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54 Cards in this Set

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Diabetes mellitus
a chronic multisystem disease related to abnormal insulin production, impaired insulin utilization, or both.
Population numbers for Diabetes
In the United States an estimated 20.8 million people, or 7% of the population, 41 million more people have prediabetes. More than 2 million Canadians have diabetes. Over 6 million people with diabetes mellitus are not diagnosed.
5th leading cause if death in the us?
Diabetes mellitus
Diabetes is the leading cause of ?
adult blindness, end-stage renal disease, and nontraumatic lower limb amputations. It is also a major contributing factor for heart disease and stroke.

about 73% of adults with diabetes have hypertension.
(ADA) recognizes how many different classifications of the disease?
11 different classifications
Some other common types of diabetes seen?
Gestational diabetes, prediabetes, and secondary diabetes are other classifications of diabetes commonly seen in clinical practice
highest incidence of diabetes is?
among Native Americans, 15% of whom are treated for diabetes.
Complications of diabetes are more common in?
Native Americans and African Americans than in whites.
normal glucose range
70 to 120 mg/dl (3.9 to 6.66 mmol/L).
average amount of insulin secreted daily by an adult is?
approximately 40 to 50 U, or 0.6 U/kg of body weight.
counterregulatory hormones
Other hormones (glucagon, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin.

These hormones work to increase blood glucose levels by stimulating glucose production and output by the liver, and by decreasing the movement of glucose into the cells.
Proinsulin
is composed of two polypeptide chains, chain A and chain B, which are linked by the C-peptide chain.


Insulin is released from the pancreatic β cells as its precursor, proinsulin, and is then routed through the liver.
useful indicator of β-cell function
Insulin is formed when enzymes cleave C off, leaving the A and B chains. The presence of C peptide in serum and urine.
Insulin promotes
glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell.
The rise in plasma insulin after a meal
stimulates storage of glucose as glycogen in liver and muscle, inhibits gluconeogenesis, enhances fat deposition in adipose tissue, and increases protein synthesis.
The fall in insulin level during normal overnight fasting
facilitates the release of stored glucose from the liver, protein from muscle, and fat from adipose tissue.
anabolic or storage hormone
Insulin
anabolic - characterized by or promoting constructive metabolism
insulin-dependent tissues
Skeletal muscle and adipose tissue
have specific receptors for insulin
insulin receptor sites on the liver
facilitate the hepatic uptake of glucose and its conversion to glycogen.
Although liver cells are not considered insulin-dependent tissue
Insulin peaks?
about 1 hour after a meal
Type 1 diabetes is the end result of
long-standing process in which the body's own T cells attack and destroy pancreatic beta (β) cells, which are the source of the body's insulin.
In addition, autoantibodies to the islet cells cause a reduction of 80% to 90% of normal β-cell function before hyperglycemia and other manifestations occur.
factors that may contribute to the pathogenesis of immune-related type 1 diabetes
A genetic predisposition and exposure to a virus
believed to be related to human leukocyte antigens (HLAs).

(HLA-DR3 and HLA-DR4)
type 1B diabetes
caused by nonimmune factors of unknown (idiopathic) etiologies
type 1A diabetes
Caused by an immune mechanism
honeymoon period usually lasts
3 to 12 months
Prediabetes,

also known as impaired glucose tolerance (IGT) or impaired fasting glucose
is a condition in which blood glucose levels are higher than normal (>100 mg/dl [5.56 mmol/L] but <126 mg/dl [7.0 mmol/L] when fasting) but not high enough for a diagnosis of diabetes
accounting for over 90% of patients with diabetes
Type 2 diabetes mellitus
Type 2 diabetes mellitus
the pancreas usually continues to produce some endogenous (self-made) insulin. However, the insulin that is produced is either insufficient for the needs of the body and/or is poorly utilized by the tissues.
MODY
is a kind of type 2 diabetes that accounts for 1% to 5% of people with diabetes and is a result of a defect in a single gene.
maturity-onset diabetes of the young
Most insulin receptors are located?
on skeletal muscle, fat, and liver cells.
FPG
Fasting plasma glucose
OGTT
oral glucose tolerance test
adiponectin and leptin
The two main adipokines believed to affect insulin sensitivity
Metabolic syndrome
is a cluster of abnormalities that act synergistically to greatly increase the risk for cardiovascular disease and diabetes.
Metabolic syndrome is characterized by
insulin resistance, elevated insulin levels, high levels of triglycerides, decreased levels of high-density lipoproteins (HDLs), increased levels of low-density lipoproteins (LDLs), and hypertension
Risk factors for metabolic syndrome include, but are not limited to,
central obesity, sedentary lifestyle, urbanization/Westernization, and certain ethnicities (Native Americans, Hispanics, and African Americans).
Gestational diabetes
develops during pregnancy and occurs in about 4% of pregnancies in the United States. It is detected at 24 to 28 weeks of gestation, usually following an oral glucose tolerance test (OGTT). Women with gestational diabetes have a higher risk for cesarean delivery, perinatal death, and neonatal complications.
Although most women with gestational diabetes will have normal glucose levels within 6 weeks postpartum, their risk for developing type 2 diabetes in 5 to 10 years is increased.
Secondary Diabetes
Diabetes occurs in some people because of another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels.
Secondary Diabetes diseases and drugs causing it
These include Cushing syndrome, hyperthyroidism, recurrent pancreatitis, cystic fibrosis, hemochromatosis, and the use of parenteral nutrition. Commonly used medications that can induce diabetes in some people include corticosteroids (prednisone), thiazides, phenytoin (Dilantin), and atypical antipsychotics (e.g., clozapine [Clozaril])
Secondary diabetes usually resolves when the underlying condition is treated.
Some of the more common manifestations associated with type 2 diabetes include
fatigue, recurrent infections, recurrent vaginal yeast or monilia infections, prolonged wound healing, and visual changes
Unfortunately, the clinical manifestations appear so gradually that an individual may blame the symptoms on another cause, such as lack of sleep or increasing age, and before the person knows it, he or she may have complications.
lipodystrophy
a condition that produces lumps and dents in the skin from repeated injection in the same spot.
insulin pump
a small battery-operated device that resembles a standard paging device in size and appearance.

the pump is connected via plastic tubing to a catheter inserted into the subcutaneous tissue in the abdominal wall. Every 2 to 3 days the insertion site must be changed to avoid site infection and to promote good insulin absorption. The pump is then refilled with insulin and reprogrammed. The device is programmed to deliver a continuous infusion of rapid-acting or short-acting (regular) insulin 24 hours a day, known as the “basal rate.” At mealtime, the user programs the pump to deliver a bolus infusion of insulin appropriate to the amount of carbohydrate ingested and to bring down high premeal blood glucose, if necessary.
Exubera
is a rapid-acting, dry-powder form of insulin that is inhaled through the mouth into the lungs before eating via a specially designed inhaler.
Lipodystrophy
(atrophy of subcutaneous tissue) may occur if the same injection sites are used frequently. It is best prevented by rotation of injection sites.
Hypertrophy
a thickening of the subcutaneous tissue, eventually regresses if the patient does not use the site for at least 6 months. The use of hypertrophied sites may result in erratic insulin absorption.
The Somogyi effect
is a rebound effect in which an overdose of insulin induces hypoglycemia. Usually occurring during the hours of sleep, the Somogyi effect produces a decline in blood glucose level in response to too much insulin. Counterregulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia and ketosis.
The dawn phenomenon
is characterized by hyperglycemia that is present on awakening in the morning due to the release of counterregulatory hormones in the predawn hours. It has been suggested that growth hormone and cortisol are possible factors in this occurrence.
Oral agents (OAs)
are not insulin, but they work to improve the mechanisms by which insulin and glucose are produced and used by the body.

OAs work on the three defects of type 2 diabetes: (1) insulin resistance, (2) decreased insulin production, and (3) increased hepatic glucose production.
OAs may be used in combination with agents from other classes or with insulin to achieve blood glucose targets.
The primary action of the sulfonylureas
is to increase insulin production from the pancreas.
glipizide (Glucotrol, Glucotrol XL), glyburide (Micronase, DiaBeta, Glynase), and glimepiride (Amaryl)
Meglitinides
increase insulin production from the pancreas. But because they are more rapidly absorbed and eliminated, they offer a reduced potential for hypoglycemia. When taken just before meals, pancreatic insulin production increases during and after the meal, mimicking the normal blood glucose response to eating.
Patients should be instructed to take meglitinides anytime from 30 minutes before each meal right up to the time of the meal. They should not be taken if a meal is skipped.
Biguanides
glucose-lowering agent. It can be used alone or with sulfonylureas, other OAs, or insulin to treat type 2 diabetes. The primary action of metformin is to reduce glucose production by the liver. It also enhances insulin sensitivity at the tissue level and improves glucose transport into the cells.
Besides being an effective blood glucose–lowering agent, metformin has other advantages
α-Glucosidase Inhibitors
Also known as “starch blockers,” these drugs work by slowing down the absorption of carbohydrate in the small intestine. Acarbose (Precose) and miglitol (Glyset) are the available drugs in this class.
Taken with the first bite of each main meal, they are most effective in lowering postprandial blood glucose. Effectiveness of these medications is measured by checking 2-hour postprandial glucose levels. Medications from this class are not effective against fasting hyperglycemia.
Thiazolidinediones
Sometimes referred to as “insulin sensitizers,” these agents include pioglitazone (Actos) and rosiglitazone (Avandia). They are most effective for people who have insulin resistance. They improve insulin sensitivity, transport, and utilization at target tissues.
Because they do not increase insulin production, thiazolidinediones will not cause hypoglycemia when used alone, but the risk is still present when a thiazolidinedione is used in combination with a sulfonylurea or an insulin. Patients taking these medications may experience a secondary benefit of improved lipid profiles and blood pressure levels.
Dipeptidyl peptidase-4 (DDP-4) inhibitors
The incretin hormones are normally inactivated by DDP-4. These medications inhibit DDP-4, thus slowing the inactivation of incretin hormones. When glucose levels are normal or elevated, incretins increase insulin synthesis and release from the pancreas, as well as decrease hepatic glucose production.
Incretin hormones are released by the intestines throughout the day but levels increase in response to a meal. Incretins are part of the physiologic process that regulates glucose homeostasis.