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Pathology F10
Diabetes
| Question | Answer |
|---|---|
| Diabetes Mellitus | -chronic metabolic disorder characterized by abnormal regulation of glucose, resulting in hyperglycemia -defect in the secretion of insulin, action of insulin or both |
| Type 1 Diabetes- cause | occurs due to autoimmune destruction of the beta-cells of the pancreas leading to absolute insulin deficiency |
| Type 2 Diabetes- cause | peripheral resistance to insulin is presenet & hyperglycemia develops despite above-average levels of insulin |
| Gestational Diabetes | -diagnosed during pregnancy -50-60% of women with GDM develop type 2 in the following 5 years |
| Functions of the Pancreas | -functions as an endocrine gland to secrete hormones, insulin and glucagon -also as an exocrine gland by producing digestive enzymes |
| Islets of Langerhans | -alpha cells= secrete glucagon which increases blood glucose levels -beta cells= secrete insulin which decreases blood glucose levels -delta cells= secrete somatostatin which regulates the release of insulin and glucagon |
| Type 1 Diabetes- characteristics | -generally <30 yrs -autoimmune dysfunction -insulin deficiency -quick onset -NO oral meds are effective -shots to survive |
| Type 2 Diabetes- characteristics | -generally >30 yrs -heredity/ethnicity incr risk -history of GDM -resistance to insulin -slow onset -oral anti-hyerglycemic meds -HTN & lipids meds -injectables & insulin |
| Possessing 3 or more of these 5 characteristics indicates insulin resistance (type 2): | -increased blood glucose (>200mg/dl) -increased blood pressure (>130/80) -increased triglycerides (>150) -decreased HDL (good cholesterol) -<50 for women/<40 for males -increased central obesity (apple vs pear) -waist= >35 in for women; >40 in f |
| Diabetes Mellitus Incidence | -18.2 mill ppl have diabetes -1.3 mill new cases each yr -type 2 accounts for 90% of all cases -of ppl over 40, 12% have type 2 -of ppl over 60, 18.3% have type 2 ->$100 bill spent annually to treat diabetes & its resulting health probs |
| Prevalence of Diabetes in IN | -Indiana= 14th largest -nearly 338,000 of the 6 mill ppl in IN have diabetes -180,000 have diabetes but don't know it -7.5% of pop has diabetes vs 6.7% for the entire nation |
| Diabetes Stats | -leading cause of new blindness -leading cause of end-stage renal disease -3rd leading cause of death due to disease in US -diabetics are 2-4x more likely to develop heart disease -second leading cause of leg amputation behind only trauma |
| Criteria for diagnosis of DM | -symptoms of diabetes and a causal plasma glucose of 200mg/dl -fasting plasma glucose of 126 mg/dl -2 hr plasma glucose of 200 mg/dl during an oral glucose tolerance test |
| Glycoslated Hemoglobin | -may be used for diagnosis of DM -an estimated 2-3 month mean blood glucose level -6 to 6.5= considered diabetic |
| Facts on Gestational Diabetes | -usually occurs during the 24th to 28th week of pregnancy -every woman is tested -if gestational during one birth, more likely to be in the following births as well -usually end up having babies over 9 pounds |
| Risk to baby & mother with gestational diabetes | -baby= no diabetes but at risk for developing DM -post partum: 90% return to norm; 8% diagnosed w/ pre-diabetes; 2% diagnosed with type 2 -mother is at high risk of developing type 2 in next 5 to 10 yrs -returning to norm body weight decreases risk by |
| Signs and Symptoms of DM | -polyuria -polydipsia (incr thirst) -polyphagia (incr hunger) -weight loss (T1) -blurred vision -ketonuria (T1) -weakness, fatigue, dizziness -asymptomatic (T2) |
| Ketones | -byproduct of the body burning fat for energy -usually the result of prolonged hyperglycemia or increased blood sugar -without insulin, the glucose or energy source cannot enter the bloodstream; therefore, the body turns to burning fat. |
| Acute Complication of Diabetes | -hypoglycemia -diabetic ketoacidosis -hyperosmolar hyperglycemic state *must be treated immediately |
| Hypoglycemia | -blood glucose level < or = to 70 mg/dl -three potential causes: 1. too little food or delayed meals 2.unplanned exercise or too muh w/o eating 3.too much medicine -insulin or insulin stimulators |
| Signs and Symptoms of Hypoglycemia | -unconsciousness -rapid heart rate -sweaty and shaky -paleness -dizziness -agitated, not making sense |
| Treatment for conscious person with hypoglycemia | -15 g of fast acting carbs -Ex: 120 ml of sprite, 120 ml of apple juice, 3 glucose tabs, 120 ml of milk -recheck in 15 mins (15-15 rule) -repeat until BG > 80 mg/dl |
| Treatment for an Unconscious person with hypoglycemia | -IV access: turn on side, administer 50% dextrose over 5-10 mins -no IV access: administer glucagon 1mg SQ |
| Hyperglycemia | = blood glucose >130mg/dl fasting, 3 times in a row or a post meal glucose >160mg/dl (2hrs after eating) -if left untreated, can result in DKA or HHS |
| Signs and Symptoms of hyperglycemia | -polyuria (frequent urination) -polysipsia (excessive thirst) -polyphagia (excessive hunger) -blurred vision -headaches -slow wound healing -mental status changes *some ppl experience few symptoms |
| Pathogenesis of Type 1 diabetes | deficiency of insulin=metabolic problems: -Decreased utilization of glucose -Increased fat mobilization -Impaired protein utilization |
| Decreased utilization of glucose | -the liver, muscle, & fat cells do not take up glucose from the blood stream -Excessive glucose spills over into the urine -Glucose in the urine acts an osmotic diuretic -results in excessive fluid loss through urination -Thirst and dehydration can oc |
| Increased fat mobilization | -Bc glucose can't be used as energy, fat= broken down resulting in ketones -Ketones accumulate & disrupt acid-base balance -pH falls & can lead to metabolic acidosis -Ketones excreted into urine; osmotic diuresis leads to severe dehydration |
| Impaired protein utilization | -Amino acids not transported due to lack of insulin which in turn alters protein synthesis -Protein catabolism and protein loss impairs the body’s ability to repair tissue -slowed/non-existent wound healing; no energy to build or repair tissues |
| Diabetic Ketoacidosis (DKA) | -blood glucose levels rise too high & the body becomes very dehydrated & begins to burn an excessive amt of fat for energy -most serious metabolic disturbance of type 1 DM (mortality rate ~5%) |
| Hyperosmolar Hyperglycemic State (HHS) | the most serious metabolic disturbance in type 2 DM (mortality rate ~ 15%) |
Created by:
CWestrick
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