Diabetes Mellitus

Front 1

Describe the process of insulin production.

Back 1

-The post meal rise of glucose triggers the release of insulin by the B-cells in the pancreas.

-The presence of insulin stimulates the diffusion of glucose into adipose and muscle tissue and inhibits the production of glucose by the liver.

-After diffusion into the cells may be oxidized for energy needs of the cell a process termed glycolysis.

-Most ingested glucose is utilized in glycogenysis (production of glycogen in the muscle and liver).

In the fasting state glucose is produced by glycogenolysis (breakdown of stored glycogen) in the liver and muscles and by gluconeogenesis (production of glucose from amino acids and other substances) in the liver.

- the primary source of energy to the muscle tissue in the fasting state is free acids produced by lipolysis (breakdown of fat from adipose tissue)

Front 2

What is type 1 diabetes mellitus?

Back 2

Is characterised by destruction of the B cells in the pancreas.

Front 3

What are the two forms of type 1 diabetes mellitus?

Back 3

1: Immune mediated
2: And idiopathic

Front 4

Clinical Manifestations of type 1 diabetes mellitus?

Back 4

Type 1 is characterised by a absolute insulin deficiency and thus glucose cannot enter muscles and adipose tissue.

-Glucose production by the liver is no longer opposed by insulin.

-Over production of glucagon by pancreatic a cells stimulates glycogenolysis and glyconeogenesis. Plasma blood glucose levels rise.

-When the max tubular absorption capacity of the kidneys is exceeded glucose is lost in the urine resulting in glycosuria and osmotic fluid loss which leads to hypovolemia.

- Neural tissue responds by promoting eating behavior;
* polydipsia
* polyuria
* Polyphagia
and weight loss

Front 5

What is type 2 diabetes?

Back 5

-People with type two diabetes are resistant to the action of insulin on the peripheral tissues and have a secretory defect in insulin production.

Front 6

What are the symptoms of type 2 diabetes?

Back 6

-Polydipsia
-Polyuria
-Polyphagia

Weight loss may be subtle or absent.

Front 7

What is Gestational Diabetes?

Back 7

Insulin resistance during pregnancy.

Front 8

Why does gestational diabetes occur?

Back 8

Because of the presence of placental hormones, weight gain, and because during pregnancy women require 2-3 times as much insulin as they do in a non-pregnant state women with gestational diabetes are unable to meet their needs.

Front 9

What are the complications of gestational diabetes?

Back 9

Can result in metabolic abnormalities or still birth. the most common is macrosomia (birthweight greater than 4kg) which is a result of increased glucose, free fatty acids and amino acids being delivered to the fetus.

Front 10

What is the treatment for gestational diabetes mellitus?

Back 10

Good diet, exercise, blood glucose and ketone monitoring if hyperglycemia persist insulin therapy should begin. Only glyburide will not cross the placental barrier so should therefore be used.

Front 11

What is acute hyperglycemia most commonly caused by?

Back 11

Alterations in nutrition, inactivity, inadequate use of anitdiabetic drugs

Front 12

What are the complications of hyperglycemia?

Back 12

The three P's
Polydipsia, polyuria and polyphagia

infections of the skin, urinary tract and vagina. Infections that particularly effect elderly patients include malignant otitis externa, necrotosing faciitis and persistant candidal infections (thursh). Tuberculosis infection and reactivation can be a particular problem in diabetic residents of extended care facilities. Nausea, fatigue, malaise, blurred vision.

Front 13

What are the two types of complications of chronic hyperglycemia?

Back 13

Either vascular or neuropathic

Front 14

What are the vascular complications?

Back 14

Macrovascular complications are defined as damage to the large blood vessels providing circulation to the brain, heart, and extremities. Such as;
*cardiovascular diseasea and stroke
*peripheral vascular disease

*

Front 15

What are the complications of microvascular disease?

Back 15

retinopathy and nephropathy (kidney damage)

Front 16

What are the neuropathic complications?

Back 16

Theya re divided into autonomic dysfunction and sensory dysfunction. Autonomic complications include gastrointestinal disturbances, bladder disfunction,orthostatic hypotension and sexual disfunction.

sensory disturbances include carpal tunnel syndrome and parasthesias or lack of sensation in the feet.

Front 17

What is the ideal BMI?

Back 17

20-24

Front 18

What class of drug would you use in the management of type 2 diabetes?

Back 18

Sulfonylureas- They exert their hypoglycemic effect by inducing insulin release by B cells, augmenting the action of insulin in glucose disposal, diminishing insulin clearance by the liver, and reducing glucose production.

Front 19

What is the initial way to control hyperglycemia in individuals with type 2 diabetes?

Back 19

Diet and exercise.

Front 20

The efficiency of therapy can be assessed by monitoring what two things?

Back 20

Blood glucose and HbA 1c levels.

Front 21

Is blood glucose monitoring better for assessing short or long term efficiency?

Back 21

Short-term

Front 22

Is HbA 1c better for assessing short term or long term efficiency?

Back 22

Long-term