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Pathology F10

Diabetes

QuestionAnswer
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