Flashcards in Endocrine Pancreas Deck (66):
What are the hormones secreted by the endocrine portion of the pancreas?
Where is the endocrine pancreas located? what are the cell types?
Tail of the pancreas; islets of langerhans
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
Glucagon is related by _____ cells. Its release is inhibited by ______.
alpha; serum glucose/insulin
What does glucagon increase?
1. serum glucose levels
5. Output of ketones by liver
What are factors (hormones) that influence diabetes?
3. Catecholamines (epi and NE)
4. Growth hormone
Disorder of carbohydrate, fat, and protein metabolism
Absolute insulin deficiency
Type I diabetes
Inadequate or defective insulin receptor or response to insulin
Type II diabetes
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)
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
About __% of diabetes cases are type I while __% are type II
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
Gestational diabetes occurs in ___% of pregnancies.
What are the risk factors for gestational diabetes?
1. Family history
3. Hx of stillborn or spontaneous abortion
5. 5 or more pregnancies
What are women at a higher risk for if they develop gestational diabetes?
1. Complications during pregnancy
3. Fetal Abnormalities
What are the normal resting glucose levels? Glucose intolerance? diabetes? gestational diabetes?
What are the signs and symptoms of diabetes?
1. Poly uria
3. Polyphagia (usually not in type II)
Why does polyuria occur?
High glucose levels = high glucose in urine; osmotic pressure moves water into urine
What are other signs and symptoms of hyperglycemia?
1. Recurrent blurred vision
3. Paresthesias (tingling in skin)
4. Skin infections
What are the acute complications of diabetes when glucose levels are too hight?
1. Diabetic ketoacidosis
2. Hyperglycemia, hyperosmolar syndrome
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)
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
Diabetic is more common in type [I/ II] while hyperosmolar syndrome is more common in type [I/ II]
Result of increase in serum osmolarity, but no increase in ketones
Hyperosmolar syndrome (hyperglycemia)
What are the S and S of hyperglycemia?
2. Polyuria and thirst, leading to decreased urine output
3. Neurological signs
What are the neurologic signs of hyperglycemia?
1. Grand mal seizures
3. Babinski sign
What can occur when there is relative excess of insulin?
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)
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
7. Hand stiffness
8. Limited joint mobility
9. Dupuytren's contractors
10. Flexor tenosynovitis
What can macrovascular changes result in?
1. Cerebrovascular disease
2. Coronary artery disease
3. Renal artery stenosis
4. Peripheral vascular disease
Thickening of capillaries
What do microvascular changes lead to?
Diabetic neuropathy (leading cause of end-stage renal disease ~36%)
20 years after onset of diabetes, the incidence of blindness in type 1 is ____% and ____% in type 2 due to diabetic retinopathy.
What is the most common type of of diabetic neuropathy?
Polyneuropathy (damage in peripheral nerves in the distal extremities; longer nerves)
What NS's does diabetic neuropathy affect?
PNS and/ or autonomic NS; may affect CNS (so everything)
What are the symptoms of sensory neuropathy?
1. Mild tingling
4. Complete loss of sensation
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)
Muscle atrophy due to diabetes; bilateral, asymmetrical proximal muscle weakness
Diabetic amyotrophy (result of motor neuropathy)
Results in the loss of normal regulation of sweating, temperature control, and blood flow in limbs.
___________ 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)
inflammation of hand and finger joints
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.
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
Accumulation of fibrous tissue in synovial sheath; aching modularity and contractors; 1st, 3rd and 4th digits; more often in women
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
What receptor type does insulin bind to? glucagon?
Tyrosine kinase (also binds growth factors); G-protein mediated receptors
What is type I diabetes usually treated with?
What is type II diabetes usually treated with?
Oral hypoglycemic drugs; may get supplemental insulin
What are the types of insulin?
3. Human recombinant
4. Modified human recombinant
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
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)
What are types of oral hypoglycemic drugs used to treat type 2 diabetes?
2. Metformin (glucophage)
3. Alpha-glucosaidase inhibitors
5. Benzoic acid derivatives
Hypoglycemic drugs that stimulate the release of insulin
2. Benzoic acid derivatives (repaglinide)
Hypoglycemic drugs that act on the liver to decrease glucose synthesis
1. Metformin (glucophage, biguanide)
2. ThiaZlidONEs (troglitaZONE, rosiglitaZONE)
Hypoglycemic drugs that block the breakdown of glucose in GI tract
What drug is used to treat hypoglycemia?
What drugs are used in type 1 diabetes to limit beta-cell destruction?
Immunosuppressants (cyclosporine, glucocorticoids, methotrexate)
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)
What are non-pharmacological interventions used to treat diabetes?
1. Dietary management
3. Beta-cell replacement
What is the most important factor in controlling diabetes?
Increases insulin sensitivity
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
When are type 1 diabetics at greatest risk of severe hypoglycemia?
6-14 hours after strenuous exercise
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)