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BioScience II > Diabetes PPt-josh > Flashcards

Flashcards in Diabetes PPt-josh Deck (65):
1

Diabetes:

DM is a disease process that is a resut of what 2 things?

 

  1. Inadequate supply of insulin
  2. inadequate tissue response to insulin

 

2

Diabetes:

what are the 2 types?

  • Type I
  • Type II

IDDM and NIDDM are no onger terms reccommended for use

3

Insulin:

is synthesized by what cells?

Beta cells

4

Insulin:

is regulated by what 3 ways

  1. Chemical
  2. Hormonal
  3. Neural

5

Insulin:

facilitates the uptake of what"?

Glucose

6

Insulin:

is metabolized by what organs

Liver and kidneys

7

Type I DM:

represents what % of cases?

5-10%

8

Type I DM:

___ cells mediated autoimmune destruction of beta cells within the pancreatic islets!

T-cells

9

Type I DM:

what is teh exact cause?

Unk

10

Type I DM:

what is up with the insulin?

there is minimal to complete absence of circulating Insulin

11

Type II DM:

makes up what % of cases

90%

12

Type II DM:

what is up with the insulin

Slow insensitivity and resistance to insulin

13

Type II DM:

there is a slow exhaustion of what cells?

Beta

14

Type I vs Type II:

onset sudden?

1

15

Type I vs Type II:

onset gradual

II

16

Type I vs Type II:

onset mostly adulthood

II

17

Type I vs Type II:

onset any age (mostly young)

 

I

 

18

Type I vs Type II:

THIN bodies

I

19

Type I vs Type II:

chuncky monkies

II

20

Type I vs Type II:

Ketoacidosis

I-often

II-rare

21

Type I vs Type II:

has autobodies

I

22

Type I vs Type II:

endogenous insulin low or absent

I

23

Type I vs Type II:

endogenous insulin normal, decreased, or increased

II

24

DM:

cllinical features!

  • Polydipsia
  • Polyuria
  • Polyphagia
  • Tired
  • Fungal infection
  • poor wound healing
  • Deterioration of vision

25

DM:

complications

  • DKA
  • HHS
  • Microvasular
  • Macrovascular
  • Autonomic neuopathy

26

DM:

what are the 3 main microvascular comlications

  1. Nephropathy
  2. Neuropathy
  3. Retinopathy

27

DKA:

most common in what DM

Type I

28

DKA:

the glucose levels exceed what

Renal excretion

29

DKA:

what happens to fluids in the body

Diuresis

Hypovolemia

30

DKA:

give me quick patho

  • Glucose levels exceed renal tubular excretion
  • Diuresis and hypovolemia ensue
  • Increased ketoacidosis
  • Substantial deficits of water K+ Na+ and Phosphorus

31

HHS:

more common in what type

 

II

32

HHS:

onset is how long or fast

days weeks

33

HHS:

the persistent glycosuric diuresis leads to what?

  • Polyuria
  • polydipsia
  • hypovolemia
  • hypotension
  • tachycardia
  • organ hypoperfusion
  • mental obdunation

34

DKA:

treatment

rehydration with normal saline,

insulin drip

electrolyte supplementation

Important to note that you must correct sodium level as you correct hyperglycemia or devastating cerebral edema may result.

35

HHS:

treatment

  • rehydration with normal saline
  • insulin drip
  • electrolyte supplementation
  •  
  • (electrolyte disturbances won’t be as severe)

36

Nephropathy

occurs more with what type

 

type I

 

37

Nephropathy:

causes what complication to kidneys

Glomerulosclerosis

-a scarring and hardening of the glomeruli, tiny blood vessels that are involved in filtering urine. Along with this, glomerular basement membrane thickening and arteriosclerosis and tubulointerstitial disease.

38

Nephropathy:

Symptoms

  • hypertension
  • albuminuria
  • peripheral edema
  • progressive decrease in GFR.

 

39

Nephropathy:

    When the GFR decreases below __-__ ml/min the body cannot excrete potassium and acids leading to hyperkalemia and metabolic acidosis.
    Hypertension, hyperglycemic episodes, high cholesterol, and microalbuminuria decrease the GFR as well

  15-20ml/min

40

Nephropathy:

treatment

 

tx HTN

ACEi's

41

Nephropathy:

what part of the nephron is affected first and most severly?

distal

42

Neuropathy:

which fibers are affected

 

  • Small- unmyelinated C fibers
  • Large myelinated A fibers

 

43

Neuropathy:

Complications

 

  • recurrent infection
  • foot fractures
  • amputations

 

44

Neuropathy:

treatments

  • tight glucose control
  • NSAIDs
  • Antidepressants
  • Anticonvulsants

45

Neuropathy:

what is a dangerous end product from hyperglycemia

AGE- advanced glycosylation end product!

46

AGE:

what does it do? why is it bad?

  • forms on collogen cause loss f elasticity, predisposes them to sheering and endothelial injury
  • decreasing cell adhesion and allowing leakage
  • Increases rate of athrogenesis

47

Retinopathy:

is a result of what?

 

result of vessel occlusion, dilation, increased permeability, and microaneurysm.

48

Retinopathy:

occurs in what 3 stages?

  1. Stage 1: Nonproliferative retinopathy. Increase in capillary permiability, venous dilation and tortuosity, microaneurysm formation, flame and blot hemmorhages, cotton wool spots and macular edema.
  2. Stage 2: Preproliferative retinopathy. Progression of retinal ischemia, poor perfusion, culminates in infarcts.
  3. Stage 3: Proliferative diabetic retinopathy. Neovascularization and fibrous tissue formation in retina and optic disc, can lead to retinal detachment and/ or hemorrhage. 

Causes visual impairments from minor color changes to total blindness.
 

49

Retinopathy:

S/S

 

  • visual impairment

50

Retinopathy:

treatment

No specific treatment

51

DM and CV:

20-30% of the pt's who present to the Hospital w/ a ___ have DM

MI

52

DM and CV:

the incidence of ____ is higher in DM pt's and may be r/t increased amouts of collagen in teh ventricular wall, whch reduces the mechanical compliance of teh heart during filling, inflammatiom and changes in the Ca++ handleing

 

53

DM and CV:

most DM pt's have what presenting sign w/ an MI

NONE usually a silent MI- may have back pain or indigestion pain

54

Insulin and preop:

insulin pumps should be decreased by ___% the night before sx, then the basal rate the morning of sx

30%

55

Insulin and preop:

what about long acting insulin

  • usual dose at usual time ( continue to monitor BS throughout the day)

56

Insulin and preop:

short acting insulin

  • should be omitted day of sx
  • or 1/2'd

57

Insulin and preop:

70/30 mixed

should be 1/2'd AM of sx

58

 

Insulin and preop:

oral hypoglycemic

  • stopped 24-48 hrs prior to sx

59

Why should you avoid LR w/ DM pt's

  • Large volumes will raise BS 12-24 hrs post op BC liver converts Lactate to Glucose

60

1 ml of D50 will raise a 70kg pt's BS by how much?

  • 2 mg/dl

61

1 unit of regular insulin will lower BS by how much?

25-30 mg

62

be aware of possible allergic reaction (death) in pt's who use ____ and are reversed w/ protamine. you should give a small test dose (1-5mg) over 5-10 min prior to full dose

NPH

63

what is optimal BGL postop

none

ADA states 140-180

insulin for anyone over 180

64

It is important to note that __-___ min after the insulin drip is stopped, the patient will be insulin depleted unless they have endogenous insulin, or long acting insulin was delivered. It is recommended not to stop the insulin infusion until subcutaneous insulin has been delivered and is absorbed and taking effect.

10-15 min

65

 

Thats is awesome job Diana

your greeeaaaaat