Diabetes (week 5)

Question 1

where does the insulin diabetics inject come from

Answer 1

recombinant DNA technology

Question 2

what is used for insulin administration in compliant patients

Answer 2

insulin infusion pump

Question 3

what do insulin infusion pumps do

Answer 3

programmed to release insulin at certain times of the day

Question 4

what percent of total calories should be carbohydrates in diabetics

Answer 4

55-60%

Question 5

what percent of total calories should be fat in diabetics

Answer 5

less than 30%

Question 6

what percent of total calories should be protein in diabetics

Answer 6

15-20%

Question 7

what must diabetics do when they exercise

Answer 7

must adjust food intake and insulin doses; can become hypoglycemic

Question 8

what is the main difference between Type I and Type II Diabetes

Answer 8

Type 1= autoimmune; no beta cells; lack of insulin

Type 2= not autoimmune; still have functioning beta cells

Question 9

speculation about cause of insulin resistance in Type II DM

Answer 9

compounds released from adipose cells will decrease peripheral insulin sensitivity

Question 10

NIDDM stands for

Answer 10

Non Insulin Dependent Diabetes Mellitus

Question 11

what is the biggest risk factor for Type II DM

Answer 11

obesity

Question 12

age of Type II DM

Answer 12

over 40

Question 13

clinical manifestations of Type II DM

Answer 13

abnormal glucose tolerance
overweight
hyperlipidemic (high LDL)

Question 14

Tx for Type II DM

Answer 14

EXERCISE
restrict caloric intake
weight loss
dietary counseling

Question 15

what is gestational diabetes

Answer 15

presence of glucose intolerance during pregnancy; typically during 3rd trimester
blood glucose returns to normal after parturition
Mimics Type II DM

Question 16

possible causes of gestational diabetes

Answer 16

chorionic somatomaammopropin (produced by placenta)
estrogen
cortisol
weight gain during pregnancy

Question 17

risk factors for gestational diabetes

Answer 17

family history of diabetes
obesity
high maternal age
parity greater than 5
previous complicated pregnancy
glycosuria (presence of glucose in urine)

Question 18

tx for gestational diabetes

Answer 18

dietary counseling
exercise
monitor blood glucose and urine ketones
glyburide

Question 19

glyburide

Answer 19

promotes release of insulin

does not cross placenta

Question 20

teratogenicity

Answer 20

likelihood of a drug to create defects in developing fetus

Question 21

chronic complications of Diabetes

Answer 21

higher incidence of peripheral vascular disease
cardiac disease
renal disease retinopathy
neuropathy

Question 22

AGE stands for

Answer 22

advanced glycosylation end-products

Question 23

normal AGE process

Answer 23

glucose will attach reversibly to proteins, lipids, and nucleic acids without benefit of enzymes;
bad when bound irreversibly????

Question 24

problem with AGE

Answer 24

• can attach to basement membranes of blood vessels and verves, thickening them and decreasing permeability
• promotes production of free radicals
• inactivates nitric oxide which is a vasodilator, which leads to vasoconstriction and ischemia
• causes damage to nerves

Question 25

polyol pathway

Answer 25

pathway for glucose metabolism used by tissues that do not need insulin for glucose transport

Question 26

tissues that utilize polyol pathway

Answer 26

``` kidnes endothelium of blood vessels retinal tissue eye lens nerves ```

Question 27

what happens in the polyol pathway when a person is hyperglycemic

Answer 27

excess glucose shunted to polyol pathway

Question 28

why is it bad that there is excess glucose shunted to polyol pathway

Answer 28

excessive byproducts (sorbitol, fructose) are produced, causing osmotic injury (lysis)

Question 29

how does AGE contribute to diabetic neuropathy

Answer 29

causes hypoxia

Question 30

how does polyol pathway contribute to diabetic neuropathy/retinopathy

Answer 30

sorbitol damages Schwann cells, interferes with ion pumps, and distrupts nerve conduction

Question 31

how does AGE contribute to microvascular disease

Answer 31

-thickening of basement membrane interfering with diffusion which interferes with supply of oxygen and nutrients to tissue -damages endothelial cells, increasing plaque formation

Question 32

which type of diabetes is more common to die of renal failure

Answer 32

type I

Question 33

how does AGE lead to nephropathy

Answer 33

alters basement membrane of glomerulus, leading to glomerularsclerosis (thickening of glomerulus) - will decrease filtration - glucose toxicity

Question 34

how does polyol pathway lead to nephropathy

Answer 34

damages tubular cells

Question 35

how is the development of nephropathy slowed

Answer 35

ACE (angiotensin converting enzyme) inhibitors | control blood glucose

Question 36

macrovascular disease

Answer 36

includes: coronary artery disease (CAD) CVA peripheral vascular disease (PVD)

Question 37

which type of diabetes is more common to have macrovascular disease

Answer 37

type II

Question 38

what is the most common cause of death in NIDDM, especially in women

Answer 38

Coronary artery disease

Question 39

what does your risk of stroke increase by if you have diabetes

Answer 39

2x (due to increased BP)

Question 40

what does peripheral vascular disease typically lead to?

Answer 40

amputation

Question 41

why do diabetics have increased risk of infection

Answer 41

- impaired sensation - hypoxia (due to decreased BF and decreased release of O2 to tissue) - pathogens proliferate because of increased glucose - blood supply is decreased - WBCs have decreased chemotaxis