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39 Cards in this Set

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