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Flashcards in Diabetes Deck (63):
1

Define diabetes

a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization or both

2

diabetes is the leading cause of what diseases

end-stage kidney disease and nontraumatic lower limb amputations

3

what are the current theories about the causes of diabetes

single or combination of genetic, autoimmune, and environmental factors

4

where is insulin produced

in the Beta cells in the islets of langerhans of the pancrease

5

what is the stable normal blood glucose level

70-120 mg/dL

6

what is the average amount of insulin secreted by the pancreas

40-50 units

7

what does the rise in insulin after a meal stimulate

storage of glucose as glycogen in liver and muscle, inhibits glucogenenesis, enhances fat deposition of adipose tissue and increases protein synthesis

8

what does the fall of insulin level during normal overnight fasting facilitate in?

release of stored glucose from the liver, protein from muscle and fat from adipose tissue

9

what tissues are considered insulin-dependent

insulin dependent tissues are skeletal muscle tissue and adipose tissue

10

what are the counterregulatory hormones

glucagon, epinephrine, growth hormone, and cortisol

11

What is the etiology and pathophysiology of Type 1 DM

it is an immune mediated disease caused by autoimmune destruction of pancreatic beta cells
leading to absence of insulin production

12

what is the prediposition to type 1 diabetes

it is related to Human leukocyte antigens,

13

how do HLA contribute to type 1 DM

when exposed to a viral infection HLA destroy pancreatic beta cells either directly or through an autoimmune response

14

what is idiopathic diabetes

a form of type 1 DM that is strongly inherited not related to autoimmunity

15

what is latent autoimmune diabetes in adults (LADA)

a slowly progressing autoimmune form of type 1 DM usually occurs in people who are over the age of 35 and who are not obese

16

what is the onset of type 1 DM

the islet cell autoantibodies responsible for beta cell destruction are present for months to years before the onset of symptoms

17

what are the key manifestations of type 1 dm

polyphagia, polydipsia, polyuria

18

without insulin from an outside source what will happen to a type 1 DM

patient will develop diabetic ketoacidosis (DKA) a life-threatening condition resulting in metabolic acidosis

19

what is the most prevalent type of diabetes?

type 2 DM

20

what are risk factors for developing type 2 DM

overweight/obese
older age
family history

21

what is the etiology and pathophysiology of type 2 DM

the pancreas produces some endogenous insulin but the insulin produced is either insufficient for the needs of the body or is poorly used by the tissues or both.

22

what are the major metabolic abnormalities that have a role in the development of type 2 diabetes

1.) insulin resistance- body does not respond to the action of insulin because receptors are unresponsive or insufficient number
2.) decrease in the pancreas's ability to produce insulin, as the beta cells become fatigued from the compensatory overproduction of insulin when beta cell mass is lost
3.) inappropriate glucose production by the liver
4.) alltered production of hormones and cytokines by adipose tissue

23

what is the onset of type 2 DM

usually gradual

24

what is prediabetes

individuals that are at increased risk of development of type 2 diabetes

25

how is preediabetes diagnosed

an impired glucose tolerance (140-199) or impaired fasting glucose (100-125 mg/dL)

26

how do people with prediabetes reduce their risk of developing type 2 DM

maintaining a health weight, exercising regularly, and eating a healthy diet

27

what is gestational diabetes

diabetes that develops during pregnancy and occurs in about 2-10% of pregnancies

28

women with gestational diabetes are at risk for

cesarean delivery, perinatal death, birth injury, and neonatal complications

29

who is at risk for gestational diabetes

women who are obese, advanced maternal age, family history of diabetes

30

when are women screened for gestational diabetes

at 24-28 weeks using a 2 hour oral glucose test

31

what are some disease or treatments that cause diabetes

cushing syndrome, hyperthyroidism, recurrent pancreatitis, cystic fibrosis, hemachromatosis, parenteral nurtrition.

32

What is diabetes?

a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization or both

33

what are the classes of diabetes?

Type 1
Type 2
Gestational
other specific types

34

What is the etiology of diabetes

combination of causative factors including
- genetics
- autoimmune
- environmental

35

where is insulin produced

by beta-cells in the islets of langerhans in the pancreas

36

when is insulin normally released

released continuously into bloodstream in small increments with larger amounts released after food

37

what is the normal glucose range

70-120mg/dL

38

what are the normal functions of insulin (5)

promote glucose transport in skeletal muscle and adipose tissue
- storage of glucose as glycogen
- inhibits gluconeogenesis
- enhance fat deposition
- increase protein synthesis

39

What are the counterregulatory hormones (4)

Glucagon
epinephrine
growth hormone
cortisol

40

what are the functions of counterregulatory hormones

oppose effects of insulin
stimulate glucose production by liver
decreased movement of glucose into cell
help maintain normal blood glucose levels

41

what is the onset of type 1 DM

younger- less than 40

42

what is the etiology of type 1 DM

- autoimmune destruction of beta cells
- total absence of insulin
- genetic predisposition and viral exposure
- HLA-DR3 and HLA- DR4
- idiopathic diabetes
- latent autoimmune diabetes in adults (LADA)

43

what is the manifestations of the development of type 1 DM

develop when pancreas can no longer produce insulin- rapid onset of ketoacidosis

44

what is the most prevalent form of DM

type 2

45

what are some risk factors of type 2 DM

overweight
obesity
advancing age
family history

46

what is the etiology of type 2 DM

pancreas continues to produce some endogenous insulin
insulin is insufficient or poorly utilized

47

what are the four major metabolic abnormalities associated with type 2 DM

1.) insulin resistance
2.) decreased insulin production by pancreas
3.) inappropriate hepatic glucose production
4.) altered production of hormones and cytokines by adipose tissue

48

what are the metabolic syndromes that increase the risk for developing type 2 DM

- elevated glucose levels
- abdominal obesity
- elevated BP
- high levels of triglycerides
- decreased levels of HDLs

49

what is the onset of type 2 DM

gradual onset
hyperglycemia may go many years without being detected

50

what is prediabetes

individuals that exhibit some symptoms of type 2 DM and are at greater risk for developing type 2 DM

51

what are the tests to determine if someone is prediabetic

Impaired Glucose Intolerance- oral glucose tolerance test and
impaired fasting glucose

52

what are some important teachings for prediabetes

- undergo screening
- mange risk factors
- monitor for symptoms of diabetes
- Maintain healthy weight, exercise, healthy diet

53

what is gestational diabetes

diabetes that occurs during pregnancy

54

what are some increased risks from gestational diabetes

increased risk of need for cesarean delivery
perinatal complications

55

when do you screen for gestational diabetes

high risk pt at first visit
others at 24-28 weeks

56

what are the clinical manifestations of type 1 diabetes

classical symptoms
- polyuria
- polydipsia
- polyphagia
wt loss
weakness
fatigue

57

clinical manifestations of type 2 diabetes

nonspecific symptoms
polyuria
polydipsia
polyphagia
fatigue
recurrent infection
recurrent fungal infection
prolonged wound healing
visual changes

58

what are the diagnostic studies of diabetes

hemoglobin A1C
Fasting plasma glucose
two-hour plasma glucose level during OGTT
Classic symptoms of hyperglycemia with random plasma glucose level

59

what level indicates diabetes with hemoglobin A1C

6.5% or higher

60

what level indicates diabetes with fasting plasma glucose level

126 mg/dL

61

what level indicates diabetes with two-hour plasma glucose levels during OGTT

200 mg/dL

62

what level indicates diabetes with random plasma glucose level

200 mg/dL

63

what are the goals of diabetes management

Goals of diabetes management
Decrease symptoms
Promote well-being
Prevent acute complications
Delay onset and progression of long-term complications