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39 Cards in this Set
- Front
- Back
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diabetes mellitus
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a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
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hyperglycemia
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elevated blood glucose level; fasting level greater than 110 mg/dL; 2-hour postprandial level greater than 140 mg/dL
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postprandial
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after a meal
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insulin
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a hormone secreted by the beta cells of the islets of Langerhans of the pancreas that is necessary for the metabolism of carbohydrates, proteins, and fats; a deficiency of insulin results in diabetes mellitus
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diabetic ketoacidosis (DKA)
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a metabolic derangement in type 1 diabetes that results from a deficiency of insulin. Highly acidic ketone bodies are formed, resulting in acidosis; usually requires hospitalization for treatment and is usually caused by non-adherence to the insulin regimen, concurrent illness, or infection
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hyperglycemic hyperosmolar non-ketotic syndrome (HHNS)
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a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an intercurrent illness that raises the demand for insulin; associated with polyuria and severe dehydration
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What are the major sources of glucose?
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1. absorption of ingested food in the GI tract
2. formation of glucose by the liver from food substances |
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What does insulin do?
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Insulin controls the level of glucose in the blood by regulating the production and storage of glucose.
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Hyperglycemia may result in what two acute metabolic complications?
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1. diabetic ketoacidosis (DKA)
2. hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) |
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What are the the possible long-term contributions of diabetes?
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Macrovascular complications - coronary artery disease, CVD, PVD
Chronic microvascular complications - kidney and eye disease Neuropathic complications - disease of the nerves |
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What are the primary goals of treatment for people with diabetes?
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Controlling blood glucose levels and preventing acute and long-term complications.
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What are the risk factors for diabetes mellitus?
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-family history
-obesity BMI > or = 27 kg/m2 -race/ethnicity (African Americans, Hispanics, Native Americans, Asians, Pacific Islanders) -age > or = 45 yo -previously identified impaired fasting glucose or impaired glucose tolerance -hypertension > or = 140/90 -HDL cholesterol level < or = 35 mg/dL and / or triglyceride level > or = 250 mg/dL -hx of gestational diabetes or delivery of babies > 9 lb. |
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What are the major classifications of diabetes?
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-type 1 diabetes
-type 2 diabetes -gestational diabetes -diabetes mellitus associated with other conditions or syndromes |
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Except for patients with type 1 diabetes, may patients move between diabetic classifications?
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Yes
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Why are the terms IDDM and NIDDM no longer used?
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Because they result in classification of patients on the basis of the treatment of the diabetes rather than the underlying cause.
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type 1 diabetes - definition
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a metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas.
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What is the cause of type 1 diabetes?
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An autoimmune process destroys the insulin-producing pancreatic beta ells. As a result, patients produce little or no insulin and require insulin injection to control their blood glucose levels.
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What is the onset of type 1 diabetes?
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acute onset, usually before 30 years of age
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type 2 diabetes - definition
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a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance.
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What is the general treatment pathway of type 2 diabetes?
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Initially, type 2 diabetes is treated with diet and exercise. If hyperglycemia persists, this is supplemented with oral antidiabetic agents. In some patients, insulin injections may be necessary. In addition, insulin injections may be necessary during acute physiologic stress (ie illness or surgery).
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Insulin is secreted by...
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the beta cells in the islets of Langerhans of the pancreas.
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What kind of hormone is insulin?
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an anabolic, or storage, hormone
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When a person eats a meal, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells. In those cells, insulin does what actions?
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-transports and metabolizes glucose for energy
-stimulates storage of glucose in the liver and muscle in the form of glycogen -signals the liver to stop the release of glucose -enhances storage of dietary fat in adipose tissue -accelerates transport of amino acids (which are derived from dietary protein) into cells |
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What does insulin inhibit?
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the breakdown of stored glucose, protein, and fat
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What is basal insulin?
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The small amount of insulin that the pancreas continuously releases during fasting periods (between meals and overnight).
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glucagon
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a hormone secreted by the pancreatic alpha cells when blood glucose levels decrease and stimulates the liver to release stored glucose
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What two hormones work to maintain a constant blood glucose level?
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insulin and glucagon
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How does the liver produce glucose?
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Initially, through glycogenolysis (the breakdown of glycogen).
After 8-12 hours without food, the liver forms glucose through gluconeogenesis (the breakdown of noncarbohydrate substances, including amino acids). |
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What are the general factors contributing to beta cell destruction in type 1 diabetes?
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combined genetic, immunologic, and possibly environmental (viral) factors
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Do people inherit type 1 diabetes?
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No, they inherit a predisposition, or tendency, toward development of type 1 diabetes. This genetic tendency has been found in people with certain human leukocyte antigen (HLA) types.
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Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes.
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true
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What does the beta cell destruction result in?
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1. Decreased insulin production, leading to...
2. Unchecked glucose production by the liver 3. Fasting hyperglycemia 4. Glucose derived from food cannot be stored in the liver but instead remains in the bloodstream 5. Possibly osmotic diuresis. 6. Production and release of glucose by the liver 7. Production of ketone bodies |
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In the absence of insulin, why does production and release of glucose by the liver occur?
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Because insulin normally inhibits the breakdown of stored glucose, protein and fat. It also normally signals the liver to stop the release of glucose.
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What is osmotic diuresis (related to type 1 diabetes)?
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If the concentration of glucose in the blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL, the kidneys may not reabsorb all of the filtered glucose; the glucose then appears in the urine (glycosuria). When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes (osmotic diuresis).
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What is glycogenolysis?
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The breakdown of stored glucose that is in the form of glycogen.
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What is gluconeogenesis?
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The production of new glucose from amino acids and other noncarbohydrate substrates.
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Ketone bodies
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the byproducts of fat breakdown; ketone bodies are acids that disturb the acid-base balance of the body when they accumulate in excessive amounts.
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Signs and symptoms of DKA
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- Abdominal pain
- Nausea - Vomiting - Hyperventilation - A fruity breath odor If left untreated: - Altered LOC - Coma - Death |
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Why are ketone bodies produced in the absence of insulin?
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Because insulin normally inhibits the breakdown of stored glucose, protein, and fat. In it's absence, fat breakdown occurs and ketone bodies are produced as byproducts.
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