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Med Path Fall 2020 > Diabetes II > Flashcards

Diabetes II Flashcards

1
Q

3 main effects of chronic hyperglycemia

A
  1. Glycation of proteins
  2. Accumulation of sorbital inc ells
  3. Increased/inappropriate activation of protein kinase C
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2
Q

Glycation of proteins due to hyperglycemia results in

A

Glucose binds to protein chain and can cause slow, permanent cross linking that leads to pathology.

Abnormal cross linking.
It affects hemoglobin and collagen in vessel walls.
Causes microvascular dysfunction.

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3
Q

Accumulation of sorbital in cells causes

A

Cellular edema. May cause cataracts and nerve dysfunction due to swelling.

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4
Q

Increased/inappropriate activation of protein kinase C causes

A

Vasoconstriction of smooth muscle
Vascular permeability–> leaky vessels
Basement membrane thickening
Abnormal angiogenesis

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5
Q

how can glycation of proteins lead to AGEs (advanced glycation end products)

A

If glucose binds to protein, it can cause an enzyme activity change and increase oxidative stress/inflammatory reactions in days- weeks. (early glycation products)

In months- years, they can transition to advances glycation end products that are permanent. The proteins cross link and lead to pathology.

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6
Q

Another name for glycation process

A

Maillard reaction

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7
Q

What occurs during early glycation products

A

Occurs in days-weeks from glucose binding to protein in days to weeks. Causes oxidative and inflammatory reactions.

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8
Q

How does sorbitol cause edema

A

Once sorbitol is produced inside a cell, it cannot get out. It attracts water that remains in the cell. This causes edema and injury.

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9
Q

What increases sorbitol levels in cells?

A

If glucose levels are elevated, they will diffuse more readily into cells. Cells only use 3% for energy. The remaining extra glucose is converted to sorbitol. Sorbitol cannot travel outside the cell- trapped. Water loves sorbital, so water enters the cell and causes edema.

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10
Q

Hyperglycemia causes an increase in ___, which causes an increase in PKC

A

DAG diacylglycerol

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11
Q

Increase in PKC results in what?

A 
Blood flow abnormailities
Angiogenesis
Capillary occlusion
Vascular occlusion 
^^ all affect eyes

Also:
pro-inflam gene expression
Oxidative stress

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12
Q

How does diabetes mellitus affect macrovascular

A

Coronary artery disease- CAD, MI, CHF

Peripheral artery disease- amputations

Cerebrovascular disease- Transient ischemic attacks, stroke

Other- Immunosuppression and hearing loss due to neuropathy

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13
Q

2 most common causes of death in people with Type II DM

A

Coronary artery disease, cerebrovascular disease (stroke)

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14
Q

Peripheral artery disease (ex of macrovascular complication)

A

Atherosclerosis in major arteries of legs– causes downstream problems in lower legs/feet. May cause ulcerations and gangrene infections. Need amputations.

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15
Q

Prevalence of cerebrovascular disease with DM increases with

A

Duration of disease

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16
Q

Insulin resistance –> hyperglycemia –> ____ –> Accelerated atherosclerosis –> Vascular damage

A

Endothelial dysfunction due to blood vessel problem

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17
Q

Microvascular chronic complications of DM

A

Retinopathy
Neuropathy
Nephropathy

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18
Q

Root cause of microvascular complications

A

Endothelial glycation damages endothelium. Results in a thickening of the basement membrane, which decreases oxygen transmission.

Loss of pericytes causes a small out pouching of blood vessel- micro aneurysm that will leak blood.

Glycated platelets and RBC will stick to damage endothelium and can form thrombosis that may obstruct blood vessels and cause ischemia or rupture and cause exudate/blood leakage.

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19
Q

Prevalence of diabetic retinopathy

A

28-33%

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20
Q

Diabetic Nephropathy

A

Leading cause of renal failure due to glomerulosclerosis (scarring of glomerulus)

Most common cause of death in type 1 diabetics

Increases albumin in urine

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21
Q

Sclerosis vs stenosis

A 
Sclerosis= scarring
Stenosis= narrowing
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22
Q

Diabetes is the number 1 cause of

A

End stage renal disease- will qualify pt for medicare

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23
Q

Most common cause of death in type 1 diabetic

A

Diabetic nephropathy

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24
Q

Leading cause of renal failure

A

Diabetic nephropathy by gomerulosclerosis- scarring.

25
Q

Diabetic nephropathy risk factors

A

*Hyperglycemia
*Hypertension
genetic predisposition
Hypercholesterolemia
Smoking

26
Q

How to tx nephropathy

A

Control underlying disorder- diabetes/HTN

Hemodialysis- filter out bad products that kidney can’t get rid of on it’s own. Ex: Albumin.

27
Q

How does chronic hyperglycemia cause kidney probs

A

Increased renal blood flow (hyper fusion) results in increased glomerular pressure and protein glycation that causes glomerular damage. Eventually decreases the efficiency of the kidney and causes renal failure.

28
Q

Diabetic Neuropathy

  • What is it?
  • How many diabetics does it affect?
  • What causes it?
A

Demyelination of nerves throughout the body
60-70% of diabetics
Caused by hyperglycemia, lack of insulin, ischemia, duration and control of diabetes

29
Q

Peripheral neuropathy

A

Most common diabetic neuropathy. Affects peripheral nerves in toes/feet/legs/hands/arms.
Sensory before motor
Causes impaired sensation- numb, tingles, weakness. Muscle wasting

Damaged blood vessels = affects myelin= demyelination= affects integrity

30
Q

Most common diabetic neuropathy

A

Peripheral neuropathy

31
Q

Peripheral neuropathy affects _ before _

A

Sensory before motor

Causes impaired sensation- numb, tingles, weakness. Muscle wasting

32
Q

4 types of neuropathy

A

Autonomic
Proximal
Peripheral
Focal

33
Q

Autonomic neuropathy results in

A

Bladder incontinence
Impotence
Diarrhea
Perspiration

34
Q

Proximal neuropathy

A

Pain in thighs, hips, leg weakness

35
Q

Focal neuropathy

A

Important for us. Affects any nerve in the body. Ex: cranial nerve palsy.

36
Q

Pericytes

A

Supportive cell around vessels that regulate capillary blood flow in the CNS and retina. Once pericytes are damaged/destroyed, the capillaries become leaky or occluded and can cause micro aneurysms.

Glycated RBC/platelets stick to the damaged endothelium and lead to endothelial breakdown and thrombosis. Causes hemorrhages or ischemia.

37
Q

Why should you always ask patients when they were diagnosed with diabetes?

A

Incidence of retinopathy increases with duration of DM.

38
Q

Diabetes dx 10 yrs ago? __% incidence of retinopathy

What about diagnoses 15 years ago?

A

10 years- greater than 50%

15 years- 90%

39
Q

1 cause of blindness in working population

A

DM

40
Q

Diabetic retinopathy risk factors

A

Smoking, HTN, pregnancy

41
Q

What directly correlates to diabetic retinopathy

A

Length of time you have had diabetes

A1C percentage

42
Q

Magic A1C that will greatly reduce chances of pt developing diabetic ret

A

7%

43
Q

Diabetes increases risk of developing cataracts by ___%

A

40%

44
Q

How does diabetes cause cataracts

A

Excess glucose is converted to sorbitol and lens fibers swell- causes apoptosis and ROS

45
Q

myopic shift

A

Due to lens swelling. Decreased amp and early onset presbyopia.

46
Q

Diabetic pts are __x glaucoma risk

A

2x

47
Q

How can diabetes affect the cornea

A

Decreased sensitivity bc neuropathy

48
Q

Why are optometrists such big players in tx/management of diabetes?

A

Increased A1c results in the highest risk of developing retinopathy out of all other microvascular complications. optometrist most likely to dx

49
Q

Diabetic Ketoacidosis

  • What causes it?
  • What type of diabetes usually associated
  • What level of glucose in blood
A
  • Caused by absence of insulin
  • Type I more common
  • Hyperglycemia levels over 200mg/dl causes this
50
Q

Lack of glucose causes cells to burn ___

A

Fat

51
Q

Insulin being absent leads to keto acidosis how?

A

INsulin absent? Glucagon is unable to be suppressed, telling liver to release glucose into blood from glycogen stores. Excess glucose in the blood isn’t used and is converted to ketones by fatty acid metabolism. Ketones are acidic, which causes the blood to become acidic.

Hyperglycemia + hyper ketosis + acidosis = DKA

52
Q

Classic Triad in DKA

A

Hyperglycemia greater than 200 mg/dl
hyperketosis- ketones present in blood/urine
acidosis- pH less than 7.3 or bicarb less than 15mmol/L

53
Q

Signs/symptoms of DKA

A

Altered mental status due to lack of glucose
Fruity breath due to acetone (biproduct from ketone breakdown)
Hyperventilation in attempt to get rid of Co2 and raise pH to a more basic level

54
Q

Kussmaul breathing

A

Hyperventilation in attempt to stabilize pH of blood by releasing CO2. Goal is to make blood pH more basic

55
Q

Complications if DKA continues

A

Cerebral edema
Coma
Death

56
Q

How to Tx DKA

A

Blood glucose normalization with insulin

57
Q

Hypoglycemia emergency

  • Most commonly caused by what
  • Most common in Type I or II?
  • Blood glucose levels
A

Most commonly caused by insulin overdose in type I diabetes- on bigger doses of insulin.

Hypoglycemia: less than 70 mg/dl
Severe hypoglycemia: 50-55mg/dl Emergent!

58
Q

Signs/symptoms of hypoglycemia

A 
Nervous 
Sweating 
Tremor
Muscle weakness 
HA 
Confusion 
Loss of consciousness w decreased respiration 
Coma
59
Q

How to tx hypoglycemia

A

Treat with rapid glucose infusion, glucagon injection and close monitoring.

Blood sugar crashing- need glass of OH or emergency glucose tablets

Med Path Fall 2020 (20 decks)

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