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Anatomy and Physiology > Diabetes - Pathophysiology and Pharmacology > Flashcards

Diabetes - Pathophysiology and Pharmacology Flashcards

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1
Q

What are the nonmodifiable risks of developing diabetes?

A

Genetics (family)
Age
Gender
Post menopausal

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2
Q

What are the modifiable risks of developing diabetes?

A 
Smoking
Hypertension
Dyslipidaemia
Obesity
Physical inactivity
Excess alcohol
Stress
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3
Q

What is diabetes mellitus and its symptoms?

A

A disorder of the pancreas

Inadequate insulin for carbohydrate metabolism

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4
Q

What is diabetes insipidus (rare) and its symptoms?

A

Disorder of the endocrine system

Inadequate anti-diuretic hormone (ADH)

Blood glucose levels are normal

Excessive thirst

Excessive production of dilute urine

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5
Q

What is the reason for diabetes mellitus resulting to inadequate insulin for carbohydrate metabolism?

A

Glucose absorbed from the gastrointestinal tract cannot be metabolised or stored and so reaches higher than normal levels in the bloodstream

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6
Q

How big is the pancreas in length?

A

12-15cm long

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7
Q

Where does the pancreas lie in the body?

A

lies in the epigastric and left of the hypochondriac region

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8
Q

Where does the head of the pancreas lie?

A

It curves into the shape of the duodenum

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9
Q

Where does the body of the pancreas lie?

A

Behind the stomach

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10
Q

Where does the tail of the pancreas lie?

A

In front of left kidney

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11
Q

What space is the pancreas located in?

A

Retroperitoneal space

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12
Q

What is unique about the pancreas?

A

It is both endocrine and exocrine

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13
Q

What is the exocrine function of the pancreas?

A

Digestive enzymes released into duodenum via ducts

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14
Q

What is the endocrine function of the pancreas?

A

Insulin and glucagon directly into the bloodstream

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15
Q

What are the three cells that the Islets of Langerhaans contains?

A

Alpha cells
Beta cells
Delta cells
F cells

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16
Q

What is the role of alpha cells?

A

(Unaffected in diabetics) Secretes the hormone glucagon which raises blood glucose levels

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17
Q

What is the role of the beta cells?

A

Secretes the hormone insulin which lowers blood glucose levels

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18
Q

What is the role of the delta cells?

A

Secretes growth hormone inhibiting cells (GHIH) or somatostatin, which inhibits secretion of insulin and glucagon

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19
Q

What is the role of the F cells?

A

Secretes pancreatic polypeptide which regulates digestive enzymes

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20
Q

What is the process called where glucose is regulated?

A

Negative feedback

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21
Q

What are the effects of glucagon release?

A

Stimulates the liver to breakdown glycogen to be released into the blood as glucose

Activates gluconeogenesis which is the conversion of amino acids into glucose

Breakdown stored fat (triglyceride) into fatty acids for use as fuel by cells

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22
Q

What is gluconeogenesis?

A

Conversion of amino acids into glucose

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23
Q

What are the effects of insulin release?

A

Conversion of glucose into glycogen for storage in the liver and muscles (glycogenesis)

Accelerates the transport of glucose from blood into cells (especially skeletal muscle)

Allows entry of amino acids into cells and synthesises proteins

Converts glucose into fatty acids (lipogenesis)

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24
Q

What is glycogenesis?

A

Conversion of glucose into glycogen for storage in the liver and muscles

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25
What is glycogenolysis?
Breakdown of glycogen into glucose
26
How does the binding of insulin result to glucose entering the cell?
Insulin binds to complimentary receptor on cell Opens channel for glucose to enter through
27
What are the different type of Mellitus?
``` Type 1 (IDDM) Type 2 (NIDDM) ```
28
What is Diabetes Mellitus Type 1 (Insulin Dependent Diabetes Mellitus)?
More common in children and young adults Sudden onset Deficiency/absence of insulin Treated with insulin
29
What is Diabetes Mellitus Type 2 (Non-insulin Dependent Diabetes Mellitus)?
More common in the elderly, late onset Normally obese Diet controlled with tablets (can be insulin)
30
How would you treat Type 1 diabetes?
Absolute deficiency of insulin | Regular injections required to prevent death
31
What causes Type 1 diabetes?
Autoimmune genetic disorder where pancreatic beta cells are destroyed
32
What is the metabolism of untreated Type 1 (IDDM)?
Insulin not present to aid entry of glucose into cells Cells instead use fatty acids to produce adenosine triphosphate (ATP) By-products of fatty acid catabolism are organic acids called ketones Ketone bodies form acidosis which lower pH of the blood and result in death By-product of ketones is acetone smell on breath
33
What is ketones?
By-products of fatty acid catabolism of organic acids
34
What are some common types of insulin?
``` Human Actrapid Human Insulatard ge Human Mixtard 30 ge Human Monotard Human Ultratard Human Velosulin Humulin 1 Humulin Lente Humulin M1 Humulin S Humulin Zn Hypurin Human Actrapid Penfill (pen) Human Insulatard Penfill (pen) Human Mixtard 10 Penfill (pen) ```
35
What is the cause of Type 2 diabetes?
Cells in the body are less sensitive to insulin probably through downregulation of insulin receptors
36
What are the three oral hypoglycaemic agents?
Biguanides Sulfonylureas Alpha-Biguanides
37
What is the role of the oral agent Biguanides?
Stops the liver making extra sugar when it is not needed | Increases uptake of glucose by cells
38
What is the role of the oral agent Sulfonylureas?
Helps pancreas make extra insulin
39
What is the role of the oral agent Alpha-Biguanides?
These are inhibitors that slow the digestion of starches
40
What is the role of the drug called Sulphonylureas?
Helps pancreas produce more insulin
41
What are the four Sulphonylureas that helps with increased production of insulin?
Gliclazide Glibenclamide Tolbutamide Chlorpropamide
42
What is the only form of Biguanide available?
Metformin
43
When is the use of Biguanide contraindicated?
Renal impairment Risk of lactic acidosis in hepatic/respiratory and cardiac failure
44
What are some causes of hypoglycaemia?
``` Overdose of insulin Not enough food or delay in food intake Overdose of medication Too much exercise Alcohol Pregnancy Gastrointestinal disturbances (D&V) Recent illness ```
45
What are some causes of hyperglycaemia?
Undiagnosed diabetes Incorrect medication Inadequate adjustment to dose of insulin during illness
46
What are the symptoms of hyperglycaemia?
Polyuria Polydipsia Polyphagia
47
What is polyuria?
Excessive urine
48
What is polydipsia?
Excessive thirst
49
What is polyphagia?
Excessive eating
50
What is the onset of hypoglycaemia?
Sudden and rapid - minutes
51
What is the onset of hyperglycaemia?
Gradual - hours or days
52
What happens to the skin in response to hypoglycaemia?
Profuse sweating/pale
53
What happens to the skin in response to hyperglycaemia?
Dry and flushed
54
What are the resps like for hypoglycaemia?
Normal to shallow
55
What are the resps like for hyperglycaemia?
Deep and sighing (Kaussmauls)
56
What is Kaussmauls?
Deep, laboured breathing often associated with metabolic acidosis, particularly diabetic ketoacidosis but also kidney failure Refers to high pressure in the jugular vein when a person inhales
57
What is the pulse like for someone with hypoglycaemia?
Fast and full
58
What is the pulse like for someone with hyperglycaemia?
Fast and weak
59
What would the BP be like for someone with hypoglycaemia?
Normal
60
What would the BP be like for someone with hyperglycaemia?
Low
61
What is normal blood sugar levels?
4-7mmol/l but 4-5.4mmol/l is without food consumption
62
What is the breath like for hypoglycaemia?
No odour
63
What is the breath like for hyperglycaemia?
Sweet/fruity
64
What is the food intake like for hypoglycaemia?
Low
65
What is the food intake like for hyperglycaemia?
High
66
What is the insulin level like for hypoglycaemia?
Excessive
67
What is the insulin level like for hyperglycaemia?
Insufficient
68
What are the symptoms for hypoglycaemia?
``` Hunger Headache Dizzy Confused Seizures Aggressive ```
69
What are the symptoms of hyperglycaemia?
``` Pain Nausea Fever Vomiting Thirst Drowsiness Low BP ```
70
How would you pre-hospitally manage hypoglycaemia?
``` ABCs Oxygen (if hypoxemic) Administer Hypostop (if conscious) Recovery positon Monitor blood glucose IM glucagon Reassurance Consider paramedic assistance for IV glucose ```
71
How would you pre-hospitally manage hyperglycaemia?
``` ABCs Oxygen (if hypoxemic) Recovery position Monitor blood glucose Reassurance Consider paramedic assistance for IV fluid if hypoperfused ```
72
On what circumstances should a hypoglycaemic patient be transported to hospital?
Elderly Are taking oral hypoglycaemic agents, as hypoglycaemia may occur Have no history and 1st hypo episode Have blood glucose level greater than 5mmol/l after treatment Have not returned to normal mental state within 10 minutes of IV glucose (paramedic intervention) Have been treated with glucagon Have any additional disorders or complicating factors eg. chest pain, arrhythmias, alcohol, dyspnoea Exhibits signs of infection (urinary, upper resp tract) and/or unwell
73
What are some long term complications of diabetes?
Cardiovascular problems Infection Renal failure Optical
74
What cardiovascular problems can arise from diabetes?
Atheroma leading to Peripheral Vascular Disease and MI Thickening of arteries leading to retinopathy, renal failure and peripheral neuropathy
75
Why would renal failure arise from diabetes?
Due to vascular changes Excessive glucose damages renal blood vessels because its not reabsorbed by the tubules The remaining glucose raises osmotic pressure, reducing water reabsorption, increased urine volume, electrolyte imbalance, polyuria, hypovolaemia, extreme thirst and polydipsia
76
Why would an infection arise due to diabetes?
Phagocytic activity may be depressed by insufficient intracellular glucose Complications occur in areas affected by neuropathy: Feet when sensation and blood supply impaired Boils Carbuncles Vaginal candidiasis (thrush) Pyelonephritis (bacterial infection of the kidney)
77
How would optical issues arise due to diabetes?
Loss of vision due to cataracts as excessive glucose attaches to lens proteins causing cloudiness or damage to blood vessels in the retina

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