module 15-17

Question 1

what is diabetes?

Answer 1

a chronic disease - elevated blood glucose

Question 2

what happens to the urine in untreated diabetes?

Answer 2

the transporters in the proximal tubule that normally reabsorb all the glucose, are saturated which results in significant amts of glucose in the urine

Question 3

why do people have high blood sugar (diabetes)?

Answer 3

Either because not enough insulin produced or because the body’s cells do not respond to the insulin that is produced

Question 4

what are the classic symptoms of diabetes?

Answer 4

polydipsia (increased thirst), polyuria (increased urination), polyphagia (increased hunger) & weight loss

Question 5

what is insulin?

Answer 5

• peptide hormone synth by beta cells of the islets of langerhans in the pancreas
• rapidly released into blood in response to increases in blood glucose
• it causes uptake of glucose into cells (muscle, liver, & fat)

Question 6

what happens to glucose once taken up by liver cells?

Answer 6

glycogen synthesis

Question 7

what happens to glucose once taken up by muscle cells?

Answer 7

used as energy & promotes protein synth

Question 8

what happens to glucose once taken up by fat cells?

Answer 8

increased synth of fatty acids, results in increased triglyceride synth

Question 9

what other molecule is important to the action of insulin in driving glucose uptake by cell?

Answer 9

extracellular potassium

Question 10

what are the types of diabetes?

Answer 10

Type I
Type II
Gestational

Question 11

what percentage of people with diabetes have Type I?

Answer 11

10%

Question 12

what are some of the features of type I diabetes?

Answer 12

• usually diagnosed in children or adolescents
• autoimmune reaction - beta cells destroyed
• body makes too little or no insulin & requires insulin replacement
• not preventable

Question 13

what percentage of people with diabetes have Type II?

Answer 13

90%

Question 14

what are some of the features of type II diabetes?

Answer 14

• pancreas makes sufficient insulin, however, the insulin produced is resistant to use
• over the course of the disease insulin synth may be reduced
• typically diagnosed later in life but trend toward younger people getting it

Question 15

what are the risk factors for type II?

Answer 15

age, genetics, previous gestational, lack of exercise, obesity, ethnicity (African/Native increased risk)

Question 16

what are some of the features of gestational diabetes?

Answer 16

• usually begins halfway through pregnancy
• diet and exercise sufficient to keep blood glucose levels within normal ranges
• tend to have larger babies & babies with hypoglycemia within first few days of life
• the mother can develop diabetes 5-10 years later

Question 17

what is diabetic retinopathy?

Answer 17

• a complication of diabetes
• most common cause of blindness in people under the age of 65
• hyperglycemia causes damage to retinal capillaries
• type I & type II should have eye exam 1x/year

Question 18

what is diabetic nephropathy?

Answer 18

• characterized by proteinuria (protein in the urine) [earliest sign of diabetic nephropathy], decreased glomerular filtration, increased BP
• ACE inhibitors & ARBs are useful in prevention - pt.s with type I should take one of these regardless of BP

Question 19

Diabetic nephropathy is the leading cause of…

Answer 19

morbidity & mortality in pts. with type I diabetes

Question 20

what is the connection between cardiovascular disease (CVD) and diabetes?

Answer 20

• leading causes of morbidity & mortality in type II diabetics
• atherosclerosis develops much earlier in those with diabetes compared to those without
• results from combo if hyperglycemia & altered lipid metabolism
• statins reduce cardiovascular events in diabetic pt.s regardless of LDL cholesterol levels

Question 21

what’s the deal with diabetic foot ulcers?

Answer 21

• most common cause of hospitalization for diabetic patients
• diabetes accounts for approx. half of all lower limb amputations every year due to infection
• all diabetic should have regular foot exams

Question 22

what are the tests used to diagnose diabetes?

Answer 22

1. Fasting plasma glucose test
2. Casual Plasma glucose test
3. oral glucose tolerance test (OGTT)

Question 23

what are the details of the fasting plasma glucose test?

Answer 23

• pt.s fast for 8 hrs then have blood sample drawn to measure blood glucose
• Preferred test for diagnosing

Question 24

what are the details of the casual plasma glucose test?

Answer 24

• blood drawn at any time

* if initial test suggests diabetes, f/u with fasting plasma glucose test

Question 25

what are the details of the oral glucose tolerance test?

Answer 25

- used when other testes unable to definitively diagnose diabetes - pts. given 75 g dose of glucose & plasma glucose is measured 2 hrs later

Question 26

what's the deal with glycosylated hemoglobin?

Answer 26

upon prolonged exposure in the blood, glucose interacts with hemoglobin to form glycosylated derivatives, mostly HbA1c - measuring this is a poor diagnostic tool but is useful for providing index of avg. glucose levels over the previous 2-3 mths - also measuring it is a good determinant of how pt. responding to therapy - target: maintain HbA1c less than 7% of total hemoglobin

Question 27

what is the primary goal of diabetes therapy?

Answer 27

maintain tight control of plasma glucose levels (normal range)

Question 28

due to risk of cardiovascular disease what should be monitored in diabetics?

Answer 28

BP LDL triglycerides HDL

Question 29

what is the target to keep in mind for kidney function in those with diabetes?

Answer 29

urine albumin to creatinine ratio

Question 30

what does it mean that insulin can be thought of as anabolic?

Answer 30

-"building up" or conservative -promotes energy storage & conservation -insulin's anabolic actions include: uptake of glucose liver, muscle, fat results in formation of glycogen & triglycerides decreased gluconeogenesis cellular uptake of amino acids (mostly muscle) resulting in protein synth

Question 31

what happens re: metabolic processes when there is an insulin deficiency?

Answer 31

puts body in catabolic state (breaking down) body favours breaking down complex molecules into simpler substances catabolic effects include: glycogenolysis - conversion of glycogen to glucose gluconeogenesis - new glucose synth decreased glucose utilization *all these contrib to signs and symptoms of diabetes & they all act to raise blood glucose

Question 32

what are the types of insulin?

Answer 32

short duration-rapid acting short duration-slower acting intermediate duration long duration

Question 33

talk about mixing insulins

Answer 33

sometimes combo of short acting with longer acting mix in single syringe Rules: only NPH can be mixed with short acting insulins draw short acting first mixtures are stable for 28 days

Question 34

what are complications of insulin therapy?

Answer 34

primary complication is hypoglycemia (

Question 35

how do you manage hypoglycemia?

Answer 35

requires rapid tx to prevent irreversible brain damage conscious - oral sugar (glucose tablets, orange juice, corn syrup, honey and pop) unconscious - IV glucose *it's also recommended that diabetic patients keep hormone glucagon on hand

Question 36

how is glucagon used to treat hypoglycemia?

Answer 36

usually in the community when a patient it unconsious - injected * IV glucose is preferred for unconscious pt.s but impractical in the community * also not effective in starving or malnourished pts. as they will have little to no stores of glycogen

Question 37

what are the different types of oral antidiabetic drug?

Answer 37

these are for type II diabetics ``` biguanides sulfonylureas meglitinides thiazolidinediones (glitazones) alpha-glucosidase inhibitors gliptins ```

Question 38

what are virulence factors of bacteria?

Answer 38

fimbriae and pilli (eg. e.coli have fimbriae - cause bladder infections) flagella secretion of toxins and enzymes (food poisoning - colonize & secrete toxins into foods) invasion (bacteria that cause TB hide in lung cells)

Question 39

what is gram staining?

Answer 39

a technique used to classify bacteria as gram + or gram - | why? gram stain tells us which antibiotic will be effective

Question 40

what are characteristics of gram + bacteria?

Answer 40

purple stain thick peptifoglycan wall techoic acids (provide rigidity to wall, major surface antigen)

Question 41

what are characteristics of gram - bacteria?

Answer 41

pink stain thin petidoglycan layer lipopolysaccharides (LSPs) - a structural component of the outer membrane and the major surface antigen Outer membrane - protects gram - bacteria from bile salts & detergents Porins - on outer membrane, allow certain sugars, ions, and amino acids to enter bacteria

Question 42

signs of infection?

Answer 42

``` fever *not always overall malaise local redness swelling increased RR tachycardia ``` *babies may have immature hypothalamus or elderly may have decreased hypothalamic function therefore no fever

Question 43

how does antibiotic produce selective toxicity?

Answer 43

- disrupting cell wall (human cells don't have one) - targeting enzymes that are unique to bacteria - disrupting bacteria protein synthesis (ribsomes are different)

Question 44

what does bacteriostatic mean?

Answer 44

that an antibiotic stops the growth and replication of bacteria and therefore stops the spread of infection -the body's immune system can then attack & remove the bacteria

Question 45

what does bactericidal mean?

Answer 45

antibiotics kill the bacteria

Question 46

what does MIC & MBC mean?

Answer 46

MIC - minimum inhibitory concentration - concentration required to stop growth & replication MBC - minimum bactericidal concentration - min concentration required to kill *microbiologists can culture bacteria to find out the MIC & MBC of antibiotics

Question 47

what are types of infections that are difficult to treat?

Answer 47

``` meningitis UTI osteomyelitis abscesses otitis media ```

Question 48

what type of antibiotic should be used for pt.s with compromised immune system?

Answer 48

bactericidal as the bacteriostatic ones still require the person's immune system to do work ppl with AIDS, organ transplantation, cancer chemo, elderly

Question 49

what are potential complication of antibiotic therapy?

Answer 49

``` resistance allergy serum sickness superinfection destruction of normal bacterial flora bone marrow toxicity ```