CMN 573 Unit 3: Diabetes & Endocrine
ESSENTIALS OF DIAGNOSIS: Type 1 diabetes - CORRECT ANSWER-Polyuria,
polydipsia, and weight loss associated with random plasma glucose of 200
mg/dL or fasting >126 on more than 1 occasion
Ketonemia, ketonuria, or both.
Islet autoantibodies are frequently present.
Essentials of Diagnosis: Type 2 Diabetes - CORRECT ANSWER-Polyuria and
polydipsia. Many patients have few or no symptoms.
Plasma glucose of 126 mg/dL or more after an overnight fast on more than one
occasion. Glucose >200 two hours after 75g oral glucose test
HbA1c 6.5% or more.
Hypertension, dyslipidemia, and atherosclerosis; >40yo and obese
Type 1 Diabetes caused by: - CORRECT ANSWER-due to pancreatic islet B cell
destruction predominantly by an autoimmune process
An absolute deficiency of insulin results in accumulation of circulating glucose
and fatty acids, with consequent hyperosmolality and hyperketonemia
Exogenous insulin is therefore required to reverse the catabolic state, prevent
ketosis, reduce the hyperglucagonemia, and reduce blood glucose
most important factor causing insulin resistance - CORRECT ANSWER-Obesity;
Visceral obesity, due to accumulation of fat in the omental and mesenteric
regions, correlates with insulin resistance;
subcutaneous abdominal fat seems to have less of an association with insulin
insensitivity.
,diet recommendations for type 2 DM - CORRECT ANSWER-limiting the
carbohydrate intake and substituting some of the calories with monounsaturated
fats, such as olive oil, rapeseed (canola) oil, or the oils in nuts and avocados, can
lower triglycerides and increase HDL cholesterol.
A Mediterranean-style eating pattern has been shown to improve glycemic
control and lower combined endpoints for cardiovascular events and stroke
max saturated fat and cholesterol intake - CORRECT ANSWER-10% of daily
calories and dietary cholesterol intake less than 300 mg/day
Sulfonylureas MOA - CORRECT ANSWER-The primary mechanism of action of
the sulfonylureas is to stimulate insulin release from pancreatic B cells
[Glipizide, Glimepiride]
*risk of hypoglycemia and weight gain
sites of injection for insulin - CORRECT ANSWER-body covered by loose skin
can be used, such as the abdomen, thighs, upper arms, flanks, and upper
buttocks
Rotation of sites is recommended to avoid delayed absorption when fibrosis or
lipohypertrophy occurs from repeated use of a single site
Symptoms of hypoglycemia - CORRECT ANSWER-tachycardia, palpitations,
sweating, tremors and parasympathetic (nausea, hunger) nervous system
symptoms
To prevent and treat insulin-induced hypoglycemia: - CORRECT ANSWER--carry
glucose tablets or juice at all times. For most episodes, ingestion of 15 grams of
carbohydrate is sufficient to reverse the hypoglycemia then recheck in 15
minutes and treat again if blood glucose low.
-A parenteral glucagon emergency kit (1 mg) Family or friends should be
instructed how to inject it subcutaneously or intramuscularly into the buttock, arm,
or thigh in the event that the patient is unconscious or refuses food. The
medication can occasionally cause vomiting, and the unconscious patient should
be turned on his or her side to protect the airway.
, The glucagon mobilizes glycogen from the liver, raising the blood glucose by
about 36 mg/dL (2 mmol/L) in about 15 minutes. After the patient recovers
consciousness, additional oral carbohydrate should be given.
-identification MedicAlert bracelet or necklace or carry a card in his or her wallet
Ocular complications of DM - CORRECT ANSWER--Cataracts
-Non-proliferative retinopathy (DM type 2):microaneurysms, dot hemorrhages,
exudates, and retinal edema
-Proliferative retinopathy (DM type 1): growth of new capillaries and fibrous tissue
within the retina and into the vitreous chamber. It is a consequence of small
vessel occlusion, which causes retinal hypoxia; this in turn stimulates new vessel
growth.
-Glaucoma
diabetic nephropathy - CORRECT ANSWER-Diabetic nephropathy is initially
manifested by albuminuria; subsequently, as kidney function declines, urea and
creatinine accumulate in the blood from high blood glucose
diabetic neuropathy - CORRECT ANSWER-peripheral: dulled perception of
vibration, pain, and temperature
Tx: Gabapentin, TCA's, SSRI's
autonomic: blood pressure and pulse, gastrointestinal activity, bladder function,
and erectile dysfunction. Treatment is directed specifically at each abnormality
cardiovascular complications of diabetes - CORRECT ANSWER-coronary
atherosclerosis leads to CAD, MI risks & PVD
*lower LDL
when to refer for diabetes patients: - CORRECT ANSWER--All Type 1 should
see an endocrinologists
-Type II only with complex regimen or goals continuously not met
-optho for dilated vision exams
-peripheral neuropathy should see podiatrist
ESSENTIALS OF DIAGNOSIS: Type 1 diabetes - CORRECT ANSWER-Polyuria,
polydipsia, and weight loss associated with random plasma glucose of 200
mg/dL or fasting >126 on more than 1 occasion
Ketonemia, ketonuria, or both.
Islet autoantibodies are frequently present.
Essentials of Diagnosis: Type 2 Diabetes - CORRECT ANSWER-Polyuria and
polydipsia. Many patients have few or no symptoms.
Plasma glucose of 126 mg/dL or more after an overnight fast on more than one
occasion. Glucose >200 two hours after 75g oral glucose test
HbA1c 6.5% or more.
Hypertension, dyslipidemia, and atherosclerosis; >40yo and obese
Type 1 Diabetes caused by: - CORRECT ANSWER-due to pancreatic islet B cell
destruction predominantly by an autoimmune process
An absolute deficiency of insulin results in accumulation of circulating glucose
and fatty acids, with consequent hyperosmolality and hyperketonemia
Exogenous insulin is therefore required to reverse the catabolic state, prevent
ketosis, reduce the hyperglucagonemia, and reduce blood glucose
most important factor causing insulin resistance - CORRECT ANSWER-Obesity;
Visceral obesity, due to accumulation of fat in the omental and mesenteric
regions, correlates with insulin resistance;
subcutaneous abdominal fat seems to have less of an association with insulin
insensitivity.
,diet recommendations for type 2 DM - CORRECT ANSWER-limiting the
carbohydrate intake and substituting some of the calories with monounsaturated
fats, such as olive oil, rapeseed (canola) oil, or the oils in nuts and avocados, can
lower triglycerides and increase HDL cholesterol.
A Mediterranean-style eating pattern has been shown to improve glycemic
control and lower combined endpoints for cardiovascular events and stroke
max saturated fat and cholesterol intake - CORRECT ANSWER-10% of daily
calories and dietary cholesterol intake less than 300 mg/day
Sulfonylureas MOA - CORRECT ANSWER-The primary mechanism of action of
the sulfonylureas is to stimulate insulin release from pancreatic B cells
[Glipizide, Glimepiride]
*risk of hypoglycemia and weight gain
sites of injection for insulin - CORRECT ANSWER-body covered by loose skin
can be used, such as the abdomen, thighs, upper arms, flanks, and upper
buttocks
Rotation of sites is recommended to avoid delayed absorption when fibrosis or
lipohypertrophy occurs from repeated use of a single site
Symptoms of hypoglycemia - CORRECT ANSWER-tachycardia, palpitations,
sweating, tremors and parasympathetic (nausea, hunger) nervous system
symptoms
To prevent and treat insulin-induced hypoglycemia: - CORRECT ANSWER--carry
glucose tablets or juice at all times. For most episodes, ingestion of 15 grams of
carbohydrate is sufficient to reverse the hypoglycemia then recheck in 15
minutes and treat again if blood glucose low.
-A parenteral glucagon emergency kit (1 mg) Family or friends should be
instructed how to inject it subcutaneously or intramuscularly into the buttock, arm,
or thigh in the event that the patient is unconscious or refuses food. The
medication can occasionally cause vomiting, and the unconscious patient should
be turned on his or her side to protect the airway.
, The glucagon mobilizes glycogen from the liver, raising the blood glucose by
about 36 mg/dL (2 mmol/L) in about 15 minutes. After the patient recovers
consciousness, additional oral carbohydrate should be given.
-identification MedicAlert bracelet or necklace or carry a card in his or her wallet
Ocular complications of DM - CORRECT ANSWER--Cataracts
-Non-proliferative retinopathy (DM type 2):microaneurysms, dot hemorrhages,
exudates, and retinal edema
-Proliferative retinopathy (DM type 1): growth of new capillaries and fibrous tissue
within the retina and into the vitreous chamber. It is a consequence of small
vessel occlusion, which causes retinal hypoxia; this in turn stimulates new vessel
growth.
-Glaucoma
diabetic nephropathy - CORRECT ANSWER-Diabetic nephropathy is initially
manifested by albuminuria; subsequently, as kidney function declines, urea and
creatinine accumulate in the blood from high blood glucose
diabetic neuropathy - CORRECT ANSWER-peripheral: dulled perception of
vibration, pain, and temperature
Tx: Gabapentin, TCA's, SSRI's
autonomic: blood pressure and pulse, gastrointestinal activity, bladder function,
and erectile dysfunction. Treatment is directed specifically at each abnormality
cardiovascular complications of diabetes - CORRECT ANSWER-coronary
atherosclerosis leads to CAD, MI risks & PVD
*lower LDL
when to refer for diabetes patients: - CORRECT ANSWER--All Type 1 should
see an endocrinologists
-Type II only with complex regimen or goals continuously not met
-optho for dilated vision exams
-peripheral neuropathy should see podiatrist
