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N182 Chronic Health Problems in Elderly > Diabetes > Flashcards

Diabetes Flashcards

(108 cards)

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1
Q

glycogenolysis

A

conversion of glycogen to glucose in the liver

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2
Q

when does glycogenolysis occur?

A

during periods of fasting/low BGL

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3
Q

gluconeogenesis

A

conversion of a non-carb source like protein to glucose

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4
Q

where does gluconeogenesis occur

A

liver

kidneys

intestines

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5
Q

ketogenesis

A

break down of fatty acids for energy

produces ketones

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6
Q

when can ketogenesis occur

A

low BGL

low insulin levels

sometimes during hyperglycemia

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7
Q

proinsulin

A

has extra peptide chain that when removed becomes active insulin

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8
Q

6 actions of insulin

A
  1. helps glucose get into cells by attaching to insulin receptors
  2. promotes glycogenesis
  3. inhibits glycogenolysis
  4. inhibits ketogenesis
  5. inhibits gluconeogenesis
  6. stimulates enzymes needed for energy production
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9
Q

glycogenesis

A

conversion of glucose to glycogen to store it in the liver and skeletal muscle

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10
Q

4 actions of glucagon

A
  1. promotes glycogenolysis
  2. promotes gluconeogenesis
  3. inhibits glycogenesis
  4. inhibits glycolysis
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11
Q

2 types of incretins

A

Glucagon-like peptide-1 (GLP-1)

Glucose-dependent insulinotropic peptide (GIP)

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12
Q

Where and when is GLP-1 secreted?

A

intestines in the presence of nutrients

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13
Q

actions of GLP-1

A
  1. increases insulin secretion in amount that depends on how much glucose is in the body
  2. decreases glucagon secretion
  3. inhibits acid secretion in the stomach and slows gastric emptying time
  4. promotes insulin sensitivity in the periphery
  5. increases satiety
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14
Q

4 hormones that decrease blood glucose levels

A

GLP-1

GIP

Amylin

Insulin

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15
Q

3 hormones that increase BGL

A

DPP4

SGLT2

Glucagon

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16
Q

Where is GIP synthesized

A

duodenum and jejunum

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17
Q

action of GIP

A

stimulates insulin secretion

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18
Q

where is amylin secreted?

A

beta cells in pancreas

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19
Q

3 actions of amylin

A
  1. suppresses post-prandial glucagon secretion
  2. delays gastric emptying
  3. increases satiety
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20
Q

main outcome of amylin

A

decrease in post-prandial BGL

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21
Q

DPP4

action

A

dipeptidylpeptidase 4

breaksdown incretins (elevates BGL)

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22
Q

SGLT2

A

sodium-glucose cotransporter 2

resorbs most glucose by the kidneys (elevates BGL)

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23
Q

2 things that happen when glucose is available but unusable and cells are starved

A

glycogenolysis in the liver

gluconeogenesis

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24
Q

osmotic diuresis

A

large amounts of glucose reaches the kidneys

glucose pulls water with it → extreme water loss

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25
what quality of glucose causes polyuria
it is hyperosmolar
26
how does the renal system attempt to correct acidosis?
sodium bicarbonate neutralizes ketones so body can excrete them
27
why won't the renal attempt to correct acidosis work?
sodium bicarbonate levels are too low because of osmotic diuresis which causes the loss of sodium
28
When the renal attempt to correct acidosis doesn't work, how does the pulmonary system attempt?
the increase in H+ and CO2 in the blood stimulates kussmaul respirations
29
kussmaul respirations
deep and rapid respirations acetone is exhaled
30
Normal fasting blood glucose (FBG)
70-99 mg/dl
31
Impaired FBG (Pre-diabetes)
100-125 mg/dl
32
Diabetic FBG
+126 mg/dl on more than one occasion
33
Normal glucose tolerance after 2 hour OGTT
less than 140 mg/dl
34
impaired glucose tolerance after 2 hour OGTT (prediabetes)
140-199 mg/dl
35
diabetic glucose tolerance after 2 hour OGTT
over 200 mg/dl on more than 1 testing occasion
36
Diagnostic criteria for metabilic syndrome
3 of the following: * abdominal obesity * inc. triglycerides * low HDL cholesterol * inc. BP or on antihypertensive meds * inc. FBG or on hypoglycemic meds
37
What qualifies as abdominal obesity in the diagnostic criteria for metabolic syndrome?
Male \> 40 in. Female \> 35 in. (non asian)
38
What qualifies as high triglycerides in the diagnostic criteria for metabolic syndrome?
\> 150 mg/dl or on meds for high triglycerides
39
What qualifies as low HDL cholesterol in the diagnostic criteria for metabolic syndrome?
M \< 40 mg/dl F \< 50 mg/dl
40
What qualifies as high BP in the diagnostic criteria for metabolic syndrome?
\> 130/85 mmHg or on antihypertensive medications
41
What qualifies as high FBG in the diagnostic criteria for metabolic syndrome?
\> 100 mg/dl or on hypoglycemic medications
42
3 features for risk factr screening of metabolic syndrome
1. obesity 2. hypertension 3. insulin resistance
43
Overweight BMI
25 - 29.9
44
Obese BMI
greater than/equal to 30
45
4 symptoms of insulin resistance
acanthosis nigricans fatigue drowsiness after meals dyslipidemia
46
acanthosis nigricans
patchy brown pigmentation of skin around neck and axilla
47
arcus cornealis
thin gray-white arc at the edge of the cornea
48
xanthelasma
yellowish raised skin plaques found along the nose near the eyelids
49
4 criteria for the diagnosis of diabetes mellitus
1. hallmark symptoms of diabetes PLUS casual blood glucose over 200 mg/dl 2. increased fasting plasma glucose 3. increased 2 hour plasma glucose during OGTT 4. A1C \> 6.5%
50
example of a serum autoimmune marker that can be detected and used for early detection
islet cell auto-antibody
51
how does the autoimmune feature of Type I work?
immune system destroys beta cells
52
onset in children compared to adults
rapid beta cell destruction more gradual in adults
53
how to diagnose children with Type I
high random BGL with the hallmark symptoms
54
Many adults are misdiagnosed with Type II When should the diagnosis be reconsidered?
they have persistant hyperglycemia with non-insulin medications they have a first degree relative with Type I have 2+ autoantibodies
55
how much does the level of risk for developing Type I increase when you have a first generation relative with it?
15%
56
who has the highest risk for Type I diabetes?
patients with 2 or more autoantibodies
57
Stage I Type I DM
asymptomatic glucose levels normal despite autoantibodies
58
Stage II Type I DM
asymptomatic slight increase in BGL but less than diagnostic criteria
59
Stage III Type I
symptomatic meets general diagnostic criteria
60
idiopathic Type I diabetes
periods of no insulin production without evidence of autoimmunity strong inheritance
61
Which ethnic groups have the highest incidence of ideopathic Type I?
African and Asian
62
What makes treatment difficult for Ideopathic Type I?
intermittance of insulin production
63
percentage of people with diabetes who have Type II?
90 - 95%
64
2 main characteristics of Type II diabetes
insulin resistance increased hepatic glucose production
65
percentage of people with Type II who are obese
85%
66
3 processes that hinder the effective use of insulin (Type II)
1. beta cell dysfunction 2. insulin receptor defects (less sensitive/decrease in number) 3. increased hepatic glucose production
67
define insulin resistance
an increase of plasma insulin has less of an effect in lowering plasma glucose than it does in the normal population (glucose can not enter cell)
68
what happens to insulin levels in a case of insulin resistance?
at first beta cells try to compensate by increasing beta cell production eventually insulin secretions decrease
69
describe glucose levels in someone with insulin resistance
higher glucose levels after meals prolonged periods of high glucose
70
what are people with insulin resistance at risk for?
developing type II complications like heart disease
71
who is likely to develop insulin resistance?
excess weight and inactivity
72
not a distinct disease but indicates increased risk for diabetes and peripheral vascular disease
prediabetes
73
prediabetes
condition where BGL is elevated but not high enough for a diagnosis
74
3 criteria for prediabetes
1. impaired fasting glucose (IFG) 2. impaired glucose tolerance (IGT) 3. A1C 5.7-6.4%
75
combination of insulin resistance and beta cell dysfunction
prediabetes
76
what percentage of people with prediabetes will develop to Type II?
up to 70%
77
2 types of complications related to unregulated BGL
microvascular problems macrovascular problems
78
3 types of microvascular problems
neuropathy nephropathy retinopathy
79
7 risk factors for developing prediabetes
1. family history 2. first degree relative with Type II 3. native american, african american, latino, asian, pacific-highlanders 4. age 5. obesity and inactivity 6. hypertension 7. lipid problems
80
4 ways to prevent prediabetes
1. lifestyle changes that target obesity 2. activity 3. eating 4. smoking cessation
81
activity recommendations for children | (prevention)
60 minutes of moderate to intense activity daily
82
activity recommendations for ages 18-64 | (prevention)
150 minutes of moderate activity weekly or 75 minutes of vigorous activity weekly
83
activity recommendations for ages 64+ | (prevention)
same criteria for ages 18-64 plus incorporate balance and muscle strengthening activities
84
2 other names for metabolic syndrome
insulin resistance syndrome syndrome X
85
collection of risk factors that may affect development of Type II or cardiovascular problems
metabolic syndrome
86
4 typical abnormalities of metabolic syndrome
1. hyperinsulinemia 2. dyslipidemia 3. central obesity 4. hypertension
87
3 things that may cause dyslipidemia
1. hypertriglyceridemia 2. decrease HDL cholesterol 3. reduction in size and density of LDL cholesterols
88
what causes hypertriglyceridemia
insulin causes conversion of glucose to triglycerides
89
what causes decreased HDL cholesterol
increased insulin
90
what may cause central obesity?
increased insulin causes increased fatty acids which increases adipose tissue in the stomach
91
how can increase insulin cause hypertension?
it causes sodium retention
92
risk factor screening for asymptomatic adults for diabetes (11)
BMI greater or equal to 25 (23 for asian) and 1 of the following: 1. A1C \> 5.7% 2. IGT or IFG 3. Inactivity 4. First degree relative 5. High risk ethnic group 6. Previous diagnosis of gestational diabetes 7. PCOS 8. CV disease 9. BP \> 140/90 (or treated for hypertension) 10. low HDL (less than 35) or high triglycerides (+250) 11. over age 45
93
risk factor screening for asymptomatic teens (BMI)
BMI \> 85% for age and gender, greater than 85% for height and weight, or weight is 125% of ideal for their height plus 2 of the other factors
94
risk factor screening for asymptomatic teens for type II (other factors)
2 of following 1. first/second degree relative with Type II 2. high risk ethnic group 3. signs of insulin resistance 4. mother had gestational diabetes
95
when should teens with risk factors be screened for type II diabetes
age 10 or at the onset of puberty at any age under 10
96
why should you ask about family history of endocrine disorders during the history assessment?
correlation between autoimmune thyroid disease and type I
97
main assessment topics
1. history 2. hydration 3. medications 4. eating habits 5. exercise 6. hallmark symptoms 7. other medical issues that could be complications of diabetes
98
normal casual blood glucose (before meals)
80 - 120 mg/dl
99
normal blood glucose at bed time
100-140 mg/dl
100
what is preferred way of testing BGL blood glucose test or OGTT
blood glucose
101
what do serum creatinine and BUN indicate?
renal problems not truly diagnostic for diabetes
102
glycosylation
glucose attaches to hemoglobin protein
103
how does A1C test work?
when glucose levels are elevated over long period of time glucose saturation will be high
104
how many months back will A1C test
2-3 months
105
A1C results for non-diabetic
2-5%
106
A1C results for a controlled diabetic
less than 7%
107
why isn't urine glucose as effective as blood glucose?
the renal threshold for the point where kidneys spill excess glucose into nephrons varies from person to person (threshold may be 220 mg so will not detect BGL of 190)
108
what does urine albumin measure
microvascular issues in kidneys | (not diagnostic for diabetes)

N182 Chronic Health Problems in Elderly (2 decks)

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