Diabetes and Endocrine System

Question 1

Definition of Diabetes

Answer 1

A chronic metabolic condition characterized by elevated circulating glucose concentrations resulting fro the insufficient supply or action of the hormone insulin

Question 2

Insulin

Answer 2

Stimulates glucose uptake by peripheral tissues (mainly skeletal),
Suppresses endogenous glucose production (by hepatic glycogenolysis and gluconeogensis)
Suppresses lipolysis in adipocytes and proteolysis in muscle.

Question 3

Different Types of Diabetes

Answer 3

Type 1
Type 2
Latent Autoimuune Diabetes of Aging (LADA)
Maturity Onset Diabetes of Youth (MODY)

Question 4

LADA

Answer 4

Type 1.5 is one of several names now applied to adults diagnosed with diabetes who not immediately require insulin treatment, are not often overweight, and have little or no resistance to insulin. They are found to have anitbodies that attack their beta cells.

Question 5

Pre-Diabetes

Answer 5

refers to a person with BG fasting 100-125 mg/dl or 5.5-6.875mm. You do not have diabetes yet and without lifestyle changes you will develop T2DM. (IGT or IFG)

Question 6

Type 1 Diabetes

Answer 6

5-10% of diagnosed cases
Immune mediated- autoimmune destruction of beta cells
Need EXOGENOUS insulin
Idiopathic (arrives spontatenously)
usually not obese; often recent weight loss
First sign in children/adolescented (KDA)

Question 7

Type 2 Diabetes

Answer 7

Insulin resistance
Pancreases increases production
Pancreas stops producing insulin
Insulin def
Glucose intolerance
Develops in obese who lack capacity to step up production of insulin
Hyperglycemia develops

Question 8

Hormones

Answer 8

Chemical messengers that are secreted by glands in to the blood and give out numerous interactions between various glands.

Question 9

Endocrine

Answer 9

Ductless glands that secrete hormones:

Hypothalamus, Posterior Pituitary, Anterior pituitary, Thyroid gland, adrenal gland, PTH,

Question 10

Exocrine glands

Answer 10

Have ducts that secrete products like saliva, sweat, digestive.

Question 11

What are the secretions of the pancreas?

Answer 11

Alpha cells secrete glucagon, beta cells secrete insulin, and delta cells secrete somatostatin, F cells secrete pancreatic polypeptide.

Question 12

Too little hormone activity

Answer 12

Not enough secretion by endocrine gland
Increased removal of the hormone from blood
Abnormal tissue responds to hormone
Lack of target cell responsiveness to hormone
Lack of an enzyme essential to the target cell response

Question 13

Too much hormone activity

Answer 13

A lot of secretion of hormone by gland
Reduced plasma-protein binding of hormone (too much free biologically active hormone)
Decreased removal of the hormone from the blood
Decreased inactivation
Decreased excretion

Question 14

How many are projected to have DM by the year 2030?

Answer 14

592 million

Question 15

What is the 7th leading cause of death in US

Answer 15

DM

Question 16

Criteria for Diagnosing DM

Answer 16

1) A1C >6.5% using stand lab measures
OR
2) Fasting BG >126mg/dl
OR
3) Symptom of DM plus random BG concentration >200mg/dl
OR
4) 2 hour post prandial glucose >200 mg/dl during an oral glucose tolerance test (OGTT)

Question 17

Pathophysiology of Hyperglycermia

Answer 17

Increase in gluconeogenesis in liver
Stimulation of glycogenlysis
Excess glucose lost in urine to compensate
Glycosuria and polyuria are present which then leads to polydipsia

Question 18

Insulin resistance?

Answer 18

Polygenic b/c several factors contribute to its development. Obesity, poor nutrition, and physical inactivity.
Central adiposity seems to increase the degree of insulin resistance

Question 19

Why do Beta Cells fail?

Answer 19

Over secretion of insulin to compensate for insulin resistance
High circulating free fatty acids
Hyperglycemia

Question 20

Metabolic syndrome?

Answer 20

Shares characteristics with T2DM
Central obesity and insulin resistance significant contributors
With atheroscelortic risk factors (HTN and dyslipidemia)
Places people at risk for CAD.

Question 21

Criteria to diagnosis MetS

Answer 21

1) Elevated waist circumference: Men >40in.
Women >35in
2) Elevated TG >150mg/dl
3) Reduced HDL (good) cholesterol
Men <40
Women <50
4) Elevated BP
>130/85 mm Hg
5) Elevated Fasting BG
>100mg/dL

Question 22

Criteria for Testing for DM

Answer 22

Habitually Physically Inactive
First degree relative with DM
Members of high risk ethnic population
Delivered a baby weight >9lbs or been diagnosed with GDM
Hypertensive
Have HDL chol <35 mg/dl
Have PCOS
Had IGT or IFG on previous testing
Other clinical conditions assoc with insulin resistance
History of vascular disease

Question 23

What is HbA1c?

Answer 23

Glycated Hemoglobin (A1C)
Hemoglobin in RBC’s binds glucose irreversibly
Amount of glucose bound to HGB indicated hyperglycemia b/c past 2-3 months of data
It is measured every 3 months since lifespan of RBC is 120 days
Higher amount of glucose the higher amount of glycated HGB

Question 24

Normal HbA1c?

Answer 24

<5.7%

Question 25

What is fructosamine?

Answer 25

The carbonyl group of glucose reacts with amino group of Albumin --> glycated serum albumin glucose attached to plasma albumin protein resembles fructose molecule but no relationship with fructose sugar. This is not HgbA1c. Advantage of this test is to show serum glucose control over 2-3 weeks. Shorter period compared to HgbA1c.

Question 26

Warning signs of T1DM

Answer 26

``` Drowsiness, lethargy, blurred vision Extreme thirst Frequent urination Fruity, sweet, wine like odor on breath Glucose or ketones in urine Heavy labored breating increased appetite suddent weight loss stupor ```

Question 27

T1DM Pathophysiology

Answer 27

``` Hyperglycemia and cells starve Excess glucose in urine and polyuria Thirst Hunger Lipolysis FA transformed to Ketones and so pH falls ```

Question 28

Management of T1DM

Answer 28

Intensive therapy to achieve near normal glucose levels Prevent hypoglycemia BG measured 3-8x daily Eating at consistent times and synchronized with insulin dose Teach client CHO counting Type/Amount of carb influence BG levels

Question 29

Gestational DM

Answer 29

Glucose intolerance during pregnancy 14-25% of all pregnancies Alterations in insulin secretion, affecting glucose, a.a., and fat metabolism Similar to T2DM Effects fetus, induces fetal hyperglycemia (abnormally large infants)

Question 30

Clinical manifestations of GDM

Answer 30

``` Hypertension (preclampsia) Polyhydraminos (excess accumulate of amniotic fluid) Difficult birth Preterm delivery High rate of C section ```

Question 31

Medical treatment of GM

Answer 31

Nutrition counseling individualized with focus on energy and nutrient needs Insulin therapy if needed Oral meds not recommended.

Question 32

Nutrition Intervention for GDM

Answer 32

``` Adequate energy for weight gain First Tri: 0.5-1kg Second and Third Tri: 0.2-0.5kg/week Increase PRO in 2/3 trimester Vit/Min status Use CC Meal plan to provide adequate energy/nutrients. Typicaly diet may have 30-35kcal/kg 20% protein 40-45%CHO 35-40%fat Glycemic stat at 6 weeks after delivery ```

Question 33

Acute complications of DM

Answer 33

SE of insulin therapy: hypoglycemia Dawn phenomenon: Hyperglycemia between 5am -9am because cortisol and growth hormone stimulate gluceoneogensis DKA: life threatening situation include: nausea/vomitting/ stomach pain, fruity acetone breath, Kussmaul respirations, and mental status change HHS Short term illness

Question 34

Long term complications of DM

Answer 34

``` Microvascular and macrovascular complications that increase morbidity. Typically occur 15-20 yrs after onset of DM. CVD Nephropathy (CKD) Retinopathy Nervous System Diseases ```

Question 35

Macrovascular Complications of DM

Answer 35

Cardiovascular diseases

Question 36

Microvascular Complications of DM

Answer 36

Nephropathy: Decreased filtering ability of kidneys from persistent albumin in urine. Retinopathy

Question 37

Gastroparesis

Answer 37

delayed gastric emptying results from damage to vagus nerve which controls peristalsis.

Question 38

Diabetic Ketoacidosis

Answer 38

severe form of hyperglycemia When adequate insulin not available, glucose production via gluconeogenesis and lipolysis are stimulated by counter-regulatory hormones in an effort to avoid starvation. One by product of lipolysis is ketones. As glucose and ketones accumulate in blood stream, osmotic diuresis occurs, resulting in dehydration and electrolyte imbalances. As fluid is lost the blood becomes concentrated further contributing to hyperglycemia.