Unit 4: Endocrine Flashcards
T/F: Diabetes is a disorder where people can’t metabolize 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.
What is the term for the breakdown of glycogen by the liver to make glucose.
Glycogenolysis
What is the term for the creation of glycogen for the storage of excess glucose. This is done by the liver.
Glycogenesis
What is the term for the creation of glucose from non-carbohydrate sources like amino acids.
Gluconeogenesis
What is the hormone excreted by the pancreas to trigger the liver to release glucose into the bloodstream.
Glucagon
Insulin is a/an ____________ steroid as it makes the body build up from the use of foodstuffs that are ingested.
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
What characteristics are most likely in a patient who is newly diagnosed with Type 1 DM?
- Chronically ill patient with a number of co-morbidities like HTN and high cholesterol.
- Over the age of 65 years.
- Young individual who comes to the hospital acutely ill.
- A patient with ongoing episodes of hypoglycemia despite eating well.
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 or total. T1DM patients no longer make insulin= absolute insulin deficiency.
Which statement best describes one aspect of the patho that occurs in T1DM?
- Gluconeogenesis is blocked due to the presence of glycerol.
- There is increased glycogenesis in the liver.
- Alpha cells are destroyed leading to dysfunction of glucagon.
- There is inhibition of glucose uptake at the GLUT-4 receptors since there is no insulin binding.
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?
Hyperglycemia, ketosis, metabolic acidosis
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? Select. all. that. apply.
- genetics
- autoimmune disorder
- viral infection
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.
What are two pathological changes that happen in someone with Type 2 DM?
Insulin resistance at target cells and increased production of glucose by the liver
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?
- Most people have T2DM because they ate too much sugar.
- Patients who are thin and have T2DM don’t have long-term complications from DM.
- Weight loss can make a big impact on T2DM and can be completely managed by diet and exercise.
- T2DM is all about genes. Weight loss won’t make a difference.
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. t/f: they will have metabolic acidosis.
False
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.
Which type of diabetes
is diagnosed during pregnancy?
Gestational
Which type of diabetes is
caused by chronic steroid (prednisone) use?
Secondary
Which type of diabetes is caused by a genetic predisposition where there is an environmental trigger that stimulates an autoimmune response?
T1DM
t1/t2 DM: when the pancreas makes insulin but there is insulin resistance at the cellular level?
T2DM
t1/t2 DM: the individual is most likely to be very sick when diagnosed.
T1DM
t1/t2 DM: patients tend to be overweight. Initial treatment includes weight loss and exercise.
T2DM
t1/t2 DM: all patients have to be treated with insulin
T1DM
t1/t2 DM: patients tend to get diagnosed during their yearly physical exam?
T2DM
type of DM: caused by pancreatic diseases?
Secondary
t1/t2 DM: “juvenile diabetes”
T1DM
t1/t2 DM: A woman who is diagnosed with gestational diabetes has a very high chance (80-90%) of developing _______ later in life.
T2DM
Which of the following are abnormal findings and can be used when diagnosing diabetes? Go ahead and select all that apply.
- Blood glucose 2 hours after a meal of 148 mg/dL
- Fasting blood glucose of 60 mg/dL
- Hemoglobin A1C of 8%
- Random blood sugar of 280 mg/dL
- Hemoglobin A1C of 8%
- Random blood sugar of 280 mg/dL
DM can be diagnosed using any of the 3 below. Often it is tested on 2 separate occasions before diagnosis.
Random blood glucose
Equal to or greater than 200 Fasting blood glucose Equal to or greater than 126 HgA1C: greater than 6.5%
A hemoglobin A1C tells the provider the average blood glucose reading over the last _________ (time frame).
3-4 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.
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
A diabetic is experiencing hypoglycemia after taking insulin, but not eating enough food. Initially the symptoms are due to the parasympathetic system and then followed by the sympathetic system. Severe situations can result in coma due to lack of glucose to the brain.
Which of the following are symptoms of hypoglycemia?
- sweating
- dry mouth
- difficulty concentrating
- tachycardia
- incontinence of urine
Sweating, difficulty concentrating, tachycardia
Hypoglycemia symptoms include: shaky, tachycardia, sweating, dizzy, hungry, blurred vision, weakness or fatigue, headache, irritable.
Dry mouth is hyperglycemia. Urinary incontinence is neither.
What is the result of prolonged levels of hyperglycemia on blood vessel walls?
Advanced glycosylation endoproducts (AGE) form leading to hardening and thickening of blood vessels.
Glycosylation - increased glucose levels allow glucose to bind to proteins in blood vessel walls and interstitial tissue.
called AGE (advanced glycosylation 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?
Select all that apply :(
- increased risk for gout
- osteoporosis
- amputations
- blindness
- dialysis
- amputations
- blindness
- dialysis
There are a lot of complications from DM:
blindness-diabetic retinopathy
Renal failure and dialysis–nephropathy, glomerular damage
Foot ulcers, neuropathy, erectile dysfunction, loss of libido, chronic infections (UTI, cellulitis, osteomyelitis), gastroparesis, constipation, CAD, MI, stroke, PVD,
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 3 am.
Both dawn phenomenon and Somogyi effects result in hyperglycemia in the morning when BS is checked upon waking. Somogyi is related to middle of the night hypoglycemia 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.
Which of the following can cause a goiter? Select all that apply!!!
- hyperthyroidism
- normal thyroid function
- hypoparathyroidism
- hypothyroidism
- thyroid cancer
Hyperthyroidism, normal thyroid function, hypothyroidism, thyroid cancer
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
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
Tachycardia: Hyperthyroidism or hypothyroidism?
Hyperthyroidism
Intolerance to heat: Hyperthyroidism or hypothyroidism?
Hyperthyroidism
Brittle nails and hair: Hyperthyroidism or hypothyroidism?
Hypothyroidism
Constipation: Hyperthyroidism or hypothyroidism?
Hypothyroidism
Rough and dry skin: Hyperthyroidism or hypothyroidism?
Hypothyroidism
Cardiac dysrhythmias (like atrial fibrillation): Hyperthyroidism or hypothyroidism?
Hyperthyroidism
The primary role of insulin in the body is:
Attach to receptors on cells activating the GLUT-4 receptors to glucose into the cell
If the body does not have glucose available for use, what will occur?
Gluconeogenesis. This is the production of glucose from non-carb sources
Extra glucose is stored for use between meals. In what form is this stored?
Glycogen
What effect do counter-regulatory hormones have on blood sugar?
Increase blood sugar
What might make blood sugar go down? SATA MFers:
- glucocorticoids
- food
- exercise
- infection
- insulin
Exercise, insulin
Glucagon is made by what cells?
Alpha cells
If blood sugar is low, what happens?
Pancreas releases glucagon which stimulates the liver to break down glycogen
If a person has type 1 DM and does not have insulin, what would the person look like?
Exhibit weight loss and muscle atrophy *Remember the picture of the first child treated with insulin. Insulin is an anabolic hormone—builds the body up. Patients with Type2 DM make insulin but have insulin resistance at the cells. Eventually they will stop making insulin but that takes many years.
What occurs in the pancreas in Type 1 DM?
Destruction of beta cells inhibiting the production of insulin.
When are most people diagnosed with Type 1 DM?
Age 12
*This is the average age of diagnosis. As early as 9 months and can be as late as 30s.
Which type of diabetes mellitus tends to be an autoimmune cause whereby genetics and the environment cause the body to start attacking itself?
T1DM
This is the best option. Insulin-dependent DM is not a good description, but that is not exclusively Type 1 diabetics.
What seems to play a strong environmental factor in the occurrence of T2DM (type 2 diabetes mellitus)?
Obesity. Obesity is the only environmental factor listed here and seems to play a big role in the development of DM in many individuals (not all). Adipose tissue seems to act as a hormone in the body and leads to insulin resistance.
What type of DM is a result of destruction of beta cells?
T1DM
