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Pathopharmacology Fundamentals > Week 3 Diabetes Pathophysiology > Flashcards

Week 3 Diabetes Pathophysiology Flashcards

1
Q

What percentage of the population has diabetes?

A

10%

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2
Q

Diabetes is the __ leading cause of death in the United States?

A

7th

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3
Q

What is diabetes?

A

A metabolic disorder characterized by hyperglycemia that results from defects in insulin secretion or action

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4
Q

Why is diabetes a problem?

A

It can cause extensive long-term damage to multiple organ systems

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5
Q

What are simple sugars and complex chemical units?

A

Carbohydrates

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6
Q

Where are carbohydrates broken down?

A

duodenum and proximal jejunum

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7
Q

Regulating glucose depends on the __

A

Liver

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8
Q

When we eat carbs they are broken down into glucose, and our liver does what?

A

extracts glucose from the blood

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9
Q

After our liver extracts glucose from the blood it will synthesize it into __

A

glycogen (store it)

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10
Q

If our liver detects we need sugar it will __ __

A

breakdown glycogen

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11
Q

Breakdown of glycogen aka __

A

glycogenolysis

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12
Q

__ __ extract glucose for their energy need

A

Peripheral tissues (all cells)

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13
Q

The pancreas controls our body’s fuel supply in connection with the __

A

Liver

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14
Q

The pancreas controls how much __ and __ is in the blood

A

glucose and insulin

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15
Q

The pancreas has __ and __ functions

A

exocrine and endocrine

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16
Q

Exocrine function of the pancreas:

A

pancreatic cells secrete directly into ducts, NOT the bloodstream

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17
Q

endocrine function of the pancreas:

A

cells secrete insulin directly into the blood stream

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18
Q

Where in the pancreas is insulin secreted?

A

Islet of Langerhans

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19
Q

Islet of Langerhans accounts for __% of the pancrease

A

1-2%

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20
Q

Islet of Langerhand takes up __ to __% of the pancreatic blood flow

A

15-20%

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21
Q

2 types of cells in the Islet of Langerhans are…

A

alpha and beta cells

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22
Q

Alpha cells secrete __ in response to low blood sugar

A

glucagon

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23
Q

What does glucagon do?

A

Stimulates the liver to release stored glucose into the blood

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24
Q

How does the liver release glucose in response to glucagon?

A

Glycogenesis

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25
Q

What do beta cells in the Islet of Langerhans do?

A

produce insulin

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26
Q

How does insulin lower blood glucose?

A

It stimulates the movement of glucose into body tissues

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27
Q

Insulin is what stimulates your cells to be able to…

A

use glucose

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28
Q

4 hormones that RAISE blood glucose levels are…

A

Glucagon
epinephrine
growth hormone
glucocorticoids

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29
Q

Where is glucagon released?

A

Islet of Langerhans in the pancreas

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30
Q

Where is epinephrine released?

A

adrenal medulla and other chromatin tissues

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31
Q

Where are glucocorticoids released?

A

adrenal cortex

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32
Q

Where is growth hormone secreted from?

A

anterior pituitary

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33
Q

Insulin will __ blood sugar

A

decrease

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34
Q

Glucagon will __ blood sugar

A

increase

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35
Q

Epinephrine will __ blood sugar

A

increase

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36
Q

Glucocorticoids will __ blood sugar

A

increase

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37
Q

Growth hormone will __ blood sugar

A

increase

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38
Q

Together, insulin, glucagon, epinephrine, glucocorticoids, and growth hormone will create a…

A

counter-regulatory mechanism

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39
Q

Counter-regulatory mechanism prevents __ under the effect of insulin

A

hypoglycemia

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40
Q

Insulin is produced by the __ __

A

beta cells

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41
Q

Insulin stimulates the… (3 things) of glucose

A

Uptake, utilization, and storage of glucose

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42
Q

All cells need glucose, what hormone tells your body to use this glucose?

A

Insulin

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43
Q

Insulin also stimulates the liver to store glucose as __

A

glycogen (when the cells do not need glucose)

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44
Q

Insulin inhibits the breakdown of __ __

A

adipose tissue

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45
Q

Once the liver has been saturated with glycogen, insulin will promote the liver to synthesize __ __

A

fatty acids

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46
Q

In the healthy person, insulin has a __-__ effect

A

fat-sparing

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47
Q

The fat-sparing effect of insulin drives cells to use __ instead of fat for energy

A

carbohydrates

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48
Q

What happens when you don’t have enough insulin?

A

Can’t breakdown carbohydrates efficiently

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49
Q

If your body cannot breakdown carbohydrates efficiently, this will cause a decrease in __ use by the cells

A

glucose

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50
Q

If cells can’t use glucose, __ results.

A

hyperglycemia

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51
Q

When cells can’t use glucose, this causes cells to use an alternate source of energy, which is __ __

A

fatty acids

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52
Q

Decrease in insulin leads to impaired __ __

A

fat metabolism

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53
Q

Insulin deficiency increases __

A

lipolysis

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54
Q

Insulin deficiency decreases __

A

lipogenesis

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55
Q

Impaired fat metabolism causes __ __ __ in the blood

A

free fatty acids

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56
Q

Free fatty acids are an alternate energy source for when…

A

glucose cannot be used

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57
Q

Excess free fatty acids is converted to __ and __

A

cholesterol and phospholipids

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58
Q

Free fatty acids will breakdown into __

A

acetyl-CoA

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59
Q

Acetyl-CoA is used by the liver to become __ __

A

acetoacetic acid

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60
Q

Substances that is composed of the acid breakdown product acetoacetic acid are __ __

A

ketone bodies

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61
Q

Short-term complication of impaired fat metabolism is increased __ __

A

serum ketones

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62
Q

Increased serum ketones aka

A

ketosis

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63
Q

Ketosis is measured by __ and __ levels

A

blood and urine levels

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64
Q

Ketosis can cause severe __ __

A

metabolic acidosis

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65
Q

Severe metabolic acidosis can lead to __

A

coma

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66
Q

Long-term complication of impaired fat metabolism

A

atherosclerosis

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67
Q

Why does long-term impaired fat metabolism cause atherosclerosis?

A

Due to the increased serum lipid levels

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68
Q

Insulin deficiency can also lead to __

A

proteolysis

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69
Q

What is proteolysis?

A

protein breakdown

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70
Q

Proteolysis causes the body to store protein ineffectively due to…?

A

increased protein catabolism and cessation of protein synthesis

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71
Q

Proteolysis causes increased in circulating __ __

A

amino acids

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72
Q

During increased circulation of amino acids, cells can then use amino acids as an __ __ when glucose is not available

A

energy source

73
Q

Protein catabolism = __ __

A

muscle wasting

74
Q

Protein catabolism also happens in people who are __

A

starving

75
Q

Why do people who are starving have protein catabolism?

A

they don’t have carbohydrates for an energy source

76
Q

Protein catabolism leads to… (4)

A

1) Muscle wasting
2) multiple organ dysfunction
3) aminoacidemia
3) increased urea nitrogen (BUN)

77
Q

Protein catabolism is more common in Type __ diabetics

A

Type 1 diabetics

78
Q

Hyperglycemia increases __ __ pressure

A

plasma osmotic pressure

79
Q

What is plasma osmotic pressure?

A

High blood concentration

80
Q

High plasma osmotic pressure causes fluid in the tissues to shift to…

A

the vascular space to maintain homeostasis

81
Q

When fluid shifts into the vascular space to decrease osmotic pressure, this results in __ __

A

cellular dehydration

82
Q

Osmotic diuresis will cause __

A

glycosuria

83
Q

Glycosuria definition

A

Excretion of sugar in the urine

84
Q

When does glycosuria occur?

A

When hyperglycemia reaches a point beyond what the kidneys can reabsorb

85
Q

Insulin deficiency leads to… (3 Ps!)

A

polyuria, polyphagia, polydipsia

86
Q

Polyphagia definition

A

increased hunger

87
Q

Polydipsia definition

A

increased thirst

88
Q

Polyuria definition

A

increased urination

89
Q

Why does insulin deficiency lead to polyphagia?

A

Catabolism of fat and protein, and also cellular starvation

90
Q

What does insulin deficiency lead to polydipsia?

A

It’s related to increased serum osmolarity

91
Q

Because of vascular osmolarity there is increased water excretion and loss of __

A

electrolytes such as K+, Na+, Cl-

92
Q

Diabetes is either an __ or __ insulin deficiency

A

absolute or relative

93
Q

What are the three main types of diabetes?

A

Type 1, Type 2, and Gestational

94
Q

Prediabetic A1C range

A

5.7-6.4

95
Q

Diabetic A1C range

A

6.5 or higher

96
Q

Fasting plasma glucose prediabetic range

A

100-125

97
Q

Fasting plasma glucose diabetic range

A

126 or higher

98
Q

Oral glucose tolerance test pre diabetic range

A

140-199

99
Q

Oral glucose tolerance test diabetic range

A

200 or higher

100
Q

When is an oral glucose tolerance test used?

A

to test gestational diabetes

101
Q

Type 1 diabetes is the most common

A

pediatric chronic disease

102
Q

When is type 1 diabetes usually diagnosed?

A

around 12 years of age

103
Q

Type 1 diabetes can be __

A

idiopathic

104
Q

Type 1 diabetes is much less common than…

A

Type 2 diabetes

105
Q

You can be diagnosed with diabetes as an __

A

as an adult

106
Q

Type 1 diabetes is considered an __ disease

A

autoimmune disease

107
Q

With an autoimmune disease, there is a genetic predisposition and some sort of __ __

A

environmental factor/trigger

108
Q

Sometimes the trigger for type 1 diabetes is thought to be a __

A

Virus that causes your body to attack the pancreatic beta cells

109
Q

Diabetes type 1 is a slowly progressive T-cell mediated disease where your T-cells destroy…

A

your own beta cells

110
Q

__ form on beta cells and circulate in the blood and lymphatics

A

autoantigens

111
Q

Autoantigens activate cellular and humoral immunity which destroy what?

A

destroy the beta cells

112
Q

When beta cells are destroyed they cannot be __, resulting in.,..

A

cannot be regenerated, resulting in a complete lack of endogenous insulin

113
Q

Type 1 diabetes represents __ % of all diabetics

A

5-10% of all diabetics

114
Q

Old names for type 1 diabetes are…

A

Insulin dependent diabetes, juvenile onset diabetes

115
Q

Type 1 diabetes is often incorrectly diagnosed as…

A

type 2

116
Q

Type 1 diabetes has a long preclinical period with symptoms showing when….

A

Insulin is almost gone, which produces the hyperglycemia symptoms

117
Q

The preclinical period of type 1 diabetes typical age range

A

6-12 years

118
Q

Type 1 diabetes symptoms

A

Polyuria, polyphagia, polydipsia, weight loss, fatigue, frequent infections, itching, visual changes, parathesia

119
Q

Genetic and __ __ responsible for type 2 diabetes

A

environmental factors

120
Q

Risk factors for type 2 diabetes (5)

A

Age, obesity, hypertension, inactivity, family history

121
Q

Type 2 diabetes is most likely due to __ __

A

Insulin resistance

122
Q

Insulin resistance is where cells….?

A

don’t respond to insulin

123
Q

With type 2 diabetes, in addition to insulin resistance there is also decreased insulin secretion. Why?

A

due to beta cells being overwhelmed

124
Q

Sub-optimal response of insulin sensitive tissues is most likely the result of what?

A

Long-term obesity, because insulin is constantly being secreted into the blood stream. Cells become insensitive

125
Q

Non-modifiable risk factors for type 2 diabetes

A

Family history, age of 45 years or higher, race/ethnicity, previous gestational diabetes

126
Q

Modifiable risk factors for type 2 diabetes

A

Physical inactivity, obesity, hypertension, hyperlipidemia

127
Q

Insulin is the key to…

A

letting glucose into the cells

128
Q

Symptoms are not as evident in type 2 as they are in..

A

type 1

129
Q

Symptoms for type 2 diabetes are usually vague…

A

nonspecific manifestations of hyperglycemia

130
Q

Symptoms of type 2 diabetes

A

Fatigue, recurrent infections, visual changes, prolonged wound healing

131
Q

Doctors usually test those at high risk for type 2 diabetes such as

A

Overweight, hyperlipidemia, hypertension

132
Q

Type 2 diabetes: Causes impaired insulin secretion because of…

A

B cell exhaustion due to overuse

133
Q

Type 2 diabetes: Peripheral insulin resistance because of…

A

Increased visceral fat

134
Q

Type 2 diabetes causes increased hepatic production because of…

A

Impaired suppression of gluconeogensis within the liver

135
Q

Another metabolic complication of type 2 diabetes

A

Altered production of hormones and cytokines by adipose tissue

136
Q

Characterized by hyperglycemia, acidosis, and ketonuria

A

diabetic ketoacidosis (DKA)

137
Q

DKA is more common in…

A

Type 1 diabetics

138
Q

Acidosis can be so severe that they…

A

go in a coma

139
Q

DKA blood sugars are in the…

A

400-600 range

140
Q

Extremely high blood sugar (600-800), very thick blood, BUT normal pH

A

Hyperosmolar hyperglycemic syndrome (HHS)

141
Q

HHS is more common in…

A

Type 2 diabetics

142
Q

HHS has less profound insulin deficiency than DKA, but

A

more significant fluid deficiency (osmolarity)

143
Q

Rapid onset, blood sugar less than 55-60

A

hypoglycemia

144
Q

Hypoglycemia is usually related to…

A

medications

145
Q

Hypoglycemia is common in…

A

BOTH types of diabetics

146
Q

Patients whose blood sugar is normally in the 200 range will experience

A

symptoms of hypoglycemia before getting to 55-60 range

147
Q

Symptoms of hypoglycemia - make sure you know these!

A

Pallor, sweating, increased heart rate, palpitations, convulsions, coma, tremors, anxiety, restlessness, hunger

148
Q

Acute complications of diabetes (3)

A

DKA, HHS, hypoglycemia

149
Q

Chronic complications of diabetes are typically associated with…

A

Poorly controlled diabetes

150
Q

2 types of tissue damaged caused by chronic poorly controlled diabetes

A

microvascular and macrovascular

151
Q

Damage to capillaries, retinopathies, neuropathies, nephropathies

A

microvascular tissue damage

152
Q

Damage to large vessels, coronary artery, pheriphal vascular, and cerebrovascular

A

microvascular tissue damage

153
Q

Microvascular tissue damage: Frequency and severity of lesions are proportional to…

A

length of time with uncontrolled diabetes or duration of the disease

154
Q

Accompany microvascular disease usually in the eyes, kidneys, and nerves

A

Hypoxia and ischemia

155
Q

Diabetes can damage capillaries causing…

A

capillary membrane thickening

156
Q

Microangiopathy

A

Small vessel disease

157
Q

Microvascular tissue damage can lead to

A

dead toes, feet, damaged nerves

158
Q

Most common complication of diabetes

A

Diabetic neuropathy

159
Q

Diabetic neuropathy related to the

A

metabolic and vascular factors associated with chronic high blood sugar

160
Q

Chronic hyperglycemia can cause diabetic neuropathy by

A

Ischemia and demyelination of the nerves which causes neural changes and delayed conduction

161
Q

Diabetic neuropathy causes loss of

A

pain, temperature, and vibration sensations

162
Q

Diabetic neuropathy leads to…

A

ulcers, infections, and results in amputation

163
Q

Diabetic retinopathy is the

A

leading cause of blindness worldwide

164
Q

Diabetic retinopathy results from..

A

relative hypoxemia, damage to retinal blood vessels, red blood cell aggregation, and hypertension

165
Q

Diabetic retinopathy: Small vessels become occlude and cause

A

infarction

166
Q

Diabetic nephropathy is the most common cause of…

A

chronic kidney disease and end stage renal disease

167
Q

Why do diabetics get diabetic nephropathy?

A

The glomerular basement membrane becomes thick and hard and nonfunctional (sclerosed)

168
Q

What percentage of diabetic develop diabetic nephropathy?

A

50%

169
Q

What do you need to educated diabetic patients to do?

A

Check their feet, know if they are feeling pain or not, get eyes checked, have kidneys monitored and watch urine output. Are you peeing?

170
Q

Macrovascular problems are more common in…

A

Type 2 diabetes

171
Q

Example of macrovascular complication of type 2 diabetes

A

Atherosclerosis

172
Q

Diabetics are at increased risk for __

A

Infection

173
Q

Atherosclerosis puts type 2 diabetics are higher risk for

A

Infection, strokes, CAD, PAD

174
Q

Macrovascular complications in diabetes are thought to b caused from… (4)

A

Oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased cytokine production

175
Q

When you have hyperglycemia your body starts to do a lot of other things such as…

A

Oxidative stress, inflammation, contributes to the development to atherosclerosis

176
Q

Diabetics have diminished __ __ of infection

A

warning signs of infection

177
Q

Because of the vascular damage many diabetics have, when there is an infection

A

WBCs can’t get there to heal it

178
Q

Bacteria grow more rapidly in diabetics because

A

Bacteria use glucose to grow, so they can proliferate quicker

179
Q

Sometimes in response to diabetes, WBCs become __ and __

A

become abnormal and ineffective

Pathopharmacology Fundamentals (13 decks)

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