Week 1 - Diabetes Patho Flashcards
What are the 4 counter regulatory hormones?
Cortisol
Epi
glucagon
growth hormone
Do the counter regulatory hormones increase or decrease blood sugar?
increase
What are the 4 things that the incretin hormone GLP-1 (glucagon like peptide) does to control blood sugar levels?
- talks to the pancreas to release insulin - drops BS
- talks to the pancreas to stop glucagon - stops BS rise
- slows gastric emptying - prevent hyperglycemia
What 3 things does insulin do for the cell?
helps it take in
1. glucose
2. K+
3. amino acids
glycogenesis in the liver and muscle cells
glucose to glycogen storage
(genesis - making glycogen)
glycogenolysis in the liver
glycogen stores broken down to release glucose
gluconeogenesis
breakdown of proteins to make glucose
what are the 5 aspects of metabolic syndrome?
- HTN
- Diabetes
- Central obesity
- high LDL
- low HDL
Insulin is decreased when activity is (decreased/increased) and food intake is (decreased/increased)
increased
decreased
Insulin is increased when stress is (decreased/increased) and infection is (increased/decreased)
increased
increased
What are the macrovascular consequences of DM?
- Brain
- Heart
- extremities
Is atherosclerosis microvascular or macrovascular?
macrovascular
What does the macrovascular effect of DM do to the brain?
- stroke (TIA)
- decrease mental status
What does the macrovascular effect of DM do to the Heart?
CAD (arteries) due to HTN and insulin resistance
What does the macrovascular effect of DM do to the extremities?
PVD - feet and hands - gangrene- necrosis
what are the 3 chronic complications of DM (macrovascular)?
- Stroke
- Heart attack (MI)
- PAD
what are the 3 things that occur with DMII?
- tired beta cells
- insulin resistance on muscle, fat, liver
- liver is unreliable (basal & bolus insulin)
What are the 3 microvascular complications of DM?
- Eye problems
- Kidney issues
- Neuropathy
What eye problems occur with DM?
retinopathy
glaucoma
cataracts
what are the 2 kidney problems that occur with DM?
- HTN (glomerulus filtration issue)
- over worked kidney trying to constantly deal with too much sugar
what are the 2 neuropathy problems that occur with DM?
- nerve damage = no feeling and worse damage = gangrene and numbness
- PNS/SNS impaired
What are the 4 reasons why infection is bad with DM?
- inflammatory cells have problems (neutrophils, phagocytes, monocytes)
- increase in yeast infections (sugar)
- increase in UTI - (sugar in urine)
- can’t feel infected areas- gangrene
What are the 7 signs of hyperglycemia?
- glucoseuria
- polyuria
- polydipsia
- polyphagia
- weight loss
- blurry vision/ blind
- dehydration
what are the 7 signs of early hypoglycemia and what is the bs number?
- diaphoresis
- tremors
- hunger
- nervous
- anxious
- pallor
- pallpations
<4 mmol/L
what is the late stage of hypogycemia and what is the progression and what is the bs number?
neuroglycopenic
confused/can’t speak, seizure, coma, death
<2.8 mmol/L
What type of DM does DKA affect ONLY
Type 1
19-28 mmol/L
What is DKA and why does it happen?
hyperglycemia because the body can’t use the glucose due to not enough insulin
What physiological process does DKA lead to?
break down of fat for glucose - ketogenesis
What does prolonged ketogenesis lead to?
Metabolic acidosis
Kussmal respirations
Why does dehydration occur in DKA?
because in metabolic acidosis there are too many H+ ions and they kick K+ into the blood stream.
Na+ goes into the blood stream to try to get keytones out.
loss of K+ and Na+ in urine. Where Na+ goes - so does water
What makes acidosis worse?
vomitting because eventually all the bicarb is thrown up and you are left with H+ - which leads to dehydration as in DKA
What is hyperosmolar hyperglycemic state (HHS) and which type of diabetes does it occur in?
type II
> or equal to 34 mmol/L
too much glucose and not enough insulin (but can still deal with it somewhat)
causes osmotic diuresis
What electrolytes are lost in HHS?
Na+, K+, Phos =dehydration (water follows Na+)
will hematocrit be high or low with HHS?
high - b/c of lots of Na+ in blood stream compared to fluid
what are late stages of hyperglycemia in a type 1 diabetic?
severe dehydration
fruity breath
kussmals respirations
abdominal pain
lethargy - coma
why might someone with diabetes develop hypoglycemia?
- meds effects
- lack glucose
- too much insulin
What are the 4 classic symptoms of hyperglycemia?
1.Polyuria
2. Polydipsia
3. glucoseuria
4. elevated bs
what is diabetic foot?
motor neuropathy= foot deformities
can’t feel toes, lose them, pressure ulcers etc. (microvascular)
- lack of circulation to the extremities (macrovascular)
