Diabetes Flashcards
4 types of diabetes
- Type I Diabetes*
- Type II Diabetes*
- Gestational Diabetes
- Maturity-Onset Diabetes of the Young
definition of diabetes
=Chronic, complex disorder with impaired nutrient metabolism (glucose).
-Main feature is impaired glucose regulation (hyperglycemia).
= Chronic hyperglycemia that results from issues with glucose regulation manifested by
◦ Reduced insulin secretion
◦ Reduced insulin function
Diabetes Mellitus
Viral infections can be a trigger for what type of Diabetes?
Type 1
Type of Diabetes that is autoimmune with beta cells destroyed
Type 1
Type 1 diabetes results in _______ insulin secretion
decrease
Type 1 Diabetes Patho
- Cells cannot use glucose
- Onset: Sudden
- Glucose builds up in blood b/c no insulin to carry it in
- Back up mechanism: Break down of fat and protein (Lipolysis & proteolysis) as energy source
- Increased ketogenesis (breakdown of fat) –> ketone bodies
- Increased release of counter-regulatory hormones
- Glucagon —> causes more glucose release
Polyuria and Diabetes- What happens to K levels?
‣ Loss of electrolytes- overall K is low but it looks high
3 things that are happening b/c of polyuria
‣ Loss of glucose in urine
‣ Loss of electrolytes- overall K is low but it looks high
‣ Loss of water
3 things Dehydration in Type I leads to ….
- Hypovolemia
- Hypoxia –> Ischemic tissue –> Lactic acid production (due to anaerobic)—>
- Metabolic acidosis
WTF is ketogenesis
• Conversion of fat to ketone bodies
◦ Acetone, Acetoacetate, B-hydroxybutyrate
• Metabolic acidosis
How does body try to fix metabolic acidosis from Type 1 DM ketogenesis ?
-Metabolic acidosis yields an attempt by the lungs to correct the acidosis
-We need to blow off some CO2 & acid
• Increased rate of breathing
• Increased depth of breathing
• Kussmaul breathing- rest alkalosis
Hallmark sign of acidosis related to hyperglycemia =
kussmaul breathing
• Increased rate and depth of breathing
What is type II DM? What’s up with insulin, beta cells? How?
• Insulin resistance, progresses to decreased beta cell secretion.
• Decreased insulin secretion.
◦ Pancreas responds to decreased insulin sensitivity by developing more insulin
◦ Eventually, the beta cells can no longer produce as much insulin
◦ =Less insulin production
Metabolic syndrome has strong correlation with Type 1 or Type 2 DM?
Type 2
when do we see onset of Type 2 DM?
in 50’s ….becoming more common in youth
If you have gestational diabetes you are more likely to develop….
type 2 DM
Islet Cells: Alpha vs Beta, what is the difference?
◦ Alpha ->Secrete glucagon
◦ Beta->Produce insulin and amylin
Glucagon vs Insulin, whats the difference?
- Glucagon triggers a release of glucose from the liver and skeletal muscle.
- Insulin, secreted with food intake, moves glucose from blood into cells (energy).
Insulin keeps blood glucose and _____ levels in normal range
lipid
Where does insulin get converted into a usable hormone?
in the liver
_____ is the key that helps the glucose get inside the cell
Insulin
In the liver, insulin does 6 things. What are they?
- Suppresses production of glucose
- Promotes production and storage of glycogen
- Inhibits glycogen breakdown into glucose
- Inhibits conversion of fats to acids and proteins to glucose
- Manufactures glucose from glycogen (GLYCOGENOLYSIS)
- Manufactures glucose from amino acids, waste products and fat byproducts (GLUCONEOGENESIS).
This all means: Insulin and liver KEEP BLOOD GLUCOSE LEVELS WHERE THEY NEED TO BE
Gluconeogenesis vs glycogenolysis ….taking ya back to A&P with this question
GLYCOGENOLYSIS= glucose made from glycogen GLUCONEOGENESIS= glucose made from amino acids, waste products and fat byproducts
Insulin does 2 things in the muscle, what are they?
- Stimulates glucose uptake
* Promotes protein and glycogen synthesis
In fat cells insulin does 1 thing, what is it?
• Promotes triglyceride storage
Basal VS Prandial Insulin secretion
Basal = insulin is secreted continuously throughout day (fasting).
Prandial = insulin secreted after eating.
◦ Initial burst within 10 minutes of eating
Normal blood glucose range
60-100mg/dL
Glucose is stored as _____ in the liver and ___ ____ ____ in other tissue
glycogen, free fatty acid (aka triglycerides?)
What does glucagon trigger?
= Counteracts insulin—>Triggers conversion of glycogen to glucose in liver and muscle whenever we need it
name 3 other hormones besides glucagon that help increase glucose
◦ Epinephrine
◦ Norepinephrine
◦ Cortisol
Which drug class prevents counter regulatory methods and makes it hard to tell if they have low CBG ?
Beta blockers
WTF are incretins , what do they do?
Incretin hormones = secrete in response to eating. • Increase insulin secretion • Decrease glucagon secretion • Slow gastric emptying (gastroparesis) • Prevents hyperglycemia after meals
If you have no insulin you have (2)….
◦ No insulin=No cellular energy
◦ No insulin=glucose building up in blood (hyperglycemia)
Without insulin, the body will break down stored _____ and _____ to make energy and use hormones to make glucose.
–> The breaking down of fat creates ketones bodies to form in the blood.
fat and protein
Characteristics of metabolic syndrome
- Presence of metabolic factors that increase risk for developing type II diabetes.
- Waist circumference (>40 in men, >35 in women)
- Fasting blood sugar >100
- Triglyceride levels >150, HDL <40.
- Hypertension
3 p’s of diabetes
• Polyuria- Excessive urination rapid onset
◦ Osmotic diuresis from excessive glucose in urine
• Polydipsia- Excessive thirst rapid onset
◦ Secondary to polyuria and dehydration
• Polyphagia- Excessive hunger rapid onset
◦ “cell starvation” due to insulin not moving glucose into cells
complications of type 2 DM
• Dehydration • Electrolyte imbalances • Vascular changes-> Organ Dysfunction ◦ Microvascular or Macrovascular • Neuropathies • Decreased immune response • Poor wound healing • Acid-Base imbalances • Early Mortality
Lets talk more about K levels- loss of K in urine leads to hypokalemia. During acidosis something else happens though….
Hyperkalemia!
◦ During acidosis, potassium moves out of cells into the blood (hyperkalemia) and switches place H+ ion
◦ When we correct the acidosis, potassium moves back into the cell (normal or hypokalemia)
◦ When we correct the acidosis, potassium moves back into the cell = normal or hypokalemia
◦ If fix acidosis too quickly then we can send K too low to quickly
We need to fix acidosis slowly to prevent causing ____
hypokalemia
you can also have what other electrolyte change with Diabetes?
hypo or hypernatremia
Vascular changes in diabetes occur secondary to
hyperglycemia
–causing thickening to basement membranes, glucose toxicity, chronic ischemia of small vessels, and tissue hypoxia.
Macrovascular changes associate with Diabetes
Cardiovascular disease, Cerebrovascular disease, peripheral vascular disease
Microvasular changed associated with Diabetes?
Nephropathy, neuropathy, retinopathy
How does hyperglycemia cause kidney disease? Whats the patho?
◦ Hyperglycemia > increased pressure in kidney > increased perfusion causes vessels to leak > decreasing kidney oxygenation> ischemia> CKD.
