Term
| What is the normal function of insulin in the liver? |
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Definition
| Supresses release of glycogen so it the body will use carbs for energy, rather than body stores. |
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Term
What is the normal function of insulin in
muscle tissue? |
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Definition
| Increases uptake and storage of glucose. |
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Term
| What is the normal function of insulin in Adipose tissue? |
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Definition
| Increase uptake and storage of gluces as a lipid. |
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Term
| VOCAB: Insulin Resistance |
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Definition
| Insulin is present in the blood stream, but the body is incapable of using it for glucose uptake. |
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Term
| Describe the role of skeletal muscle in insulin resistance. |
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Definition
| Contraction of skeletal muscle facilitates glucose transport into cells, increases insulin sentivity throughout the body and decreases plasma insulin levels. So those with insulin resistance can still control glucose uptake by using their muscles in exercise. |
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Term
| Describe the pathology of insulin dependent diabetes mellitus, age of onset, and treatment. |
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Definition
| Juvenile onset. There is destruction of pancreatic beta cells, so there is a lack of insulin production. Tx: Insulin injections, or oral insulin. |
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Term
| Describe the pathology of non-insulin dependent diabetes mellitis. |
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Definition
| Adult onset. Insulin is produced normally, but the body is incapable of using it. |
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Term
| What are the risk factors for NIDDM? |
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Definition
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Term
| What three major metabolic problems arise with lack of insulin? |
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Definition
| Decreased utilization of glucose, Increased fat metabolism, Impaired protein utilization. |
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Term
| How does lack of insulin cause decreased utilization of glucose for metabolism? |
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Definition
| The insulin can't help cells use the plasma glucose. |
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Term
| How does decreased utilization of glucose affect the body? (in terms of glucose in blood stream, and actions of the liver, and kidney.) |
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Definition
| 1. Glucose accumulates in the blood stream. 2. The liver increases synthesis of glucose because insulin isn't stopping it. 3. The kidney exretes excess glucose, resulting in glucose in the urine. This causes increased urine production, leading to decreased fluid volume deficit, so the person becomes thirsty and drinks large amounts of water. |
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Term
VOCAB: Polydypsea
What causes it? |
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Definition
| Excessive thirst. Caused by increased excretion of fluid through the kidneys due to glucoseurea. |
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Term
| Why does decreased insulin lead to increased fat metabolism? What problems result from this? |
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Definition
| The body can't uptake glucose for energy, so it has to break fat down into ketones. As a result, lipid levels rise in the blood stream which leads to increased risk for atherosclerosis. |
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Term
| What are some short-term signs and symptoms of diabetes? (6) |
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Definition
| Polyuria, polydipsia, polyphagia, weight loss, fatigue, acetone breath. |
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Term
| Why would a diabetic suffer from polyphagia? |
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Definition
| Because glucose isn't absorbed into cells, the person feels hungry and is triggered to eat more. |
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Term
| Why would diabetes lead to weight loss? |
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Definition
| Because glucose isn't be stored, and stored fat is being broken down for energy. |
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Term
What are some long-term effects of diabetes? (6)
What are some secondary problems that arise from these long-term effects? |
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Definition
Retinopathy, Nephropathy, Vascular Problems, Neuropathy, Osteoporosis, Ulceration.
Secondary Problems:
Deformity (claw toes, flatfoot w/ valcus of midfoot, collapse of long arch b/c of motor neuropathy, charcot foot), Loss of sweat regulation --> dry, cracking skin, ulceration. |
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Term
VOCAB: Charcot Foot
Where do ulcerations appear? |
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Definition
Rigid rocker-bottom foot.
Ulcerations appear under the talus and navicular. |
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Term
| What are some complications of insulin therapy? |
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Definition
| Hypoglycemia, Erratic insulin action |
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Term
| What are some symptoms of hypoglycemia? |
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Definition
| Increased sympathetic activity (rapid HR, perspiration, piloerection - goosebumps), Weakness, irritability, lack of muscle coordination, shakiness, Inability to respond to verbal commands, confusion, difficulty concentrating, headache, double/blurred vision, hunger, shallow respiratoins, dilated pupils, convulsions, tremors, coma. |
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Term
| What is the definition of hypoglycemia? |
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Definition
| Blood glucose less than 70mg/Dl |
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Term
| Signs and symptoms of hyperglycemia |
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Definition
| Acetone breath, dehydration/thirst, weak puls, headache, fever, flushed face, polyuria, diminished reflexes, paresthesias, lethargy, confusion, coma |
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Term
| What is the definition of hyperglycemia? |
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Definition
| Blood glucose level greater than 300mg/dl |
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Term
| Treatment for Hypoglycemia: |
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Definition
| provide carbs immediately, ie:juice. If unconscious, they need immediate medical attention, don't try to feed them. |
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Term
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Definition
| Administer fluids and insulin. |
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Term
| What do you do if you're not sure if your patient is hyper or hypoglycemic? |
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Definition
| Give them juice. If they're hypoglycemic it will make them better immediately, but it won't really harm the patient if they're hyperglycemic. If juice doesn't make them better you know they're hyperglycemic. |
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Term
| What are the two mechanisms for the transport of glucose into muscle? |
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Definition
| Insulin mediated and muscle-contraction induced. |
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Term
| How can the non-insulin dependent diabetic patient benefit from exercise? (6) |
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Definition
| 1. Improves skeletal muscle glucose transport and glucose homeostasis. 2. Incrases carb metabolism, which lowers blood glucose level. 3. Aids in maintaining optimal body weight. 4. Increases HDLs while decreasing triglycerides, BP, stress and tension. 5. Controls hyperglycemia 6. Improves short-term insulin sensitivity. |
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Term
| How does exercise improve glycemic control in the IDDM pt? |
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Definition
It DOESN'T!
But it does help other systems: cardiac, etc... |
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Term
| What is the major risk associated w/ exercise in the IDDM pt? |
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Definition
| Hyperglycemia can be profound, and present even days after exertion. So it can result in a rise in blood glucose, ketosis, and ketoacidosis. |
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Term
| Why do you have to time exercise and insulin injections carefully? |
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Definition
| If exercise is done within 1hr of an insulin injection it can lead to hypoglycemia, by potentiating the effects of the injected insulin. |
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Term
| Contraindications to exercise in DM: |
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Definition
| 1. Poor control of blood glucose levels. 2. Poorly controlled associated conditions(ie: HTN, retinopathy, nephropathy) 3. Dehydration |
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Term
| Whare are the important key elements to discuss with the diabetic pt who wants to start an exercise program? |
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Definition
1. Assess glucose levels before and after exercise. If glucose is OK after exercise, that exercise is safe for them.
2. Carbohydrate and insulin requirements for the exercise. 3. Risk of injury, especially w/ walking. |
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Term
What is the optimal blood glucose level?
What is considered a "safe" glucose level? |
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Definition
Optimal = 80-120 mg/dl
Safe = between 100 and 250. |
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Term
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Definition
| 1. Monitor glucose levels. 2. Monitor ketone levels in urine. Postpone exercise if these numbers are high. Wait at least 1hr after injection of insulin. |
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Term
| A diabetic patient comes to you requesting an exercise program. Prescribe a program, taking into account risk factors and precautions. Make sure you tell her how often, how hard, and how long she should exercise. |
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Definition
| Begin exercise gradually, 3 days a week for 30 minutes, and keep it low impact. Exercise at the same time each day you work out, and don't exercise within an hour of taking insulin. Be sure to monitor your glucose levels before exercise, and wait until it is lower than 250mg/dl before working out. Be aware of your state as you exercise, and keep hydrated. If you should begin to feel faint, dizzy, have fuzzy vision, ect... stop, and monitor your glucose levels. Have a snack every 30 minutes. You can gradually build the duration up as your body is able to tolerate it. At the conclusion of exercise, monitor your blood glucose every 15 minutes. Be sure to inspect your feet for any sores that may have begun to develop during your workout, particularly if you were walking. |
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Term
| What effects does inactivity have on glucose transport? |
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Definition
| Inactivity --> decr. glucose tolerance, and decr. insulin-mediated glucose disposal. Peripheral insulin resistance can be seen within 3 days of absolute bed rest. Insulin resistance progresses as duration of inactivity increases. |
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Term
| What effect does limb immobilization have on glucose transport? |
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Definition
| Causes skeletal muscle insulin resistance for glucose uptake and glycogen synthesis. Within 1 week of immobility, a decrease occurs in insulin mediated glucose uptake. |
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Term
What do glut 4 transmitters do?
Why are they so important in the diabetic pt? |
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Definition
| Glut 4 transporters allow skeletal muscle to uptake glucose independent of insulin presence. This allows the NIDDM pt to control their glucose levels. |
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Term
| What is important for your diabetic patients to know if they decide to stop exercising? |
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Definition
| The exercise helped their body uptake some of the extra glucose in their bloodstream. If they stop exercising, this glucose won't be taken up, and their medication may need to be increased to counteract the higher plasma glucose levels. |
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