Term
| Which organ produces the hormones that regulate blood glucose levels? |
|
Definition
|
|
Term
| Describe the general pathway for pancreatic control of glucose |
|
Definition
High blood glucose -> beta cells secrete insulin -> transport of glucose into cells
-> homeostasis
Low blood glucose -> alpha cells secrete glucagon -> Gluconeogenesis in the liver -> homeostasis |
|
|
Term
| What is the cause of diabetes? |
|
Definition
|
|
Term
| Describe the normal glucose balance at a fed state and fasted state |
|
Definition
Fed: Insulin dominates - increased glycogen creation, fat and protein synthesis
Fasted: glucagon dominates - ketogenesis, glucogenolysis, gluconeogenesis |
|
|
Term
| What is the cause of diabetes mellitus? |
|
Definition
| Inadequate insulin production by the beta cells of the pancreas |
|
|
Term
| What is the cause of inadequacy in TI diabetes? |
|
Definition
| - None (or very low) insulin secretion |
|
|
Term
| What is the cause of inadequacy in TII diabetes? |
|
Definition
| - Decline in receptor sensitivity, with normal (or elevated) insulin levels |
|
|
Term
| What does diabetes lead to? (5) |
|
Definition
– Increased blood glucose
– Increased glucose in urine
– Increased urine output (polyuria)
– Increased drinking (polydipsia)
– Increased eating (polyfasia) |
|
|
Term
| (T/F) It is a very prevalent disease (6-7% prevalent in Canada) |
|
Definition
|
|
Term
| What % of diabetes cases are TI diabetes? |
|
Definition
|
|
Term
| What is another name for TI? |
|
Definition
|
|
Term
| What % of diabetes cases are TII diabetes? |
|
Definition
|
|
Term
| What is another (outdated) name for TII? |
|
Definition
| Adult onset (although it affects children as well) |
|
|
Term
| Why is the insulin deficit in TII called a relative deficit? |
|
Definition
| Because the hormonal levels are actually normal, the insulin receptors are just desensitized to the hormone |
|
|
Term
| Describe the insulin hormone level pathway over the course of TII? |
|
Definition
| Initially increases, then gradually insulin levels decrease |
|
|
Term
|
Definition
| Autoimmune destruction of beta cells |
|
|
Term
| What is the cause of TII? |
|
Definition
| Reduced sensitivity to insulin |
|
|
Term
| What is often associated with TII? |
|
Definition
|
|
Term
| (T/F) The mechanism of insulin insensitivity in TII is well understood |
|
Definition
| False, it is not well understood |
|
|
Term
| What also accompanies both types of diabetes? |
|
Definition
|
|
Term
| What is used for TI treatment? |
|
Definition
- Insulin
- Monitor glucose levels |
|
|
Term
| (T/F) The source of the insulin is primarily recombinant |
|
Definition
|
|
Term
| Describe the two ways insulin is given to the patient? |
|
Definition
- Sub-cut injection
- Continuous pump |
|
|
Term
| List two possible future therapies? |
|
Definition
1. Pancreatic transplant
2. Stem cell therapy |
|
|
Term
| What 4 things encompass TII treatment? |
|
Definition
1. Diet
2. Exercise
3. Oral hypoglycemics
4. Bariatric surgery |
|
|
Term
| What does a diet change do? |
|
Definition
| Reduces the demand for insulin |
|
|
Term
|
Definition
| Stimulates insulin-independent glucose uptake |
|
|
Term
| How are hypoglycemics taken? |
|
Definition
|
|
Term
| What occurs in bariatric surgery? |
|
Definition
| Stomach size is reduced, even bypassed |
|
|
Term
| What patients usually receive this therapy? |
|
Definition
| Patients with metabolic syndrome |
|
|
Term
| Name 3 oral hypoglycemics |
|
Definition
1. Sulfonylureas
2. Biguanides
3. Alpha-glucosidase inhibitors |
|
|
Term
| Describe the method of action for each? |
|
Definition
1. Sulfonylureas: stimulate beta cells to release insulin
2. Biguanides - increase sensitivity to insulin and reduce glucose production/adsoprtion
3. Alpha-glucosidase inhibitors - reduces glucose absorption by inhibiting digestion of disaccharides to monosaccharides |
|
|
Term
| List two acute complicaitons of diabetes |
|
Definition
- Insulin shock
- Ketoacidosis |
|
|
Term
| What causes insulin induced hypoglycemia (shock)? |
|
Definition
Error in insulin dose; doing these 3 things after taking insulin
- Skipping a meal
- Exercising
- Vomiting |
|
|
Term
| What two things arise as a result of the shock? |
|
Definition
1. CNS function depressed
2. SNS activation |
|
|
Term
|
Definition
| Neurons need glucose to function |
|
|
Term
|
Definition
| Increases glucose in blood - attempted counter-regulatory mechanism |
|
|
Term
| List symptoms of insulin shock |
|
Definition
1. Inability to concentrate
2. Slurred speach
3. Lack of coordination
4. Staggering |
|
|
Term
| List 5 other symptoms of insulin shock, related to SNS stimulation |
|
Definition
1. Sweating
2. Tachycardia
3. Pallor (vasoconstriction)
4. Tremor
5. Anxiety |
|
|
Term
| Describe the general pathway of insulin shock |
|
Definition
| Excess insulin leads to increased transport into cells, which causes hypoglycemia, depressing the CNS. This causes activation of the SNS, and both CNS depression and SNS activation cause the symptoms of insulin shock. SNS activation leads to gluconeogenesis, which then leads to transport of glucose into cells, further contributing to hypoglycemia |
|
|
Term
| How is insulin shock remedied? |
|
Definition
|
|
Term
| What happens if there is no glucose intake to counteract the insulin shock? |
|
Definition
| Further decline in blood glucose, neurons can no longer function. Leads to coma and death |
|
|
Term
| What is the difference between treatment of someone suffering from insulin shock, if they are conscious vs unconscious? |
|
Definition
C: sugary foods
UC: IV glucose, no oral sugar |
|
|
Term
| (T/F) Diabetic ketoacidosis is acute onset |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What can cause inadequate insulin? (4) |
|
Definition
– Infection
– Stress
– Underdosing
– Food or alcohol binge |
|
|
Term
| What characterizes diabetic ketoacidosis? |
|
Definition
- Hyperglycemia
- Lipid mobilization
- Ketonuria |
|
|
Term
| Describe the development of ketoacidosis, starting with decreased glucose tranport into cells |
|
Definition
|
|
Term
| What are the symptoms of ketoacidosis related to? |
|
Definition
| Dehydration, metabolic acidosis and electrolyte imbalance |
|
|
Term
| List some symptoms of dehydration |
|
Definition
- Thirst
- Dry mucosa
- Warm dry skin
- Low BP
- Oligouria |
|
|
Term
| List symptoms related to metabolic acidosis |
|
Definition
– Rapid respirations
– Acetone breath (sweet, fruity)
– Lethargy
– Unconsciousness if pH falls |
|
|
Term
|
Definition
| Ketoacids binding to bicarbonate, so there is a shift towards bicarbonate/hydrogen ion creation. This decreases pH |
|
|
Term
| List the symptoms related to electrolyte imbalance |
|
Definition
– Abdominal cramping
– Vomiting
– Lethargy |
|
|
Term
| What are the 4 treatments for ketoacidosis |
|
Definition
– Administer insulin
– Rehydrate
– Replace electrolytes
– Treat acidosis with bicarbonate |
|
|
Term
| Why does differential diagnosis of an unconscious diabetic matter? |
|
Definition
| Because both ketoacidosis and insulin shock can cause unconsciousness, but each has to be treated differently |
|
|
Term
| Describe how you would differentially diagnose an unconscious diabetic |
|
Definition
| Look for SNS activation signs - this means its insulin shock. Ketoacidosis will show signs of electrolyte imbalance, metabolic acidosis and dehydration |
|
|
Term
| List 7 chronic complications of DM |
|
Definition
• Heart disease (2 – 4 fold increase)
• Stroke (2 – 4 fold)
• Blindness (leading cause of adult blindness)
• Neural (60 – 70 % mild – severe impairment)
• Kidney disease (leading cause of end stage renal
disease)
• Amputation (60% of non-traumatic amputations)
• Pregnancy complications |
|
|
Term
| What causes these chronic malignancies? |
|
Definition
| Due to changes in lipid, carb and protein metabolism caused by chronic hyperglycemia, which is caused by defective insulin |
|
|
Term
| Why are chronic malignancies more often seen in TI patients? |
|
Definition
|
|
Term
| (T/F) Macrovascular malignancies are the cause of the high amputation rate in diabetes |
|
Definition
|
|
Term
| What three things are seen macrovascularly, because of DM? |
|
Definition
1. Myocardial infarction
2. Stroke
3. Compromised circulation to extremities |
|
|
Term
| List two complications of decreased circulation |
|
Definition
| 1. Poor healing 2. More prone to infection |
|
|
Term
| What 2 organs are affected by microvascular complications due to DM? |
|
Definition
|
|
Term
| What two things happen in the eyes? |
|
Definition
|
|
Term
| What happens in retinopathy? |
|
Definition
| Capillaries in retina become thick and hard, and eventually rupture -> blindness |
|
|
Term
| (T/F) Sorbitol in the lens causes cataracts |
|
Definition
|
|
Term
| What is the cause of nephropathy? |
|
Definition
| Microvascular damage to glomerulus causes increased permeability |
|
|
Term
| (T/F) This is the leading cause of renal failure |
|
Definition
|
|
Term
| (T/F) Neuropathy is not often seen in DM |
|
Definition
|
|
Term
| What aspects of the NS does it affect, and what is seen because of this? |
|
Definition
1. Peripheral nerves - numbness/tingling
2. Autonomic NS - urinary/fecal incontinence, ED |
|
|
Term
| What are the 3 causes neuropathies related to DM |
|
Definition
- Vascular
- Autoimmune
- Demyelenation |
|
|
Term
| (T/F) ROIs, created by hyperglycemia, likely contribute to DM neuropathy |
|
Definition
|
|
Term
| (T/F) Diabetes mellitus is the only form of diabetes |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
1. Lack of ADH
2. Resistance to ADH
3. Excessive thirst |
|
|
Term
| What is characteristic of the urine of patients with DI? |
|
Definition
| Very diluted, regardless of fluid intake |
|
|
