Unit 4 - Endocrine Diseases pt 1

Question 1

Diabetes Mellitus (DM)

Answer 1

Condition characterized by impaired glucose metabolism. There are two major types.

3rd leading cause of death and leading cause of blindness and lower extremity amputations

Question 2

diabetes and kidney disease

Answer 2

leading single cause of kidney disease in the US

diabetic nephropathy: elevated protein albumins in the urine

Question 3

diabetes process/terminology

Answer 3

inc blood glucose levels –> hyperglycemia

regulated by insulin (produced and secreted by beta/islet cells)

Question 4

insulin activity

Answer 4

Insulin attaches to receptors
Activates Glucose Transporters (G4) to transport Glucose across the Cell Membrane
Alpha Cells secrete Glucagon - Raises blood glucose
Converts Liver Glycogen to Glucose

Question 5

Type 1

Answer 5

Juvenile onset – (~ 5% Type 1)

are insulin dependent

Question 6

Type 2

Answer 6

Maturity onset – (~ 95% Type 2)

not an insulin deficit, but poor response to insulin secretion

Question 7

Commonalities-Types I & II

3Ps

Answer 7

Polyphagia-excessive appetite
Polyuria-osmotic diuresis
Polydipsia-excessive thirst

Question 8

commonality: hyperglycemia s/s

Answer 8

dry mouth
inc thirst
blurred vision
weakness
headache
frequent urination

Question 9

commonality: glucosuria

Answer 9

glucose from the blood spills over into the urine

glucose renal t-max above 180 mg%

Question 10

other commonalities:

Answer 10

• elevated blood lipids
• poor wound healing and circulation
• peripheral neuropathy (mx weakness, decreased DTRs)
• assessed by glucose tolerance test
• hyperesthesia
• anesthesia
• atherosclerosis
• infections, gangrene, amputations

Question 11

etiology/risk factors of type 1

Answer 11

loss of Pancreatic Islet Beta Cells
Loss of Insulin Production/Secretion
Causes ??
Autoimmune mechanism
Viruses
Rubella 
Coxsackie
Mumps (Rubulavirus)
CMV

Question 12

etiology/risk factors of type2

Answer 12

Decreased sensitivity to insulin by insulin receptors
Decreased number of insulin receptors

Contributing Causes
Genetic predisposition
Lifestyle!!!
Excess bodyweight/obesity
Sedentary behavior

Question 13

differences in type 1 and 2

Answer 13

Type 1:

• Normal Body Type
• No Central Obesity
• insulin shock
• ketoacidosis
• exogenous insulin required
• autoimmune disease
• diabetic coma

Type 2:

• obesity
• respond to oral hypoglycemics

Question 14

criteria for the diagnosis of diabetes

Answer 14

A1C > 6.5% or
FPG > 126mg/dL (fasting is defined as no caloric intake for at least 8 hours) or
2 hour plasma glucose > 200 mg/dL (following glucose load containing equivalent of 75 g of anhydrous glucose dissolved in water) or
Random plasma glucose > 200 mg/dL with classic symptoms of hyperglycemia

urine glucose test

Question 15

metabolic syndrome

Answer 15

condition characterized by the presences of several risk factors in a single individual that greatly increase the risk of cardiovascular disease and diabetes

Question 16

indicators of metabolic syndrome

Answer 16

Central obesity (excessive fat tissue in and around the abdomen)
Hyperlipidemia (blood fat disorders — mainly high cholesterol & triglycerides and low HDL’s
Elevated blood pressure (130/85 mmHg or higher)
Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
Prothrombotic state (e.g. high fibrinogen or plasminogen activator inhibitor in the blood)
Proinflammatory state (e.g. inflamation present- C-reactive protein in the blood)

Question 17

diagnosis of metabolic syndrome

Answer 17

Three or more of the following risk factors in a single individual would constitute the presence of metabolic syndrome.*

Abdominal obesity 
Men 		>102 cm (>40 in)
Women		>88 cm (>35 in)
Triglycerides	>150 mg/dl
HDL cholesterol
Men		<40 mg/dl
Women		<50 mg/dl
Blood pressure	>130/>85 mm Hg
Fasting glucose	>110 mg/dl

Question 18

ketoacidosis

Answer 18

“Diabetic Coma”- (“much more likely with Type 1”)
Unable move glucose into the cell due to insufficient insulin levels. Blood sugar levels continue to rise.
Acidic state caused by elevated ketones in the blood due to incomplete breakdown of fatty acids .

Hyperglycemia
Ketone bodies (Acetone) are formed
Metabolic acidosis results (pH < 7.35)
Symptoms/consequences – “potentially life-threatening”
nausea, vomiting, abdominal discomfort, altered breathing pattern, coma, and death.

“acetone breath”

Question 19

tx of ketoacidosis

Answer 19

IV fluids
insulin
correction of electrolyte disturbance
may also require sodium bicarbonate if pH remains low despite the measures listed above

Question 20

Diabetic Gastroparesis

Answer 20

Autonomic Neuropathy
Delayed Gastric emptying
Ileus-decreased Peristalsis
Poor appetite

Question 21

diabetes insipidus

Answer 21

Affects the posterior pituitary and hypothalamus

The posterior pituitary releases the Anti-diuretic Hormone (ADH) or Vasopressin
ADH acts on the kidneys to conserve H20 and reduce urine output

ADH secretion is reduced or absent
Urine volume increases
Patient becomes dehydrated
Electrolyte imbalance (concentrated)

Question 22

causes of DI

Answer 22

Head injury
CNS Infection
Neurosurgery
Tumors

Question 23

nephrogenic DI

Answer 23

Occurs when the kidneys do not respond to ADH
Usually occurs due to:
Heredity
Acquired- adverse medication response

Question 24

Inappropriate ADH-hypersecreton of ADH

Answer 24

Retention of fluid
Dilutional Hyponatremia
Nausea
Vomiting
Confusion
Seizures