Metabolic syndrome is does not mean that a patient has DM, but is at risk of developing it (along with CV disease and stroke.
A diabetic is experiencing hypoglycemia after taking insulin, but not eating enough food. Initially the symptoms are due to the ________ system and then followed by the ________ system. Severe situations can result in _______ due to lack of glucose to the brain.
Parasympathetic, sympathetic, coma
Which of the following are symptoms of hypoglycemia?
difficulty concentrating, tachycardia, sweating
What is the result of prolonged levels of hyperglycemia on blood vessel walls?
Advanced glycation endoproducts (AGE) form leading to hardening and thickening of blood vessels.
Glycation - increased glucose levels allow glucose to bind to proteins in blood vessel walls and interstitial tissue.
called AGE (advanced glycation endproducts)
Leads to thickening of basement membrane causing hardening and thickening that leads to:
ºNephropathy – nephron ischemia
ºRetinopathy – retinal ischemia
ºMay cause increased risk of atherosclerosis
Which of the following are chronic complications of diabetes mellitus?
blindness, dialysis, amputations
Both Dawn phenomenon and Somogyi effect are very similar. How can the two be distinguished?
Patient is thought to have Somogyi effect if the person has a low blood glucose at 3am.
Both dawn phenomenom and Somogyi effects result in hyperglycemia in the morning when BS is checked upon waking. Somogyi is related to middle of the night hypoglycmia and counter-regulatory hormones causing rebound hyperglycemia.
Why does alcohol cause hypoglycemia in patients with Diabetes if alcohol is said to have a lot of sugar in it?
Alcohol prevents the liver’s ability for gluconeogenesis.
Alcohol decreases the liver ability for gluconeogenesis therefore patients with DM need to be cautioned about its potential for causing hypoglycemia especially if it is consumed in large amounts on an empty stomach.
Why are foot infections so problematic for patients with diabetes?
The combination of decreased sensation (neuropathy) and poor circulation make foot infections difficult to detect and to heal.
Foot infections (and eventually amputations) are a problem for patients with diabetes due to a combination of factors: peripheral neuropathy decreases sensation so patients don’t realize an injury occurred; poor blood circulation make healing a challenge and hyperglycemia impacts lymphocytes effectiveness which increases the risk of infection. This leads to poor healing foot ulcers and sometimes requires amputation.
