Diabetes (Patho 3)

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Diabetes (Patho 3)
2014-02-11 21:33:58

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  1. Secrete digestive juices into the duodenum.
  2. What do the Islets of Langerhans do?
    • Secrete hormones into blood:
    • beta cells secrete insulin
    • alpha cells secrete glucagon
    • delta cells secrete somatostatin
  3. Insulin increases ______ and decreases _______.
    • glycogen sythesis
    • gluconeogenesis
  4. Glucagon promotes ______ and increases _______.
    • glycogen breakdown
    • gluconeogenesis
  5. How does insulin affect fats?
    Prevents the breakdown of fat and glycogen
  6. How does insulin affect protein synthesis?
    increases it
  7. Insulin is ______ (building) in nature, whereas glucagon is ______ (breaking down) in nature.
    • anabolic
    • catabolic
  8. How does glucagon affect protein?
    • increases the transport of amino acids into hepatic cells
    • increases breakdown of proteins into aa's for use in gluconeogenesis
  9. What is the purpose of catecholamines?
    • help to maintain BGL during stress
    • (epi & NE)
  10. How does GH affect BGL?
    • increases protein synthesis in all cells
    • mobilizes fatty acids from adipose tissue
    • antagonizes the effects of insulin
  11. How do glucocorticoids affect BGL?
    • They are critical to the survival during pds of fasting and starvation
    • Stimulate gluconeogenesis by the liver
  12. What is Type 1 diabetes?
    • Loss of beta cell fxn
    • An absolute insulin deficiency
  13. What is type 1A diabetes?
    • Immune-mediates beta cell destruction
    • genetic predisposition
  14. What is Type 1B diabetes?
    • It's idiopathic
    • Strongly inherited
    • More common in blacks
  15. What is type 2 diabetes?
    • Impaired beta cell fxn and insulin secretion
    • peripheral insulin resistance
    • increased hepatic glucose production
  16. Chronic hyperglycemia can induce _________.
    beta cell desensitization ("glucotoxicity")
  17. Chronic elevation of free fatty acids can cause _____________.
    toxicity to beta cells ("lipotoxicity")
  18. What can be depositedin the beta cell that can cause dysfunction?
    amyloids (abnormal protein)
  19. What is polyuria?
    excessive urination
  20. What is polydipsia?
    excessive thirst
  21. What is polyphagia?
    excessive hunger
  22. Symptoms of hyperglycemia.
    • weight loss
    • recurrent blurred vision
    • fatigue
    • paresthesias
    • skin infection
  23. What is the target mg/dL for a fasting blood glucose test?
  24. What is the target mg/dL for a capillary bld test and for self-monitoring of capillary BGL (1-2 hr post-prandial)?
    less than 180
  25. WHat is the target % for glycated hemoglobin testing?
    less than 7%
  26. What is the metabolic syndrome?
    • -a group of s/s of people with DM
    • -"apple" shape (fat around middle)
    • -elevated triglycerides
    • -low HDL
    • -high BP
    • -fasting glucose 100 or higher
  27. Why do diabetics experience the "three p's"?
    • Cells are starving and shrinking -
    • there is high glucose in the blood so water moves into the vascular system & the kidneys work harder (more urine).  
    • Thirst because they are voiding all the liquid (cells starving)
  28. What do sulfonylureas do?
    • (oral anti-diabetic med)
    • increases insulin production through the pancreas via Ca++ channels
  29. How does repaglinide (prandin) work?
    • (oral anti-diabetic med)
    • increases insulin production through the pancreas via Ca++ channels
  30. What is the number ONE choice of oral anti-diabetic agents?
    Biguanides (metformen, glucafage)
  31. How do Biguanides (metformen, glucafage) work?
    • decrease insulin resistance (works on receptors)
    • cardioprotective
    • helps bring HDL & LDL to normal
  32. How do alpha-glucosidase inhibitors work?
    decrease glucose absorption
  33. What oral anti-diabetic agent can be given in conjunction with insulin?
    alpha-glucosidase inhibitors
  34. What oral anti-diabetic agent can be given for both Type 1 and Type 2 diabetes?
    alpha-glucosidase inhibitors
  35. How do thiazolideniones work?
    decrease insulin resistance
  36. What is the time frame for a short-acting type of insulin?
    works in 15 mins, lasts 3-5 hrs
  37. What is the time frame for a intermediate-acting type of insulin?
    lasts 12-16 hrs (it's cloudy)
  38. What is the time frame for a long-acting type of insulin?
    • up to 24 hrs
    • cumulative effect
  39. What is the risk of long-acting types of insulin?
    hypoglycemic attack
  40. What is the Somogyi Effect?
    • Hypoglycemia at night due to insulin dose at bedtime; 
    • Body rebounds and mobilizes glucose.
  41. What are some s/s of the Somogyi Effect?
    • morning headaches
    • night sweats
    • ketonuria
    • nightmares
  42. How can insulin doses be adjusted for the somogyi effect?
    Reduce bedtime insulin rather than increasing morning insulin
  43. What is the Dawn Phenomenon?
    Hyperglycemia early in morning due to release of GH during the night
  44. When is the Dawn Phenomenon most severe?
    In adolescents when the GH is peaking
  45. What complication of diabetes can lead to a coma?
    HHS (Hyperosmolar Hyperglycemic State)
  46. At what BGL is hypoglycemia?
    Less than 70 mg/dL
  47. What are some chronic microvascular complications of DM?
    • Neuropathy
    • Nephropathy
    • Retinopathy
    • Foot ulceration
  48. What are some chronic macrovascular complications of DM?
    • Cardiovascular
    • Stroke
  49. What is hPL?
    A placental hormone which antagonizes insulin produced by the placenta to give more food to the fetus when it's growing most.
  50. What causes gestational diabetes?
    The hPL hormone antagonizes insulin too much.
  51. When is gestational DM usually diagnosed?
    During 24-28 week glucose screen