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Endo I Diabetes!
3 questions?
7
Medical
Graduate
02/20/2011

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Term
What characterizes DM?
Definition
persistent fasting hyperglycemia accompanied by a glucose induced osmotic diuresis
Term
Type I DM
Definition
Patients produce little or no insulin

Ketosis more prevalent
Term
Type II DM
Definition
Resistance to insulin

More ketosis resistant

Tx: diet, weight reduction
Term
Secondary diabetes - what can cause it?
Definition
pancreatic disease, medications, endocrine dysfunction (other than insulin "pituitary diabetes"), genetic hyperglycemia
Term
Impaired glucose tolerance
Definition
Pts have normal fasting blood glucose but abnormally high glucose levels following a glucose ingestion
Term
Metabolic consequences in diabetes:
Definition
reduced insulin (or insulin effects)
inappropriately high glucagon
decreased anabolism
- reduced: lipogenesis, protein synth, glycogen synth
increased catabolism (reduced insulin, i/c glucagon)
- increased glycogenolysis (raises [glucose])
- increased lipolysis - spares [glucose], promotes ketosis
increased gluconeogenesis - raises [glucose]
osmotic diuresis
excess lipid use --> rising [ketones], falling pH, IC K+ leaks out
Term
Considerations in DKA
Definition
Acidic, ionic, osmotic factors when unchecked may lead to diabetic coma

Rapid insulin replacement will push K+ into cells --> hypokalemia --> cardiac arrhythmias

Poorly controlled DM may have hyperosmolar [glucose] which have equilibrated into the CNS: rapid insulin replacement may reduce [glucose] faster than it re-equilibrates out of CNS --> cerebral edema
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