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39 Cards in this Set
- Front
- Back
- 3rd side (hint)
What are predisposing factors for diabetes?
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• Adrenal tumors/hyperplasia
• Disease of pancreas • Exhausion of beta cells (usually preceded by hypoglycemia) • Induced by growth hormone & cortisol • Heredity • Obesity • Pituitary tumors |
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What are some effects of diabetes on the body?
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• vascular damage: walls of small arteries become thickened, occluding the lumen (causing damage to kidneys, nerves, retina, & feet)
• abnormal fat metabolism (causes ketosis, acidosis, coma, & gallstones) • elevated glucose enhances infections |
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What do beta cells produce?
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Insulin, which moves glucose into tissues
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What do alpha cells produce?
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glucagon, which antagonizes insulin by releasing glycogen from the liver
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What do delta cells produce?
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somatostatin, which inhibits release of glucagon & insulin and inhibits GI motility
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What is gluconeogenesis?
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synthesis of glucose by the liver from amino acids, glycerol, and lactic acid
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What are functions of insulin?
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• only hormone in the body that lowers sugar
• enables cells to metabolize glucose • inhibits gluoneogenesis • increases protein synthesis • inhibits conversion of protein to glucose • promotes glucose uptake by cells • promotes storage of fat & inhibits breakdown of fat • promotes storage of glycogen |
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What are effects of catecholamines on insulin and glucose?
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• decreases insulin
• decreases movement of glucose into cells • increases glycogenolysis • mobilizes fatty acids |
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What are effects of growth hormone?
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• antagonizes insulin
• decreases cell use of glucose • increases protein synthesis • increases fat burning • GH release inhibited by insulin & glucose • GH release enhanced by fasting, heavy exercise, trauma, & fever |
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What is the most powerful glucocorticoid?
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cortisol
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What are functions of glucocorticoids?
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• stimulates gluconeogenesis
• slightly decreases tissue use of glucose |
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What are stimulate production of glucocorticoids?
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• anxiety
• hypoglycemia • infection • pain, trauma, surgery • strenuous exercise |
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What is the definition of diabetes?
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• disorder of carbohydrate, protein, and fat metabolism by relative deficiency of insulin
• fasting blood glucose > 126 • random blood glucose > 200 with signs/symptoms |
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What are characteristics of Type 1 Diabetes?
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• 20% of all diabetes
• due to destruction of beta cells • no insulin is produced at all |
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Name and describe the 2 different classes of type 1 diabetes?
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• 1A is due to immune destruction of beta cells (used to be called juvenile diabetes)
• 1B is idiopathic |
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What are characteristics of type 2 diabetes?
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• 80% of all diabetes
• seen in older, overweight individuals (but rate in adolescents is increasing) • patients have truncal & intra-abdominal obesity |
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What are defects that may cause type 2 diabetes?
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• cellular resistance (eventual beta cell exhaustion)
• increased gluconeogenesis • impaired production of insulin • neutralization by antibodies |
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What are secondary causes of diabetes?
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• chemical toxins (nitrosamine)
• drugs • gestational diabetes • pancreatic disease, severe chronic pancreatits, or surgical removal • infections (mumps, rubella, coxsackie) |
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List some drugs that cause diabetes?
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• BCP • cortisol • dilantin • levodopa • phenothiazines • thiazides
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How and when do you screen for gestational diabetes?
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screen at 24 weeks with a oral glucose tolerance test
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True/False: If diet does not control gestation diabetes, insulin and oral agents can be used.
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Only use insulin. Oral agents are contraindicated. The correct answer is: False
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What is clinical presentation of type 1 diabetes?
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• usually sudden onset
• polydipsia, polyuria, polyphagia • weight loss |
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What is the clinical presentation of type 2 diabetes?
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• slow onset
• overweight • polyuria, polydipsia • blurred vision • fatigue • paresthesias • skin infections (esp. toenails & yeast infections) |
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What is the most important aspect in treatment of diabetes?
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• diet
• need consistent food intake and exercise • weight loss is essential |
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What is MOA of sulfonylureas?
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• stimulates beta cells to release more insulin
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What is the MOA of Biguanides (such as Metformin)?
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• increases cell sensitivity to insulin
• decreases gluconeogenesis |
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What is MOA of glucosidase inhibitors?
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• delays absorption of glucose from intestine
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What are characteristics of diabetic ketoacidosis (DKA)?
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• usually seen in type 1
• hyperglycemia • ketosis (positive urine dipstick) • metabolic acidosis (HCO3 < 15, pH < 7.3) |
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What are signs and symptoms of DKA?
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• abdominal pain
• breath smells like booze • nausea/vomiting • polyuria • polydipsia |
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What are characteristics of Hyperglycemia, hyperosmolar, non-ketotic coma (HHNK)?
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• onset 2 days - 2 weeks
• osmolarity > 310 • Glucose > 600 • usually seen with type 2 (exhibiting increasing insulin resistance) • presents w/ marked dehydration and CNS signs/symptoms mimicking a stroke • must correct slowly to prevent cerebral edema (watch K+ levels) |
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What are causes of hypoglycemia?
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• did not eat enough (or forgot)
• too much insulin (or pills) • did not allow for exercise |
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What are manifestations of hypoglycemia?
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• CNS: confusion, delirium, coma
• Autonomic: hunger, anxiety, sweating, tachycardia |
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What is the treatment for hypoglycemia?
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• if conscious, give OJ
• or injection of glucagon, glucose gel in mouth, or 50% glucose by IV push |
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What are peripheral neuropathic complications of diabetes?
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• obstruction of vessels that supply nerves
• demyelination • sensory deficits (paresthesias, decreased pain, temp, & light touch sensation, decreased proprioception & vibration • motor deficits (weakness & atrophy) |
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What are central & autonomic neuropathic complications of diabetes?
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• atonic urinary bladder
• GI atony • Impotence • Impairment of special senses • Orthostatic hypotension |
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What are some hormones that the body releases overnight that raise blood glucose levels?
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• Growth Hormone from the anterior pituitary gland
• Cortisol from the adrenal cortex • Glucagon from pancreatic alpha-cells • Epinephrine |
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What is the "Dawn Effect"?
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an early morning increase in glucose (usually between 4 - 11 am)
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What is the Somogyi effect?
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• The tendency of blood sugar to rise as a result of low blood sugar
• Low blood sugar can trigger release of hormones such as glucagon that raise blood sugar |
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How do you tell the difference between the Dawn Effect & the Somogyi effect?
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• check blood glucose at 2 or 3 am
• low blood glucose levels » Somogyi effect (rebound of high morning glucose due to low overnight) • normal - high blood glucose levels » Dawn phenomenon |
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