306 Diabetes

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KristaDavis
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170307
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306 Diabetes
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2012-09-12 23:48:54
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306 Diabetes
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Exam 1
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  1. Abnormality in blood glucose regulation and nutrient storage related to an absolute deficeincy of insulin or resistance to that actions of insulin
    Diabetes mellitus
  2. Glucose Metabolism
    • Glucose breaks down to form Carbon Dioxide and Water...
    • *the BRAIN and NERVOUS systems rely almost exclusively on glucose metabolism
  3. Glycogenolysis
    *Glycogen is broken down into glucose when glucose levels fall belowe normal (as they do between meals)
  4. Gluconeogenesis
    Liver syntehesis of glucose from amino acids, glycerol, and lactic acid
  5. Actions of Insulin:
    • *Promote target cell glucose uptake
    • *Promotes Glucose storage (glycogen)
    • *Inhibits gluconeogenesis
    • *Inhibits fat, protein, & glycogen breakdown
    • *Increases protein synthesis
    • *Transports glucose to fat cells
    • *Facilitates K+ transport into cells
  6. How do you measure the insulin levels in the blood?
    C-peptide levels (indicating Beta cell functioning)
  7. How is Insuling transported?
    • *From beta cells travels to liver
    • *50% used up or degraded
    • *Half life of about 15 mins
    • *Binds to & activates membrane receptor
    • *Activated receptor acts on cell
  8. Actions of Glucagon:
    -Produced by pancreatic alpha cells

    -Fosters glycogenolysis

    -Stimulates gluconeogenesis

    -Stimulates lipolysis

    -Maintains blood glucose between meals

    -Maintains blood glucose in fasting

    -Antagonistic to insulin
  9. Glucose Regulating Hormones and Effects:
    • -Amylin
    • -Somatostatin
    • -Gut-derived hormones

    • Effects: 
    • •Decreases gluconeogenesis
    • •Decreases gastric emptying
    • •Increases satiet
  10. Hormones that counteract the storage functions of insulin in regulatory blood glucose levels during periods of fasting, exercise and other situations that either limit glucose intake or deplete glucose stores
    Counterregulatory Hormones
  11. Examples of Counterregulatory Hormones:
    • Epinephrine
    • Growth Hormone
    • Glucocorticoid Hormones
  12. What do blood glucose levels reflect?
    *The difference between the amount of glucose released into the circulation by the liver and the amount of glucose removed from the blood by body tissues
  13. How does insulin work?
    Insulin's blood glucose-lowering action results from its ability to increase the transport of glucose into body cells and decrease hepatic production and release of glucose into the bloodstream
  14. Counteregulatory Hormones that INCREASE blood glucose:
    *Epinephrine *Growth Hormone *Cortisol 
  15. Manifestations of Type 1 Diabetes:
    • *Polyphagia
    • *Polydipsia
    • *Polyuria
    • *Wt. loss, fatigue
    • *Ketosis
  16. Manifestations of Type 2 Diabetes:
    • *—3 P’s possible
    • *—Pruritis
    • —*Visual changes
    • —*Fatigue
    • —*Recurrent infections, slow wound healing
  17. Pathophysiology of Type 2 Diabetes:
    • Insulin resistance
    • Beta cell dysfunction
  18. Risk Factors Increasing chances of Gestational Diabetes:
    —Family history

    —Ethnicity

    —Age > 25 yrs. old

    —Polycystic ovarian syndrome

    —Prior history

    —BMI > 25
  19. Diagnoses of Diabetes:
    *Fasting Blood Glucose (BG) > 126 mg/dL on 2 checks

    —Normal <100 mg/dL

    —Impaired fasting glucose = BG 100 -126 mg/dL

    *Random BG > 200 with symptoms

    *Glucose Tolerance Test – Abnormal > 200 mg/dL at 2 hrs post 75Gm glucose load

    *Glycosylated Hemoglobin (HgA1c or A1C)

    —Normal < 6%

    —Goal for DM < 7%

    —Only measures control of DM
  20. Hypoglycemia
    *Excess blood insulin

    *Below normal blood glucose level  (<65 mg/dL)

    *Common in insulin users
  21. Manifestations of Hypoglycemia:
    • Headache
    • Sweating
    • Impaired Vision
    • Dizziness
    • Tachycardia
    • Hunger
    • Diaphoresis, Pallor, Tremors, Seizures, Shaking, Irritability Anxiety
  22. Precipitating Factors of Hypoglycemia:
    • *Lack of food intake
    • *Insulin dose error
    • *Medication dose change
    • *Increased exercise
    • *Alcohol intake
  23. Treatment for Hypoglycemia:
    *Provide quick source of sugar
  24. Somagyi Effect
    • Hypoglycemia  ---->
    • compensatory stimulation of glucagon, catecholamines, cortisol, & GH  ---->
    • produce gluconeogenesis ---->
    • rebound hyperglycemia
  25. Dawn Phenomenon
    • *Increased fasting blood glucose &/or insulin requirements
    • *Types 1 & 2 diabetes
    • *Altered glucose tolerance  & circadian rhythm
    • *Nocturnal GH
    • *Mild to profound hyperglycemia
  26. Acute Complications of Diabetes Mellitus
    • *Somagyi Effect
    • *Dawn Phenomenon
    • *Diabetic Ketoacidosis
    • *Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNS)
  27. Diabeteic Ketoacidosis
    • *Type 1 diabetes
    • *No insulin to use glucose
    • *Increased liver glucose production
    • *Peripheral glucose use decreased
    • *Fat breakdown  ---> fatty acids ---> ketone production
    • *First diagnosis of diabetes for many
  28. Hallmark of DKA (Diabetic Ketoacidosis)
    • *Ketosis
    • *Hyperglycemia
    • *Metabolic acidosis
  29. Manifestations of Diabetic Ketoacidosis:
    • -Polyuria
    • -Polydipsia
    • -Dehydration
    • -Electrolyte imbalances
    • -Nausea
    • -Vomiting
    • -Fatigue
    • -Abdominal pain
    • -Fruity breath
    • -Low BP
    • -Tachycardia
    • -Kussmaul respiration
  30. HHNS
    • -Type 2 DM
    • -Hyperglycemia
    • -Hyperosmolarity
    • -Dehydration
    • -Ketones absent
    • -Depressed neurological state
  31. Precipitating Factors to HHNS (Hyperglycemic Hyperosmolar Non-ketonic Syndrome)
    • -Severe infections
    • -MI
    • -Acute pancreatitis
    • -Parenteral nutrition solutions
    • -Increased resistance to insulin
    • -Carbohydrate intake in excessive quantities
  32. Manifestations of HHNS
    ¢  Polyuria

    ¢  Polydipsia

    ¢  Excessive thirst

    ¢  Dehydration

    ¢  Seizures

    • ¢  Aphasia
    • ¢  Hypothermia

    ¢  Hypotension

    ¢  Tachycardia

    ¢  Nystagmus

    ¢  Hallucinations

    ¢  Coma
  33. CHRONIC complications of Diabetes:
    ¢MICRO-VASCULAR

    ¢Retinopathy

    ¢Nephropathy
  34. Micro-vascular chronic complications of diabetes:
    ¢Coronary artery disease

    ¢Cerebrovascular disease

    ¢Peripheral vascular disease

    ¢Foot ulcers
  35. Neuropathy chronic complications of Diabetes:
    • —Somatic
    • —  -Peripheral

    —Manifestations on body systems

    ¢Gastroparesis

    ¢Neurogenic bowel & bladder

    ¢Orthostatic hypotension
  36. Infections often occuring in people that have Diabetes:
    ¢ Urinary Tract Infection (UTI)

    ¢ Candida

    ¢ Soft tissue- extremities

    ¢ Tuberculosis (TB)

    ¢ Pyelonephritis

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