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Exam 2: Diabetes Mellitus

Terms in this set (82)

What is diabetes?
disorder of metabolism resulting from imbalance between insulin availability and need
What does insulin promote?
glucose uptake
What does insulin help manage?
carbohydrate; protein; fat
What is the cycle of insulin imbalance?
eat food, make insulin, cells resist insulin, sugar stores as fat, feel tired and hungry, eat food (back to start)
What organ produces insulin?
pancreas
What cells of the pancreas produce insulin?
beta cells
How is glucose stored in the liver and skeletal muscle?
as glycogen; when glycogen stores are full, glucose becomes triglycerides
Glycogen saturation leads to what?
production of triglycerides
Type 1 diabetes is also known as __ diabetes. What kind of disorder is it? What happens in the body?
juvenile; autoimmune disorder resulting from genetics, environmental trigger, hypersensitivity reaction; destruction of pancreas beta cells leads to an absolute deficiency of insulin
Type 1 or Type 2 DM: absolute deficiency of insulin
type 1
What can cause Type 2 diabetes?
genetic factors; older age; insulin resistance; progressive impairment of beta cells; increased glucose production from the liver
How can insulin resistance lead to type 2 diabetes?
effect of insulin is blunted in skeletal muscle and liver; insulin not working as efficiently
How can progressive impairment of beta cells lead to type 2 diabetes?
deranged secretion of insulin (relative deficiency); eventual exhaustion, failure of beta cells (burn out)
What cells of the pancreas produce glucagon?
alpha cells
How can increased glucose production by the liver lead to type 2 diabetes?
excessive breakdown of liver glycogen stores
Normally, glucagon will tell the liver to break down glycogen stores when?
during fasting
Normally, what tells the liver to break down glycogen stores during fasting?
glucagon
What is an important consideration when dealing with a diabetes patient who is obese?
insulin resistance could cause OR be caused by obesity (be humble)
How does deranged insulin release or insulin resistance cause hyperglycemia?
low insulin or insulin resistance means decreased glucose uptake, so glucose plasma levels increased -- hyperglycemia
What is the Ominous Octet -- where derangements lead to hyperglycemia?
pancreas increases glucagon secretion or decreases insulin secretion; decreased incretin effect; increased lipolysis of fat cells; increased glucose reabsorption in kidneys; decreased glucose uptake in muscle; NT dysfunction in the brain (i.e., appetite); increased hepatic glucose production in the liver
These are a group of metabolic hormones that stimulate a decrease in blood glucose levels
incretins
Where are incretins produced?
small intestine
What is the "key" method of explaining type 2 diabetes to patients?
insulin is the key to allow glucose to enter cells and be used effectively; but the insulin key is either not the right key or there are not enough keys, so the door to cells is not opened and glucose cannot be used effectively for energy
What are risk factors for type 1 diabetes?
family history of diabetes; beta cell autoimmunity; autoimmune disease (i.e., beta cell damage); infection; environmental exposure; chemical exposure; dietary exposure
What are risk factors for prediabetes and type 2 diabetes?
family history of diabetes; obesity; non-white ethnicities; hypertension; history of gestational diabetes; polycystic ovarian syndrome (PCOS); CV disease; sedentary lifestyle; previous impaired glucose tolerance, impaired fasting glucose; increased triglycerides +/- low HDL; history of delivering an infant > 9 lbs; psychiatric illness and associated meds
What races/ethnicities are at the highest risk of developing type 2 diabetes?
American Indians/Alaska Natives
What are risk factors for gestational diabetes?
family history of diabetes; history of stillbirth or spontaneous abortion; fetal abnormalities in previous pregnancy; previous heavy infant; obesity; advanced maternal age; 5+ pregnancies
What is metabolic syndrome?
abdominal obesity; increased free fatty acids; beta cell dysfunction; insulin resistance; overproduction of glucose by the liver
This consists of abdominal obesity, increased free fatty acids, beta cell dysfunction, insulin resistance, overproduction of glucose by the liver.
metabolic syndrome
What are the six signs and symptoms of diabetes?
polyuria; polydipsia; polyphagia (more with type 1); weight loss (typically type 1); blurred vision; paresthesia/peripheral neuropathy
Why does polyuria occur in diabetics?
excess glucose not reabsorbed, water follow glucose -- water loss
Why does polydipsia occur in diabetics?
intracellular dehydration
What is polydipsia?
excess thirst
Why does polyphagia occur in diabetics (more with type 1)?
cellular starvation
What is polyphagia?
excess hunger
Why does weight loss occur in diabetics (typically type 1)?
osmotic diuresis; fat and protein used for energy
What does blurred vision occur in diabetics?
lens and retina exposed to hyperosmotic fluid
What does paresthesia/peripheral neuropathy occur in diabetics?
temporary dysfunction of peripheral nerves
What is paresthesia/peripheral neuropathy?
tingling or prickling of the skin
All individuals over what age should be tested for diabetes?
45+
Individuals younger than 45 should be tested for diabetes when?
1st degree relative with diabetes; physical inactivity; obesity; high risk ethnicity; delivered an infant > 9 lbs or had gestational diabetes; have hypertension, hyperlipidemia, or a history of CV disease; women with polycystic ovarian syndrome (PCOS); previously met criteria for impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) -- prediabetes
Today, diabetes testing is primarily by what generally method?
venapuncture
What are the three dx tests for diabetes, aside from casual plasma glucose?
fasting blood glucose; oral glucose tolerance test (OGTT); HbA1c
What is fasting blood glucose dx test?
blood glucose level after holding food for 8 hours; preferred method
What is oral glucose tolerance test (OGTT)?
measures ability of body to store glucose by removing it from blood; patient drinks 75 g glucose load and measures blood glucose 2 hrs later; not appealing to pt, rarely used
What is HbA1c?
glycated/glycosylated hemoglobin
Why does HbA1c dx testing work?
normal hemoglobin does not contain glucose; glucose entry into RBC is not insulin dependent; rate of glucose entry results from blood glucose level; glucose binding is irreversible (lasts for RBC lifespan)
What does HbA1c provide an index of?
blood glucose over 6-12 weeks
What is ADA criteria for diagnosis of diabetes?
HbA1c greater than 6.5%; fasting plasma glucose greater than 125 mg/dL; oral glucose tolerance test (OGTT) greater than 200 mg/dL; casual plasma glucose greater than 200 mg/dL PLUS symptoms
What does monitoring of diabetes consist of?
home blood glucose levels; repeat A1c for monitoring overtime
Aside from monitoring, what else is involved in diabetes assessment?
modification of risk factors (weight loss, nutrition therapy); prevention of complications
What are goals of diabetes therapy?
stabilize blood glucose levels; optimize risk factors; prevent complications; reduce morbidity, mortality
What are the general non-pharmacologic treatments for diabetes?
medical nutrition therapy, goal to optimize blood glucose and lipids, dietitian referral; exercise
Caution: exercise as a form of non-pharmacologic diabetes treatment can actually result in what?
hypoglycemia
This is increased uptake of glucose in muscle, increased absorption of insulin.
hypoglycemia
What are the oral agent treatment options for diabetes?
stimulate insulin secretion from pancreas; decrease glucagon secretion; increase insulin sensitivity; inhibit hepatic glucose production; delay glucose absorption; inhibit renal glucose reabsorption
What are the injectable agent treatment options for diabetes?
insulin replacement is major; other -- decrease glucagon secretion, decrease appetite, delay gastric emptying
In general, what are diabetes treatment options targeting?
ominous octet
Following initial diagnosis of diabetes, what is our next step?
repeat to confirm; implement non-pharmacological treatment; initiate oral agent
What are acute complications of diabetes?
diabetic ketoacidosis (DKA); hyperosmolar hyperglycemia state (HHS); hypoglycemia
What is diabetic ketoacidosis (DKA)?
dehydration; acidotic; insulin deficiency + glucagon --> increased hepatic glucose, impaired glucose utilization in skeletal muscle, and ketones
What is hyperosmolar hyperglycemia state (HHS)?
osmotic diuresis and dehydration; non-acidotic, no ketones; relative insulin deficiency --> increased hepatic glucose and impaired glucose utilization in skeletal muscle
What are chronic complications of diabetes?
impaired immune system so increased infection risk; microvascular -- retinopathy, nephropathy, neuropathy; macrovascular - coronary artery disease, peripheral vascular disease, cerebrovascular disease
The __ state associated with diabetes is characterized by alterations in coagulation, fibrinolysis, and platelet function -- hence, vascular complications.
hypercoagulable
What are microvascular eye-related complications of diabetes?
retinopathy; cataracts; glaucoma
What are macrovascular atherosclerosis-related complications of diabetes?
ischemic heart disease; myocardial infarction
What are microvascular GI motility-related complications of diabetes?
delayed gastric emptying; diarrhea; constipation
What are microvascular genitourinary tract-related complications of diabetes?
bladder stasis and infection; erectile dysfunction
What are microvascular somatic neuropathy-related complications of diabetes?
abnormal sensory and motor function; foot ulcers
What are autonomic neuropathic complications of diabetes?
dizziness; syncope
what are macrovascular microangiopathy related complications of diabetes?
cerebral infarction; hemorrhage
What are microvascular nephropathy-related complications of diabetes?
glomerulosclerosis; chronic kidney disease
What are macrovascular atherosclerosis related complications of diabetes?
peripheral vascular disease
This is rebound hyperglycemia, a pattern of undetected hypoglycemia followed by hyperglycemia.
Somogyi effect
What is the Somogyi effect?
rebound hyperglycemia; insulin induced hypoglycemia leads to increased hormones and increased blood glucose; episode of low blood glucose occurs overnight
This is an early-morning (between 5-9 am) increase in blood glucose relevant to people with diabetes. Occurs without prior hypoglycemia.
dawn phenomenon
What is the dawn phenomenon?
an early morning (between 5-9 am) increase in blood glucose; occurs without prior hypoglycemia; increased fasting blood glucose +/- increased insulin requirements
What are the two counter regulatory mechanisms with diabetes?
Somogyi effect; Dawn phenomenon
Type 1 or 2 DM: absolute insulin deficiency; treat with exogenous insulin
Type 1
Type 1 or 2 DM: insulin resistance, eventual beta cell exhuastion; treat with first-line oral agents
Type 2
What is general treatment for Type 1 DM?
exogenous insulin
What is general treatment for Type 2 DM?
first-line oral agents
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