Exam 3 - diabetes mellitus Flashcards Preview

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Flashcards in Exam 3 - diabetes mellitus Deck (86)
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1
Q

DM is a dysfunction of:

A

the endocrine pancreas

2
Q

What does type 1 DM affect the metabolism of?

A

fat, protein, and carbohydrates

3
Q

DM is not one disease, but a what? with what in common?

A

group of diseases WITH glucose intolerance in common

4
Q

DM is characterized by:

A

hyperglycemia

5
Q

DM can be the result of defects in what?

A
  1. insulin secretion
  2. insulin action
  3. or both
6
Q

What type of DM is most common in children?

A

Type 1 diabetes

7
Q

Define type 1 diabetes mellitus:

A

insulin-dependent diabetes mellitus

8
Q

What type of DM is most common in adult? or has an onset during adulthood?

A

type 2 diabetes

9
Q

define type 2 diabetes mellitus:

A

non-insulin-dependent diabetes mellitus

10
Q

What is type 2 diabetes associated with?

A

obesity and insulin resistance

11
Q

What are four ways to diagnose diabetes mellitus?

A
  1. glycosylated hemoglobin HgA1C levels
  2. more than 1 fasting plasma glucose greater than 140 mg/dl
  3. 2 hour plasma glucose during oral glucose tolerance testing (OGTT)
  4. random glucose levels about 200 mg/dl with symptoms
12
Q

What kind of method is HgA1C?

A

method to follow plasma glucose over time

13
Q

What do glucose molecules do with hemoglobin?

A

glucose molecules join to hemoglobin in 120 day life span of RBCs

14
Q

What is typical of those with poorly controlled diabetes and HgA1C?

A

those with poorly controlled diabetes have increased levels of glycosylated hemoglobin

15
Q

What values will be elevated with DM?

A

HgA1C, FPG, or OCTT

16
Q

what are two other risk factors for DM?

A
  1. impaired glucose tolerance (IGT)

2. impaired fasting glucose (IFG)

17
Q

what does impaired glucose tolerance come from?

A

diminished insulin secretion

18
Q

what does impaired fasting glucose come from?

A

from enhanced hepatic glucose output

19
Q

What happens with the pancreas and beta cells in type 1 DM?

A
  1. pancreatic atrophy

2. loss of beta cells

20
Q

Type 1 diabetes mellitus characterizes what percent of diabetes in western world?

A

10%

21
Q

What is Type 1 diabetes the result of?

A

genetic susceptibility and environmental factors

22
Q

What is there a strong genetic associated of with type 1 DM?

A

with HLA class II antigens DR and DQ

23
Q

What are two genetic susceptibility factors that increase risk of type 1?

A
  1. first-degree relative with type 1

2. strongest association with MHC

24
Q

What are two environmental factors that increase risk of type 1?

A
  1. viral infection: H. pylori infection

2. exposure to cow’s milk proteins, relative lack of vitamin D

25
Q

Define type 1A:

A

cell-mediated destruction of the B cells

26
Q

What kind of antigen is associated with type 1A:

A

leukocyte antigen HLA-Dr4

27
Q

Define type 1B:

A

uncommon primary autoimmune condition associated with other autoimmune problems (Hashimoto disease, graves disease, myasthenia gravis)

28
Q

What kind of antigen is associated with type 1B:

A

associated with HLA-DR3 in those between 30 to 50 years of age

29
Q

In type 1 DM, what accumulates in blood? and spills into what?

A

glucose accumulates in blood and spills into urine as renal threshold exceeded

30
Q

What occurs in type 1 DM from insulin lack?

A

protein and fat breakdown

31
Q

Are type 1 DM manifestations acute or chronic:

A

acute

32
Q

What are the 3 P’s associated with type 1 DM?

A
  1. polydipsia
  2. polyuria
  3. polyphagia
33
Q

True or false: there is weight gain associated with type 1 DM:

A

false; weight loss

34
Q

Wide fluctuations of what occur with type 1 DM:

A

wide blood sugar

35
Q

What kind of condition is associated with type 1 DM:

A

ketoacidosis

36
Q

define ketoacidosis

A

increased levels of ketones occur without insulin

37
Q

Ketones cause a drop in what?

A

pH (metabolic acidosis)

38
Q

What occurs from blowing off acetone with ketoacidosis?

A

fruity breath

39
Q

There is little to no what in type 1 DM:

A

little or no insulin secretion

40
Q

What is the initial symptom of type 1 DM?

A

diabetic coma

41
Q

What combination can be used to treat type 1 DM:

A

insulin, meal planning, exercise, self monitoring of blood glucose

42
Q

What is a transplant associated with type 1 DM:

A
  1. islet cells

2. whole pancreas

43
Q

Type 2 diabetes mellitus characterizes what percent of diabetes in western world?

A

90%

44
Q

What are 5 risk factors of type 2 diabetes mellitus?

A
  1. obesity
  2. hypertension
  3. physical inactivity
  4. family history
  5. metabolic syndrome
45
Q

type 2 diabetes mellitus affect both:

A
  1. adults

2. children

46
Q

What 3 interactions cause type 2 diabetes mellitus?

A
  1. genetic
  2. epigenetic
  3. environmental
47
Q

What 2 factors account for 60-80% of type 2 cases?

A
  1. obesity

2. insulin resistance

48
Q

What occurs with abnormal glucagon secretion in type II cases?

A

decreased B-cell responsiveness to plasma glucose

49
Q

What may be due to decreased B-cell mass or abnormal function in type II diabetes?

A

islet dysfunction

50
Q

What are 2 major mechanisms of type II diabetes?

A
  1. insulin resistance

2. decreased insulin secretion by beta cells

51
Q

Type 2 diabetes has a strong what?

A

inheritance pattern

52
Q

Relatives of type 2 diabetes have a much higher risk of what?

A

developing it as well

53
Q

True or false: there is only 1 gene that is found responsible for type 11 diabetes:

A

false; many different genes associated, but no single gene found responsible

54
Q

What are 4 clinical manifestations of type 2 diabetes?

A
  1. fatigue
  2. pruritus
  3. recurrent infections
  4. visual changes or symptoms of neuropathy
55
Q

What are 5 treatment options?

A
  1. exercise
  2. diet
  3. treatment of obesity
  4. oral hypoglycemia
  5. bariatric surgery
56
Q

What are 5 complications of DM?

A
  1. hypoglycemia
  2. diabetic ketoacidosis
  3. hyperosmolar nonacidotic diabetic coma
  4. somogyi effect
  5. dawn phenomenon
57
Q

What is also called insulin shock or insulin reaction:

A

hypoglycemia

58
Q

What is a typical glucose level in newborns with hypoglycemia?

A

less than 47 mg/dL

59
Q

what is a typical glucose level in children and adults with hypoglycemia?

A

less than 70 mg/dL

60
Q

Which type of diabetes is hypoglycemia more commonly associated with?

A

type 1 diabetes

61
Q

What are 5 clinical manifestations of hypoglycemia?

A
  1. tachycardia
  2. palpitations
  3. diaphoresis
  4. tremors
  5. pallor and arousal anxiety
62
Q

What are 2 treatment options for hypoglycemia?

A
  1. oral or IV glucose

2. glucagon: prescribed for emergency use

63
Q

A neurogenic reaction occurs from what?

A

from low glucose sensed by hypothalamus (increased hr, palpitations, diaphoresis, tremors, pallor and anxiety)

64
Q

What is another type of symptom associated with hypoglycemia and cells?

A

cell malnutrition (headache, dizziness, irritability and fatigue, poor judgment, confusion, visual changes, hunger, seizures and coma, symptoms masked b-blocking drugs)

65
Q

What is a serious complication of DM?

A

diabetic ketoacidosis - responsible for many hospital admissions and death

66
Q

Diabetic ketoacidosis occurs when there is… (2 things)

A
  1. relative/absolute insulin deficiency

2. increase i insulin counter regulatory hormones (catecholamines, cortisol, glucagon, and GH)

67
Q

What 2 things increase with ketoacidosis?

A
  1. hepatic glucose production

2. fat mobilization

68
Q

What 1 thing decreases with ketoacidosis?

A

peripheral glucose usage

69
Q

What 4 things precipitate DKA?

A
  1. infection, trauma
  2. surgery, MI
  3. interruption of insulin
  4. emotional stress
70
Q

symptoms of DKA:

A
  1. polyuria
  2. dehydration
  3. kussmaul respirations
  4. acetone breath odor
71
Q

treatment of DKA:

A

administer insulin to decrease glucose levels, fluids, replacements of electrolytes

72
Q

What is normal in hyperosmolar non-acidotic diabetic coma? What is abnormal?

A

ketones; glucose over 600 mg/dl

73
Q

Due to high BS, glycouria and polyuria cause what in hyperosmolar non-acidotic diabetic coma?

A
  1. severe volume depletion

2. intracellular dehydration

74
Q

blood glucose is high during what time of the day with the somogyi effect?

A

high in the morning

75
Q

somogyi effect is common in what 2 things?

A
  1. type 1 DM

2. kids

76
Q

Hypoglycemia at night with the somogyi effect stimulates what?

A

glucose counteregulation (epinephrine, GH, cortisol, and glucagon release)

77
Q

Glucose is increased by what 2 things with the somogyi effect?

A
  1. gluconeogenesis

2. glycogenolysis

78
Q

What 2 things are mobilized with the somogyi effect? what is inhibited

A

fatty acids and proteins; peripheral glucose use is inhibited

79
Q

define the dawn phenomenon:

A

early morning rise in glucose, no hypoglycemia at night

80
Q

What decreases during the night with the dawn phenomenon?

A
  1. glucose metabolism by muscle and fat
81
Q

What are 4 chronic complications of DM?

A
  1. diabetic neuropathies
  2. microvascular disease
  3. large blood vessel disease
  4. infections
82
Q

Can some neuropathies be reversed?

A

yes; food and wrist drop

83
Q

What are microvascular problems due to?

A

basement membrane thickening

84
Q

What is diabetes the most common cause of?

A

end stage renal disease

85
Q

What is the most common cause of death in those with type 11 DM?

A

CAD

86
Q

What are infections due to in DM?

A
  1. sensory impairment (resulting in injury)
  2. hypoxia
  3. increased pathogen growth in presence of high glucose
  4. reduced blood supply