Chapter 27: MNT IN Diabetes Mellitus

Question 1

a chronic disease that occurs either when the pancreas do not produce enough insulin or when the body cannot effectively use the insulin it produces

Answer 1

diabetes mellitus

Question 2

organ that produce insulin (beta cells of the langerhans of this organ)

Answer 2

pancreas

Question 3

hormone that regulates blood sugar

an anabolic hormone synthesized by the beta cells of Langerhans of the pancreas, which facilitates the entry of glucose into the cells

Answer 3

insuin

Question 4

or raised blood sugar

a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, esp. the nerves and blood vessels

Answer 4

hyperlgycemia

Question 5

diabetes - types

previously known as insulin-dependent, juvenile or childhood onset

Answer 5

type 1 diabetes

Question 6

characterized by deficient insulin production and requires daily administration of insulin

cause: unknown and it not preventable with current knowledge

Answer 6

type 1 diabetes

Question 7

symptoms include excessive excretion of urine (polyuria), excessive thirst or drinking (polydipsia), constant hunger (polyphagia), weight loss, vision changes, and fatigue

*symptoms may occur suddenly

Answer 7

type 1 diabetes

Question 8

diabetes - types

formerly non-insulin dependent or adult-onset

Answer 8

type 2 diabetes

Question 9

results from the body’s ineffective use of insulin

comprises 90% of people with diabetes around the world and is largely the result of excess boy weight and PA

Answer 9

type 2 diabetes

Question 10

symptoms may be similar to T1DM, but are often less marked

the disease may be diagnosed several years after onset once complication have already arisen

this type of diabetes was seen only in adults, but it is now also occurring in children

Answer 10

type 2 diabetes mellitus

Question 11

is hyperglycemia with onset or first recognition during pregnancy

Answer 11

gestational diabetes

Question 12

symptoms are similar to type 1 and 2 diabetes

most often diagnosed thru prenatal screening rather than reported symptoms

Answer 12

gestational diabetes

Question 13

are intermediate conditions in the transition between normoglycemia and diabetes

people with IGT or IFG are at high risk of progressing to type 2 dm, although this is not predictable

this may cause large gestational-aged infants and hypertension

Answer 13

impaired glucose tolerance (IGT)
impaired fasting glycemia (IFG)

Question 14

features of T1DM

characteristics: age, onset

type #: viral infection, onset

Answer 14

type 1

Question 15

features of T1DM

characteristics: insulin required?

type #: yes

Answer 15

type 1

Question 16

features of T1DM

characteristics: cell response to insulin

type #: normal

Answer 16

type 1

Question 17

features of T1DM

characteristics: acute complications

type #: hyperglycemia with ketoacidosis

Answer 17

type 1

Question 18

features of T1DM

characteristics: prevalence in diabetic population

type #: 5-10%

Answer 18

type 1

Question 19

other names

IDDM
Juvenile-onset diabetes
ketosis-prone diabetes
brittle diabetes

Answer 19

type 1 diabetes

Question 20

IDDM meaning for type 1 diabetes

Answer 20

insulin-dependent diabetes mellitus

Question 21

features of T1DM

characteristics: age, onset

type #: obesity, hereditary, onset

Answer 21

type 2

Question 22

features of T1DM

characteristics: insulin required?

type #: sometimes

Answer 22

type 2

Question 23

features of T1DM

characteristics: cell response to insulin

type #: resistant

Answer 23

type 2

Question 24

features of T1DM

characteristics: acute complications

type #: hyperglycemia without ketoacidosis

Answer 24

type 2

Question 25

features of T1DM characteristics: prevalence in diabetic population type #: 90-95%

Answer 25

type 2

Question 26

other names NIDDM adult-onset diabetes ketosis-resistant diabetes stable diabetes

Answer 26

type 2

Question 27

NIDDM meaning for type 2 diabetes

Answer 27

non-insulin dependent diabetes mellitus

Question 28

diabetes - risk factors blood uric acid: >7.0 mmol

Answer 28

hyperuricemia

Question 29

diabetes - risk factors urine albumin: >50 mg albumin/24 hrs

Answer 29

microalbuminuria

Question 30

diabetes - risk factors high density lipoprotein (HDL): <35 mg/dL or 0.90 mmol/l

Answer 30

dyslipidemia

Question 31

diabetes - risk factors triglyceride: 150 mg/dL (2.8 mmol/L)

Answer 31

dyslipidemia

Question 32

diabetes - risk factors total cholesterol: >200 mg/dL

Answer 32

dyslipidemia

Question 33

diabetes - risk factors previous IGT with oral glucose tolerance test 2-hr value _____ (7.7-11.0 mmol/l)

Answer 33

140-199 mg/dl

Question 34

diabetes - risk factors previous gestational diabetes, macrosomic, or large-for-gestational-age infant (_____/8kg lb birth weight); poor obstetrical history

Answer 34

3.7 kg

Question 35

diabetes - risk factors bmi of _____ (especially waist-to-hip ratio >1), or waist circumference >80cm for females and >90cm for males

Answer 35

>23 kg/m2

Question 36

diabetes - etiology -beta-cell destruction usually leading to absolute insulin deficiency -autoimmune -idiopathic

Answer 36

type 1 diabetes

Question 37

diabetes - etiology may range from relative insulin deficiency to a predominantly secretory defect with or without insulin resistance

Answer 37

type 2 diabetes

Question 38

diabetes - etiology pregnancy hormones (placental lactogen, cortisol, prolactin, and progesterone) oppose the action of insulin

Answer 38

gastrointestinal diabetes

Question 39

diabetes - diagnosis plasma blood glucose _____ mg/dL both casual (random) or postprandial

Answer 39

>200 mg/dL

Question 40

diabetes - diagnosis fasting blood sugar of _____ mg/dL

Answer 40

>126 mg/dL

Question 41

diabetes - complications damage to the large blood vessels

Answer 41

macroangiopathies

Question 42

diabetes - complications (macroangiopathies) diabetes can increase the risk of _____ (CHD) by 300%

Answer 42

coronary heart disease

Question 43

diabetes - complications (macroangiopathies) _____ among diabetic starts early, progresses faster and is more widespread

Answer 43

atherosclerosis

Question 44

diabetes - complications (macroangiopathies) 15% of diabetics will develop _____, and 50% will have recurrence within 2 years; 20% of people with ulcers will undergo amputation

Answer 44

foot ulceration

Question 45

diabetes - complications damage to the small blood vessels

Answer 45

microangiopathies

Question 46

diabetes - complications (microangiopathies) the damage to the blood vessel supplying blood to the eyes, causing impaired vision and, eventually, blindness symptoms: blurred vision, black spots on vision, and fluctuating vision

Answer 46

diabetic retinopathy

Question 47

diabetes - complications (microangiopathies) deterioration of the nerve tissues; includes damage to the blood vessel, supply of blood to the hands and feet resulting in numbness, loss of sensation or "pins and needles," carpal tunnel syndrome, and gastroparesis

Answer 47

neuropathy

Question 48

diabetes - complications (microangiopathies) damage to the blood vessel supplying blood to the kidneys, leading to impairment of kidney function, and eventually, kidney failure

Answer 48

diabetic nephropathy

Question 49

results to uncontrolled production of ketones by the liver that leads to acidosis due to increased glucose production

Answer 49

diabetic ketoacidosis (DKA)

Question 50

diabetes - characteristics (DKA) hypoglycemia, metabolic acidosis (blood pH <_____), and positive ketones in the urine and blood

Answer 50

pH <7.35

Question 51

diabetes - characteristics (DKA) DKA is often associated with type 1 diabetes, but it may also occur in type 2 diabetes, particularly when associated with a major intercurrent illness

Answer 51

-

Question 52

diabetes - signs and symptoms (DKA) -acetone odor of the breath -nausea and vomiting -diffuse abdominal pain (seen in 30% of patients) -rapid breathing -blurred vision

Answer 52

-

Question 53

a syndrome of marked diabetic stupor, hyperglycemia, and hyperosmolarity in the absence of ketosis due to dehydration of brain cell this is due to the osmotic pressure exerted by the significant amount of glucose in the blood, causing the withdrawing out the water from the cell; insufficient insulin, defective insulin in the cell

Answer 53

nonketotic hyperosmolar coma

Question 54

nonketotic hyperosmolar coma - characteristics occurs in elderly patients w/ or w/o history of t2dm and is always associated with severe _____

Answer 54

dehydration

Question 55

nonketotic hyperosmolar coma - characteristics _____ (2) often occur days to weeks prior to the presentation of the syndrome

Answer 55

polyuria and polydipsia

Question 56

nonketotic hyperosmolar coma - characteristics impaired _____ function, which prevents clearance of excess glucose in the liver

Answer 56

renal function

Question 57

nonketotic hyperosmolar coma - characteristics there is no metabolic acidosis due to the presence of circulating insulin and lower levels of counterregulatory hormones

Answer 57

-

Question 58

death of tissue due to loss of blood supply, with or without bacterial infection

Answer 58

gangrene

Question 59

nonketotic hyperosmolar coma - characteristics overdose of insulin

Answer 59

insulin shock

Question 60

nonketotic hyperosmolar coma - characteristics depressed immune function

Answer 60

infection

Question 61

diabetes - mgmt (medical) medical drugs: 2 drugs for glucose control

Answer 61

insulin and/or hypoglycemic drugs

Question 62

these drugs are more convenient, require lower insulin dose, have higher compliance, and show less weight gain sometimes, are best taken with insulin

Answer 62

oral hypoglycemic drugs

Question 63

oral hypoglycemic drugs - types stimulate insulin secretion once or twice a day; may cause disulfiram reactions (nausea, vomiting, headache, and cramps associated with intake of alcohol); contraindicated against pregnancy, liver, and renal insufficiency

Answer 63

sulfonylurea drugs

Question 64

oral hypoglycemic drugs - types site of action of sufonylurea drugs

Answer 64

pancreas

Question 65

oral hypoglycemic drugs - types suppress glucose production, increase glucose uptake in the peripheral tissues

Answer 65

biguanides

Question 66

site of action of biguanides

Answer 66

liver

Question 67

oral hypoglycemic drugs - types lessen insulin resistance; may cause dry mouth, contraindicated against tissue hypoxia (shock), acute blood loss, myocardial infarction, heart failure, pulmonary embolism, arterial circulatory disorders, consumptive diseases, severe generalized infection, and fasting states (less than 1kcal/day)

Answer 67

metformin and pioglitazone

Question 68

metformin and pioglitazone site of action

Answer 68

fats and muscles as insulin synthesizer

Question 69

oral hypoglycemic drugs - types delay absorption of CHOs; hypoglycemic drug taken at the start of a meal; may cause diarrhea and abdominal pains

Answer 69

alpha-glucosidase inhibitors

Question 70

alpha-glucosidase inhibitors site of action

Answer 70

gut

Question 71

gestational diabetes - dietary mgmt 20% CHO at _____; no concentrated sugars, with snacks (including bedtime)

Answer 71

breakfast

Question 72

_____ kcal.kg for pregnant women with BMI of 20 to 26 kg/m2

Answer 72

30 kcal/g

Question 73

_____ kcal/kg for pregnant women who are obese prior to pregnancy

Answer 73

<30 kcal/g

Question 74

gestational diabetes - dietary mgmt _____ kcal/kg actual weight

Answer 74

24 kcal/kg

Question 75

gestational diabetes - dietary mgmt CHO: 35-45% CHON: 20-25% Fat: 35-40%

Answer 75

-