DM Flashcards
1
Q
diabetes mellitus
A
disorder of glucose metabolism r/t
- absent/insufficient insulin supply
- poor utilization of insulin that is available
2
Q
primary organ involved in DM
A
pancreas
3
Q
pancreatic beta cells
A
regulate the manufacture, storage, and release of insulin
4
Q
alpha cell
A
produce excess glucagon
5
Q
autoimmune reaction
A
beta cells that produce insulin are destroyed
6
Q
glucose in normal metabolism
A
simple sugar provides energy to body cells
7
Q
glycogen in normal metabolism
A
long chains of glucose that are produced when there is an overproduction of glucose
-stored in the liver and muscles
8
Q
insulin in normal metabolism
A
a storage hormone that is responsible for growth, repair, and storage.
-stores glucose as glycogen
9
Q
counterregulatory hormones
A
- increases BG level
- prevents hypoglycemia
- glucagon
- epinephrine
- GH
- cortisol
10
Q
glucagon
A
- polypeptide hormone
- mobilizes glucose from stores inside the body
- increases glucose concentration in the bloodstream
11
Q
type 1 diabetes
A
- JODM
- IDDM
- minimal or total absence of beta cell function
- idiopathic diabetes
- little or no insulin enters the bloodstream and glucose builds up in the bloodstream
12
Q
type 2 diabetes
A
- NIDDM
- AODM
- non functioning receptors or not enough receptors for insulin
- at least 50% of beta cell mass is functional with adequate insulin secretion preventing diabetic ketoacidosis
- insulin enters the bloodstream. glucose can’t get into the cells of the body and it builds up in the blood vessels
13
Q
DM1 risk factors
A
- children & young adults
- affects 10%
- genetics
- Native Americans, Hispanics, African American
- autoimmune
- seasonal in winter, spring
14
Q
DM2 risk factors
A
- usually 35+
- affects approx 90%
- associate with age and weight
- Native Americans, Hispanic Americans, AA, Asian Americans
- frequently 55+
15
Q
4 major metabolic abnormalties in DM2
A
- insulin resistance
- pancreas’ decreased ability to produce insulin
- inappropriate glucose production from liver
- alteration in production of hormones and adipokines
16
Q
two main adipokines
A
- adiponectin
- leptin
17
Q
prediabetes
A
- individuals at risk for diabetes
- impaired fasting glucose: 100-125
- impaired glucose tolerance: 140-199
- Hgb A1C 5.7% - 6.4%
- usually develop DM2 within 10 years
18
Q
conditions that characterize prediabetes
A
- obesity (apple)
- visceral fat around abd
- unhealthy cholesterol
- HBP
- insulin resistance
19
Q
cardinal symptoms of DM
A
- polyuria
- polyphagia
- polydipsia
- wt loss
- glycosuria
20
Q
glucosuria
A
glucose in the urine
21
Q
renal threshold
A
- concentration level above which all glucose is not reabsorbed in the blood
- the excess above the threshold level concentration remains in the urine
normal: 150-180mg/100mL
22
Q
diagnosing DM
A
- AiC > 6.5%
- fasting plasma glucose level > 126 after an 8hr fast
- 2hr oral glucose tolerance test > 200
- random plasma glucose > 200 in a pt with classic symptoms of hyperglycemia
23
Q
hemoglobin A1C test
A
- ideal goal <7%
- shows the amt of glucose attached to hgb molecules over RBC lifespan
- normal: 4-6
- reduces the risk of diabetic complications
24
Q
fructosamine
A
- reflects blood glucose values over previous 1-2 wks
- used when A1C is not reliable (pregnancy, sickle cell anemia)
25
metabolic syndrome
- insulin resistance
* obesity, esp around waist & abd
* low levels of physical activity
* prothrombotic tendencies
* aging and hormonal imbalance
* genetic predisposition
26
labs for metabolic syndrome
- increased Na, BUN/Cr, triglycerides, LDL, cholesterol
| - decreased K, HDL
27
secondary diabetes
caused by another medical condition or due to the tx of a medical condition
*medical condition, meds, hormone tx
28
macrovascular complications of DM
- caused by dmg to the large and medium sized blood vessles
- CAD
- CVD
- TIA
- PVD
29
microvascular complications of DM
caused by dmg of the small blood vessels
- retinopathy
- nephropathy
- dermopathy (late s/s)
30
acanthosis nigricans
DM2
31
necrobiosis lipoidica
DM1
32
sensory neuropathy
numbness, tingling, pain, and loss of sensation that affects extremities, distally and symmetrically
33
autonomic neuropathy
affects sexual function, digestion, bladder function
34
diabetic ketoacidosis
- diabetic coma
- caused by absolute insulin deficiency and an excess of insulin counterregulatory hormones causing and increased glucose, increased ketone bodies, and metabolic acidosis
35
factors causing DKA
- inadequate insulin dosage
- illness
- infection
- undiagnosed DM1
- poor self mgmt
- neglect
36
late signs of DKA
- Kussmaul's respiration
- fruity acetone breath
- hypotension
- weak pulse
- confusion
- renal failure
- stupor
37
HHS
hyperosmolar hyperglycemia syndrome
- where enough insulin is secreted to prevent DKA, but inadequate to control hyperglycemia, dehydration, hyperosmolarity, with little or no ketosis
- causes extreme dehyrdation
38
factors causing HHS
- hx of inadequate fluid intake
- acute illness
- meds
- concentrated glucose solutions
- other endocrine disorders
39
late signs of HHS
- hypothermia
- muscle weakness
- seizures, stupor, coma
- shock
40
mgmt of DKA & HHS
- initially NS (if hypovolemic), 1/2 NS if not
- regular insulin
- F/E imbalance
- determine/tx precipitating cause
- education to prevent future episodes
41
gestational DM
- develops during pregnancy
- detected 24-28 wks
- normal BG 6 wks postpartum
- increased irks for developing DM2 in 5-10 yrs
42
risk factors for gestational DM
- obesity
- 25+ yrs
- family hx of DM
- personal hx of GDM
- OB history of LGA baby, unexplained fetal or perinatal loss, or unexplained birth defects
- member of high risk ethnic group
- history of abnormal GTT
43
maternal concerns in diabetes
- hydramnios
- PIH
- ketoacidosis
- dystocia
- anemia
- UTI
44
fetal concerns in diabetes
- increased still births/neonatal births
- congenital defects
- macrosomia LGA
- IURG or SGA
45
insulin in pregnancy
- 1st: decrease insulin
- 2nd: increase insulin
- 3rd: increase insulin energy needs during labor
- decrease insulin need after labor, increase energy needs during labor
46
Meds causing secondary diabetes
- corticosteroid
- Dilantin
- thiazides
- epinephrine
- atypical antipsychotic
47
Medical conditions causing secondary diabetes
- pancreatitis
- pancreatic CA
- Cushing's syndrome
- hyperthyroidism
- cystic fibrosis
- use of TPN
