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System Screenings I > Endocrine Pancreas > Flashcards

Flashcards in Endocrine Pancreas Deck (66):
1

What are the hormones secreted by the endocrine portion of the pancreas?

1. Insulin
2. Glucagon
3. Somatostatin

2

Where is the endocrine pancreas located? what are the cell types?

Tail of the pancreas; islets of langerhans

3

Insulin is related by _____ cells results in:
[increase/decrease] in blood glucose
[increase/decrease] in glycogen synthesis
[increase/decrease] in gluconeogenesis
[increase/decrease] in trygliceride and protein synthesis

Beta; decrease; increase; decrease; increase

4

Glucagon is related by _____ cells. Its release is inhibited by ______.

alpha; serum glucose/insulin

5

What does glucagon increase?

1. serum glucose levels
2. Glycogenolysis
3. Gluconeogenesis
4. Lipolysis
5. Output of ketones by liver

6

What are factors (hormones) that influence diabetes?

1. Insulin
2. Glucagon
3. Catecholamines (epi and NE)
4. Growth hormone
5. Glucocorticoids

7

Disorder of carbohydrate, fat, and protein metabolism

Diabetes mellitus

8

Absolute insulin deficiency

Type I diabetes

9

Inadequate or defective insulin receptor or response to insulin

Type II diabetes

10

What happens with uncontrolled diabetes?

A person is unable to transport glucose into fat and muscle cells (body is start and begins to metabolize fats and proteins for energy)

11

Autoimmune destruction of beta cells; can be the result of a genetic disposition or due to viral infection of coxsackie B or measles; prone to ketoacidosis

Type I diabetes

12

About __% of diabetes cases are type I while __% are type II

10; 90

13

Body cells are resistant to insulin; pts are hyperglycemic and most are obese (80%); condition may improve with weight loss and exercise

Type II diabetes

14

Gestational diabetes occurs in ___% of pregnancies.

2-5

15

What are the risk factors for gestational diabetes?

1. Family history
2. Glycosuria
3. Hx of stillborn or spontaneous abortion
4. Obesity
5. 5 or more pregnancies

16

What are women at a higher risk for if they develop gestational diabetes?

1. Complications during pregnancy
2. Mortality
3. Fetal Abnormalities

17

What are the normal resting glucose levels? Glucose intolerance? diabetes? gestational diabetes?

<100
100-125
>125
=>105

18

What are the signs and symptoms of diabetes?

1. Poly uria
2. Polydipsia
3. Polyphagia (usually not in type II)

19

Why does polyuria occur?

High glucose levels = high glucose in urine; osmotic pressure moves water into urine

20

What are other signs and symptoms of hyperglycemia?

1. Recurrent blurred vision
2. fatigue
3. Paresthesias (tingling in skin)
4. Skin infections

21

What are the acute complications of diabetes when glucose levels are too hight?

1. Diabetic ketoacidosis
2. Hyperglycemia, hyperosmolar syndrome

22

What occurs due to metabolism of fats and is often preceded by emotional or physical distress?

diabetic ketoacidosis (distress causes person to inadequately use insulin)

23

What are signs and symptoms of diabetic ketoacidosis?

1. 1-2 days polyuria, polydipsia, nausea and vomiting, marked fatigue
2. Eventual stupor, may lead to coma
3. May have abdominal pain and tenderness
4. Fruity smell to breath (ketones)
5. Hypotension and tachycardia, secondary to decrease in blood volume

24

Diabetic is more common in type [I/ II] while hyperosmolar syndrome is more common in type [I/ II]

I; II

25

Result of increase in serum osmolarity, but no increase in ketones

Hyperosmolar syndrome (hyperglycemia)

26

What are the S and S of hyperglycemia?

1. Dehydration
2. Polyuria and thirst, leading to decreased urine output
3. Neurological signs

27

What are the neurologic signs of hyperglycemia?

1. Grand mal seizures
2. Hemiparesis
3. Babinski sign
4. Aphasia
5. Hyperthermia
6. Hemianopsia

28

What can occur when there is relative excess of insulin?

hypoglycemia

29

What are the S and S of hypoglycemia?

1. Altered cerebral function (low glucose)
2. Activation of autonomic nervous system
(People will have different reactions to hypoglycemia, but one individual will tend to react in a specific way)

30

What are the chronic complications of diabetes?

1. Macro- and micro-vascular changes
2. Diabetic retinopathy
3. Diabetic neuropathy (most common)
4. Carpal tunnel syndrome
5. Charcot joint
6. Periarthritis
7. Hand stiffness
8. Limited joint mobility
9. Dupuytren's contractors
10. Flexor tenosynovitis
11. infection

31

What can macrovascular changes result in?

Tissue ischemia:
1. Cerebrovascular disease
2. Coronary artery disease
3. Renal artery stenosis
4. Peripheral vascular disease

32

Thickening of capillaries

Microvascular changes

33

What do microvascular changes lead to?

Diabetic neuropathy (leading cause of end-stage renal disease ~36%)

34

20 years after onset of diabetes, the incidence of blindness in type 1 is ____% and ____% in type 2 due to diabetic retinopathy.

100; 60

35

What is the most common type of of diabetic neuropathy?

Polyneuropathy (damage in peripheral nerves in the distal extremities; longer nerves)

36

What NS's does diabetic neuropathy affect?

PNS and/ or autonomic NS; may affect CNS (so everything)

37

What are the symptoms of sensory neuropathy?

1. Mild tingling
2. Burning
3. Numbness
4. Complete loss of sensation

38

What are the complications of sensory neuropathy?

May lead to painless trauma and ulcerations:
1. Drying and cracking of skin
2. Ulcers can become infected and can lead to gangrene
3. More than ½ of nontraumatic amputations of LE due to DM (about 54K amputations/year)

39

Muscle atrophy due to diabetes; bilateral, asymmetrical proximal muscle weakness

Diabetic amyotrophy (result of motor neuropathy)

40

Results in the loss of normal regulation of sweating, temperature control, and blood flow in limbs.

Autonomic neuropathy

41

___________ is 5x more common in people with diabetes; usually type 1, typically bilateral

Periarthritis of shoulder (may regress spontaneously, remain stable, or progress to adhesive capsulitis)

42

inflammation of hand and finger joints

Cheriarthritis

43

Limited joint mobility in the hand is frequently bilateral and involves the entire hand. Its incidence is is __% in type 1 and __% in type 2.

55; 75

44

Thickening of palmar facia that is characterized by flexion contracture of fingers (in diabetic 3rd and 4th digits, in non diabetic 4th and 5th), and pain in palm and digits

Dupuytren's contractures

45

Accumulation of fibrous tissue in synovial sheath; aching modularity and contractors; 1st, 3rd and 4th digits; more often in women

Flexor tenosynovitis

46

Why is infection a common complication of diabetes?

1. Impaired wound healing due to vascular changes (hypoxia and decrease in WBC mobilization)
2. high glucose levels in tissues help support bacteria and fungi
3. More likely to have openings for pathogens

47

What receptor type does insulin bind to? glucagon?

Tyrosine kinase (also binds growth factors); G-protein mediated receptors

48

What is type I diabetes usually treated with?

Insulin injections

49

What is type II diabetes usually treated with?

Oral hypoglycemic drugs; may get supplemental insulin

50

What are the types of insulin?

1. Bovine
2. Porcine
3. Human recombinant
4. Modified human recombinant

51

How is insulin administered?

1. Subcutaneous (usually, rotate injection sites)
2. IV for emergencies
3. Insulin pump
4. Inhalation/ nasal spray (experimental)
5. Skin patch
6. Oral or buccal routes

52

What are ADRs of insulin?

1. hypoglycemia (due to too much, missing a meal, strenuous physical activity)
2. immunological adverse effects (usually reaction to animal insulin, need to switch to different insulin)

53

What are types of oral hypoglycemic drugs used to treat type 2 diabetes?

1. Sunfonylureas
2. Metformin (glucophage)
3. Alpha-glucosaidase inhibitors
4. Thiazolidones
5. Benzoic acid derivatives

54

Hypoglycemic drugs that stimulate the release of insulin

1. Sufonylureas
2. Benzoic acid derivatives (repaglinide)

55

Hypoglycemic drugs that act on the liver to decrease glucose synthesis

1. Metformin (glucophage, biguanide)
2. ThiaZlidONEs (troglitaZONE, rosiglitaZONE)

56

Hypoglycemic drugs that block the breakdown of glucose in GI tract

Alpha-gucosaidase inhibitors

57

What drug is used to treat hypoglycemia?

Glucagon

58

What drugs are used in type 1 diabetes to limit beta-cell destruction?

Immunosuppressants (cyclosporine, glucocorticoids, methotrexate)

59

What drugs is used to prevent the conversion of glucose to sorbital (in the GI); slows the progression of neuropathy

Aldose reductace inhibitors (torESTAT, zenarESTAT, epalrESTAT)

60

What are non-pharmacological interventions used to treat diabetes?

1. Dietary management
2. Exercise
3. Beta-cell replacement

61

What is the most important factor in controlling diabetes?

Dietary management

62

Increases insulin sensitivity

Exercise

63

What are exercise outcomes for type 1 diabetes?

1. Increase strength
2. Does not improve glycemic control
3. Hypoglycemia can occur
5. Need to restore glycogen stores
6. Need to adjust insulin and caloric intake

64

When are type 1 diabetics at greatest risk of severe hypoglycemia?

6-14 hours after strenuous exercise

65

What are some things you need to educate patients on for exercise with diabetes?

1. Regular schedule is best
2. Do not inject insulin into regions which will be used (increased absorption rate)
3. Eat 1-2 hours before exercise
4. Eat every 30 min during exercise
5. Monitor glucose levels before, during extended exercise, and after exercise
6. Increase caloric intake after exercise
7. Monitor fluid intake
8. Exercise times should avoid peak insulin times and times of fasting
9. If glucose is near 300 mg/dL or more, NO EXERCISE
10. Walking: proper footwear when person does not have signs of peripheral neuropathy
11. Avoid contact sports or intermittent, high intensity sports (trauma to feet or eyes)

66

What is beta-cell replacement?

Tissue transplants and gene therapy for type 1 diabetes