Ch 51 Diabetes

Front 1

continuous glucose monitoring system (CGMS)

Back 1

a device used to continuously monitor blood glucose levels;

A sensor attached to an infusion set, which is similar to an insulin pump infusion set, is inserted subcutaneously in the abdomen and connected to the device worn on the patient’s clothing or placed in a pocket.

Front 2

continuous subcutaneous insulin infusion, insulin pump

Back 2

a small device that delivers insulin on a 24-hour basis as basal insulin

Front 3

diabetes

Back 3

a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Front 4

diabetic ketoacidosis (DKA)

Back 4

a metabolic derangement in type 1 diabetes that results from a deficiency of insulin; highly acidic ketone bodies are formed, resulting in acidosis

Front 5

fasting plasma glucose (FPG)

Back 5

blood glucose determination obtained in the laboratory after fasting for at least 8 hours

Front 6

gestational diabetes

Back 6

any degree of glucose intolerance with its onset during pregnancy

Front 7

glycated hemoglobin (glycosylated hemoglobin, Hgb A 1Cor A1C)

Back 7

a measure of glucose control that is a result of glucose molecule attaching to hemoglobin for the life of the red blood cell (120 days)

Front 8

glycemic index

Back 8

the amount a given food increases the blood glucose level compared with an equivalent amount of glucose

Front 9

hyperglycemia

Back 9

elevated blood glucose level

Front 10

hyperglycemic hyperosmolar syndrome (HHS)

Back 10

a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin

Front 11

hypoglycemia

Back 11

low blood glucose level

Front 12

impaired fasting glucose (IFG), impaired glucose tolerance (IGT)

Back 12

a metabolic stage intermediate between normal glucose homeostasis and diabetes; referred to as prediabetes

Front 13

insulin

Back 13

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

Front 14

ketone

Back 14

a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin

Front 15

medical nutrition therapy (MNT)

Back 15

nutritional therapy prescribed for management of diabetes that usually is administered by a registered dietician

Front 16

nephropathy

Back 16

a long-term complication of diabetes in which the kidney cells are damaged; characterized by microalbuminuria in early stages and progressing to endstage kidney disease

Front 17

neuropathy

Back 17

a long-term complication of diabetes resulting from damage to the nerve cell

Front 18

prediabetes

Back 18

impaired glucose metabolism in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes; includes impaired fasting glucose and impaired glucose tolerance, not clinical entities in their own right but risk factors for future diabetes and cardiovascular disease

Front 19

retinopathy

Back 19

a complication of diabetes in which the small blood vessels that nourish the retina in the eye are damaged

Front 20

self-monitoring of blood glucose (SMBG)

Back 20

a method of capillary blood glucose testing in which the patient pricks his or her finger and applies a drop of blood to a test strip that is read by a meter.

Front 21

sulfonylureas

Back 21

a class of oral antidiabetic medication for treating type 2 diabetes; stimulates insulin secretion and insulin action

Front 22

thiazolidinediones

Back 22

a class of oral antidiabetic medications that reduces insulin resistance in target tissues, enhancing insulin action without directly stimulating insulin secretion

Front 23

type I diabetes

Back 23

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; formerly called insulindependent diabetes, or juvenile diabetes

Front 24

type 2 diabetes

Back 24

a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance; formerly called non–insulin-dependent diabetes, and/ or adult-onset diabetes

Front 25

25.8 million

Back 25

It is estimated that more than ________ people in the United States have diabetes, although almost one third of these cases are undiagnosed.

Front 26

Minority

Back 26

__________ populations are disproportionately affected by diabetes.

Front 27

African Americans; Native Americans; Hispanic origin

Back 27

______ Americans and members of other racial and ethnic groups (_______ Americans and persons of _________ origin) are more likely to develop diabetes, are at greater risk for many of the complications, and have higher death rates due to diabetes

Front 28

diabetes

Back 28

In the United States, ________ is the leading cause of nontraumatic amputations, blindness in working-age adults, and end-stage kidney disease (ESKD).

Front 29

death

Back 29

Diabetes is a leading cause of _________ from disease, primarily because of the high rate of cardiovascular disease (myocardial infarction [MI], stroke, and peripheral vascular disease) among people with diabetes.

Front 30

Hospitalization

Back 30

___________ rates for people with diabetes are 2.4 times greater for adults and 5.3 times greater for children than for the general population.

Front 31

insulin

Back 31

When a person eats a meal, ________ secretion increases and moves glucose from the blood into muscle, liver, and fat cells.

Front 32

insulin function in cells

Back 32

• 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 (derived from dietary protein) into cells

• Insulin also inhibits the breakdown of stored glucose, protein, and fat

Front 33

Risk Factors: Diabetes

Back 33

• Family history of diabetes

• Obesity (i.e., ≥20% desired weight or BMI ≥30 kg/m2)

• Race/ethnicity (e.g., African Americans, Hispanic Americans, Native Americans, Asian Americans, Pacific Islanders)

• Age ≥45 years

• Previously identified impaired fasting glucose or impaired glucose tolerance

• Hypertension (≥140/90 mm Hg)

• High-density lipoprotein (HDL) cholesterol level ≤35 mg/dL and/or triglyceride level ≥250 mg/dL

• History of gestational diabetes or delivery of a baby over 9 lb

Front 34

Type 1

Back 34

5%–10% of all diabetes; previously classified as juvenile diabetes, juvenile-onset diabetes, ketosis-prone diabetes, brittle diabetes, and insulin-dependent diabetes mellitus [IDDM]

Front 35

Type 1

Back 35

Onset any age, but usually young (<30 y)

Usually thin at diagnosis; recent weight loss

Etiology includes genetic, immunologic, and environmental factors (e.g., virus)

Often have islet cell antibodies

Often have antibodies to insulin even before insulin treatment

Little or no endogenous insulin

Need exogenous insulin to preserve life

Ketosis prone when insulin absent

Acute complication of hyperglycemia: diabetic ketoacidosis

Front 36

Type 2

Back 36

90%–95% of all diabetes: obese—80% of type 2, nonobese—20% of type 2; previously classified as adult-onset diabetes, maturity-onset diabetes, ketosis-resistant diabetes, stable diabetes, and non–insulin-dependent diabetes mellitus [NIDDM]

Front 37

Type 2

Back 37

Onset any age, usually >30 y

Usually obese at diagnosis

Causes include obesity, heredity, and environmental factors

No islet cell antibodies

Decrease in endogenous insulin, or increased with insulin resistance

Most patients can control blood glucose through weight loss if obese

Oral antidiabetic agents may improve blood glucose levels if dietary modification and exercise are unsuccessful

May need insulin on a short- or long-term basis to prevent hyperglycemia

Ketosis uncommon, except in stress or infection

Acute complication: hyperglycemic hyperosmolar syndrome

Front 38

Diabetes associated with other conditions or syndromes (previously classified as secondary diabetes)

Back 38

Accompanied by conditions known or suspected to cause the disease: pancreatic diseases, hormonal abnormalities, medications such as corticosteroids and estrogen-containing preparations

Depending on the ability of the pancreas to produce insulin, the patient may require treatment with oral antidiabetic agents or insulin.

Front 39

Gestational diabetes

Back 39

Onset during pregnancy, usually in the 2nd or 3rd trimester

Due to hormones secreted by the placenta, which inhibit the action of insulin

Above-normal risk for perinatal complications, especially macrosomia (abnormally large babies)

Treated with diet and, if needed, insulin to strictly maintain normal blood glucose levels

Occurs in about 2%–5% of all pregnancies

Front 40

Gestational diabetes

Back 40

Glucose intolerance transitory but may recur:

• In subsequent pregnancies

• 30%–40% will develop overt diabetes (usually type 2) within 10 years (especially if obese)

Risk factors include obesity, age >30 y, family history of diabetes, previous large babies (>9 lb)

Screening tests (glucose challenge test) should be performed on all pregnant women between 24 and 28 weeks of gestation

Should be screened for diabetes periodically

Front 41

Prediabetes

Back 41

Previous history of hyperglycemia (e.g., during pregnancy or illness)

Current normal glucose metabolism

Impaired glucose tolerance or impaired fasting glucose screening after age 40 years if there is a family history of diabetes or if symptomatic

Encourage ideal body weight, because loss of 10–15 lb may improve glycemic control

Front 42

Prediabetes

Back 42

previously classified as previous abnormality of glucose tolerance [PrevAGT]

Front 43

basal

Back 43

During fasting periods (between meals and overnight), the pancreas continuously releases a small amount of insulin (________insulin)

Front 44

glucagon

Back 44

another pancreatic hormone called _______ (secreted by the alpha cells of the islets of Langerhans) is released when blood glucose levels decrease, which stimulates the liver to release stored glucose.

Front 45

glycogen; amino acids

Back 45

Initially, the liver produces glucose through the breakdown of _________ (glycogenolysis). After 8 to 12 hours without food, the liver forms glucose from the breakdown of noncarbohydrate substances, including ________ (gluconeogenesis)

Front 46

beta-cell

Back 46

Combined genetic, immunologic, and possibly environmental (e.g., viral) factors are thought to contribute to _________ destruction, which results in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia.

Front 47

postprandial

Back 47

glucose derived from food cannot be stored in the liver but instead remains in the bloodstream, contributes to ________ (after meals) hyperglycemia.

Front 48

180 to 200 mg/dL (9.9 to 11.1 mmol/L)

Back 48

If the concentration of glucose in the blood exceeds the renal threshold for glucose, usually ____ to ______ mg/dL (____ to ______ mmol/L), the kidneys may not reabsorb all of the filtered glucose; the glucose then appears in the urine (glycosuria).

Front 49

osmotic diuresis

Back 49

When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes. This is called _______.

Front 50

glycogenolysis

Back 50

breakdown of stored glucose

Front 51

gluconeogenesis

Back 51

production of new glucose from amino acids and other substrates

Front 52

hyperglycemia

Back 52

Because insulin normally inhibits glycogenolysis and gluconeogenesis, these processes occur in an unrestrained fashion in people with insulin deficiency and contribute further to _______ .

Front 53

metabolic derangements

Back 53

The three major __________ _______ are hyperglycemia, ketosis, and metabolic acidosis

Front 54

Diabetic ketoacidosis (DKA)

Back 54

____________is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated. The breath has a characteristic fruity odor due to the presence of ketoacids.

Front 55

type 2

Back 55

The two main problems related to insulin in __________diabetes are insulin resistance and impaired insulin secretion.

Front 56

Insulin resistance

Back 56

___________refers to a decreased tissue sensitivity to insulin. Normally, insulin binds to special receptors on cell surfaces and initiates a series of reactions involved in glucose metabolism. In type 2 diabetes, these intracellular reactions are diminished, making insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver

Front 57

metabolic syndrome

Back 57

Insulin resistance may also lead to_______________, which is a constellation of symptoms including hypertension, hypercholesterolemia, abdominal obesity, and other abnormities

Front 58

impaired insulin secretion

Back 58

Despite the impaired ___________, that is characteristic of type 2 diabetes, there is enough insulin present to prevent the breakdown of fat and the accompanying production of ketone bodies. Therefore, DKA does not typically occur in type 2 diabetes.

Front 59

hyperglycemic hyperosmolar syndrome (HHS)

Back 59

DKA does not typically occur in type 2 diabetes. However, uncontrolled type 2 diabetes may lead to another acute problem— _____________.

Front 60

Type 2 diabetes symptoms

Back 60

If the patient experiences symptoms, they are frequently mild and may include fatigue, irritability, polyuria, polydipsia, poorly healing skin wounds, vaginal infections, or blurred vision (if glucose levels are very high).

Front 61

placental

Back 61

Hyperglycemia develops during pregnancy because of the secretion of ____________ hormones, which causes insulin resistance.

Front 62

Gestational diabetes

Back 62

occurs in as many as 18% of pregnant women and increases their risk for hypertensive disorders during pregnancy

Front 63

24 and 28

Back 63

If the high-risk women do not have gestational diabetes at initial screening, they should be retested between ____ and ____weeks of gestation, as well as all women with average risk.

Front 64

Low-risk women

Back 64

_________ are those who meet all of the following criteria: age younger than 25 years, normal weight before pregnancy, member of an ethnic group with low prevalence of gestational diabetes, no history of abnormal glucose tolerance, no known history of diabetes in first-degree relatives, and no history of poor obstetric outcome (

Front 65

105 mg/dL (5.8 mmol/L)

130 mg/dL (7.2 mmol/L)

Back 65

Goals for blood glucose levels during pregnancy are_____ mg/dL (5.8 mmol/L) or less before meals and________ mg/dL (7.2 mmol/L) or less 2 hours after meals

Front 66

Polyuria

Back 66

increased urination; occurs as a result of the excess loss of fluid associated with osmotic diuresis

Front 67

polydipsia

Back 67

increased thirst; occurs as a result of the excess loss of fluid associated with osmotic diuresis

Front 68

polyphagia

Back 68

increased appetite; results from the catabolic state induced by insulin deficiency and the breakdown of proteins and fats

Front 69

Diabetes manifestations

Back 69

polyuria, polydipsia, polyphagia

fatigue & weakness

sudden vision changes

tingling/numbness in hands or feet

dry skin

lesions or wounds that are slow to heal

recurrent infections

Front 70

Onset of type 1 diabetes

Back 70

The onset of _________ diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal pains, if DKA has developed.

Front 71

Criteria for diagnosis of diabetes

Back 71

Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200 mg/dL (11.1 mmol/L). Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss.

Front 72

Criteria for diagnosis of diabetes

Back 72

Fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.

Front 73

Criteria for diagnosis of diabetes

Back 73

Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.

Front 74

glucose tolerance

Back 74

A________ test is more effective in diagnosis than urine testing for glucose in older patients due to the higher renal threshold for glucose

Front 75

insulin

Back 75

The main goal of diabetes treatment is to normalize __________activity and blood glucose levels to reduce the development of vascular and neuropathic complications.

Front 76

Diabetes Laboratory Examination

Back 76

• Hgb A1C (A1C)

• Fasting lipid profile

• Test for microalbuminuria

• Serum creatinine level

• Urinalysis

• Electrocardiogram

Front 77

Diabetes: Need for Referrals

Back 77

• Ophthalmologist

• Podiatrist

• Dietitian

• Diabetes educator

• Others if indicated

Front 78

Diabetes: Physical Examination

Back 78

• Blood pressure (sitting and standing to detect orthostatic changes)

• Body mass index (height and weight)

• Funduscopic examination and visual acuity

• Foot examination (lesions, signs of infection, pulses)

• Skin examination (lesions and insulin injection sites)

• Neurologic examination

Vibratory and sensory examination using monofilament Deep tendon reflexes

• Oral examination

Front 79

euglycemia

Back 79

The therapeutic goal for diabetes management is to achieve normal blood glucose levels, or _________, without hypoglycemia while maintaining a high quality of life.

Front 80

Diabetes management

Back 80

__________ has five components: nutritional therapy, exercise, monitoring, pharmacologic therapy, and education.

Front 81

Nutritional management of diabetes includes the following goals:

To achieve and maintain:

Back 81

a. Blood glucose levels in the normal range or as close to normal as is safely possible

b. A lipid and lipoprotein profile that reduces the risk for vascular disease

c. Blood pressure levels in the normal range or as close to normal as is safely possible

Front 82

25 to 29

Back 82

overweight is considered to be a BMI of _____ to _______.

Front 83

30

Back 83

obesity is defined as 20% above ideal body weight or a BMI equal to or greater than ____.

Front 84

calories

Back 84

A meal plan for diabetes focuses on the percentages of ________ that come from carbohydrates, proteins, and fats.

Front 85

carbohydrate

Back 85

ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from __________, 20% to 30% from fat, and the remaining 10% to 20% from protein

Front 86

whole grains

Back 86

The majority of the selections for carbohydrates should come from _________ .

Front 87

300 mg/day

Back 87

Additional recommendations include limiting the total intake of dietary cholesterol to less than______ mg/day. This approach may help reduce risk factors such as increased serum cholesterol levels

Front 88

kidney disease.

Back 88

The meal plan may include the use of some nonanimal sources of protein (e.g., legumes, whole grains) to help reduce saturated fat and cholesterol intake. In addition, the amount of protein intake may be reduced in patients with early signs of ________.

Front 89

Fiber

Back 89

Increased ________ in the diet may improve blood glucose levels, decrease the need for exogenous insulin, and lower total cholesterol and low-density lipoprotein levels in the blood

Front 90

Soluble fiber

Back 90

__________slows stomach emptying and the movement of food through the upper digestive tract. The potential glucose-lowering effect of fiber may be caused by the slower rate of glucose absorption from foods that contain _____ fiber.

Front 91

Insoluble fiber

Back 91

___________ is found in whole-grain breads and cereals and in some vegetables. This type of fiber along with soluble fiber increases satiety, which is helpful for weight loss. At least 25 g of fiber should be ingested daily.

Front 92

starchy

Back 92

Combining __________ foods with protein- and fat-containing foods tends to slow their absorption and lower the glycemic index.

Front 93

raw and whole

Back 93

In general, eating foods that are_______ & _______results in a lower glycemic index than eating chopped, puréed, or cooked foods (except meat).

Front 94

glycemic index

Back 94

Eating whole fruit instead of drinking juice decreases the _________ , because fiber in the fruit slows absorption.

Front 95

sugars

Back 95

Adding foods with _______ to the diet may result in a lower glycemic index if these foods are eaten with foods that are more slowly absorbed.

Front 96

DKA

Back 96

Alcohol is absorbed before other nutrients and does not require insulin for absorption. Large amounts can be converted to fats, increasing the risk for_______ .

Front 97

hypoglycemia

Back 97

A major danger of alcohol consumption by the patient with diabetes is ________, especially for patients who take insulin or insulin secretagogues (medications that increase the secretion of insulin by the pancreas)

Front 98

insulin secretagogues

Back 98

medications that increase the secretion of insulin by the pancreas

Front 99

hypoglycemia

Back 99

Alcohol may decrease the normal physiologic reactions in the body that produce glucose (gluconeogenesis). Therefore, if a patient with diabetes consumes alcohol on an empty stomach, there is an increased likelihood of _______ .

Front 100

one; two

Back 100

Moderate intake is considered to be __ alcoholic beverage per day for women and __ per day for men.

Front 101

sorbitol

Back 101

Sweeteners containing ___________may have a laxative effect.

Front 102

Nonnutritive

Back 102

________ sweeteners include saccharin, aspartame (NutraSweet), acesulfame-K (Sunett), and sucralose (Splenda), produce minimal or no elevation in blood glucose levels and have been approved by the U.S. Food and Drug Administration (FDA) as safe for people with diabetes.

Front 103

General considerations for exercise in people with people with diabetes

Back 103

• Exercise 3 times each week with no more than 2 consecutive days without exercise.

• Perform resistance training twice a week (for people with type 2 diabetes).

• Exercise at the same time of day (preferably when blood glucose levels are at their peak) and for the same duration each session.

• Use proper footwear and, if appropriate, other protective equipment (i.e., helmets for cycling).

• Avoid trauma to the lower extremities, especially in patients with numbness due to peripheral neuropathy.

• Inspect feet daily after exercise.

• Avoid exercise in extreme heat or cold.

• Avoid exercise during periods of poor metabolic control.

Front 104

stress

Back 104

An abnormal _________ test may indicate cardiac ischemia. Typically, an abnormal __________ test is followed by a cardiac catheterization and, in some cases, with an intervention such as angioplasty, stent placement, or cardiac surgery.

Front 105

250 mg/dL

Back 105

Patients who have blood glucose levels exceeding_______ mg/dL (14 mmol/L) and who have ketones in their urine should not begin exercising until the urine test results are negative for ketones and the blood glucose level is closer to normal.

Front 106

insulin

Back 106

The physiologic decrease in circulating insulin that normally occurs with exercise cannot occur in patients treated with ____ .

Front 107

15-g

Back 107

Initially, patients who require insulin should be taught to eat a ________ carbohydrate snack (a fruit exchange) or a snack of complex carbohydrates with a protein before engaging in moderate exercise to prevent unexpected hypoglycemia.

Front 108

hypoglycemia

Back 108

Another potential concern for patients who take insulin is __________ that occurs many hours after exercise. To avoid postexercise___________, especially after strenuous or prolonged exercise, the patient may need to eat a snack at the end of the exercise session and at bedtime and monitor the blood glucose level more frequently.

Front 109

food

Back 109

Patients with type 2 diabetes who are not taking insulin or an oral agent may not need extra _____before exercise.

Front 110

Physical fitness

Back 110

_________ in the older adult population with diabetes may lead to improved glycemic control, decreased risk for chronic vascular disease, and an improved quality of life

Front 111

Plasma

Back 111

_______ glucose values are 10% to 15% higher than whole blood glucose values, and it is crucial for patients with diabetes to know whether their monitor and strips provide whole blood or plasma results.

Front 112

SMBG

Back 112

For patients not taking insulin, ________is helpful for monitoring the effectiveness of exercise, diet, and oral antidiabetic agents.

Front 113

SMBG

Back 113

For patients with type 2 diabetes, ______ is recommended during periods of suspected hyperglycemia (e.g., illness) or hypoglycemia (e.g., unusual increased activity levels) and when the medication or dosage of medication is modified

Front 114

before

Back 114

To evaluate basal insulin and determine bolus insulin doses, testing is performed ______ meals.

Front 115

after

Back 115

To determine bolus doses of regular or rapid-acting insulin (lispro [Humalog], aspart [NovoLog], or glulisine [Apidra]), SMBG testing is done 2 hours ______ meals.

Front 116

type 2

Back 116

Patients with ___________ diabetes are encouraged to test daily before and 2 hours after the largest meal of the day until stabilized.

Front 117

3 am

Back 117

Patients who take insulin at bedtime or who use an insulin infusion pump should also test at _________ once a week to document that the blood glucose level is not decreasing during the night.

Front 118

continuous glucose monitoring system (CGMS)

Back 118

After 72 hours, the data from the device are downloaded, and blood glucose readings are analyzed. Although the _________ cannot be used for making decisions about specific insulin doses, it can be used to determine whether treatment is adequate over a 24-hour period. This device is most useful in patients with type 1 diabetes

Front 119

120 DAYS

Back 119

This complex (hemoglobin attached to the glucose) is permanent and lasts for the life of an individual red blood cell, approximately _________ days.

Front 120

7%

Back 120

Normal values typically range from 4% to 6% and indicate consistently near-normal blood glucose concentrations. The target range for people with diabetes is less than _____.

Front 121

Ketones

Back 121

are by-products of fat breakdown, and they accumulate in the blood and urine;

signal that there is a deficiency of insulin and control of type 1 diabetes is deteriorating.

Front 122

purple

Back 122

Most commonly, the patient uses a urine dipstick (Ketostix or Chemstrip uK) to detect ketonuria. The reagent pad on the strip turns _________ when ketones are present.

Front 123

acetone

Back 123

One of the ketone bodies is called _______, and this term is frequently used interchangeably with the term ketone

Front 124

insulin

Back 124

_____________ is secreted by the beta cells of the islets of Langerhans and lowers the blood glucose level after meals by facilitating the uptake and utilization of glucose by muscle, fat, and liver cells.

Front 125

exogenous insulin

Back 125

In type 1 diabetes,_________must be administered for life because the body loses the ability to produce insulin.

Front 126

long-term

Back 126

In type 2 diabetes, insulin may be necessary on a_______ basis to control glucose levels if meal planning and oral agents are ineffective or when insulin deficiency occurs.

Front 127

Human insulins

Back 127

___________ are produced by recombinant deoxyribonucleic acid (DNA) technology and are the only type of insulin available in the United States.