Chapter 41

Question 1

What is Diabetes Mellitus?

Answer 1

Chronic hyperglycemia

Question 2

Diabetes mellitus results in defects in what?

Answer 2

-Insulin secretion
-Insulin action
-OR BOTH

Question 3

What is the most common form of DM?

Answer 3

Type 2 DM

Question 4

TYPE 1 DIABETES MELLITUS
-What is this characterized by?

Answer 4

Destruction of the B cells in the pancreas

Question 5

TYPE 1 DIABETES MELLITUS: Pathophysiology
-what are beta cells responsible for?

Answer 5

Insulin synthesis

Question 6

TYPE 1 DIABETES MELLITUS: Pathophysiology
-Explain what happens

Answer 6

1. B cells are destroyed
2. Insulin levels decrease EARLY in the disease
3. Insulin levels eventually fall to 0 as destruction progresses

Question 7

TYPE 1 DIABETES MELLITUS: Pathophysiology
-What do both types of Type 1 DM result in?
-What happens because of this?

Answer 7

-Absolute insulin deficiency (0)
-Glucose can’t enter muscle or adipose tissue

Question 8

TYPE 1 DIABETES MELLITUS: Pathophysiology
-What are the contributing factors?

Answer 8

1. Genetic predisposition
2. Environmental influences
3. Possible infectious agents

Question 9

TYPE 1 DIABETES MELLITUS
-What is Type 1A DM

Answer 9

Immune-mediated diabetes (most common)

Question 10

TYPE 1 DIABETES MELLITUS
-What is Type 1B DM?

Answer 10

Idiopathic (rare)

Question 11

TYPE 1 DIABETES MELLITUS
-Describe how glucagon becomes a problem

Answer 11

OVERproduction of glucagon by pancreatic alpha cells stimulates the break down of glycogen (glycogenolysis) & production of new glucose (gluconeogenesis)

Question 12

TYPE 1 DIABETES MELLITUS: Clinical Manifestations
-What are the Clinical Manifestations & how do you remember it?

Answer 12

3 P’s!!!
Polyuria
Polydipsia
Polyphagia

Question 13

TYPE 1 DIABETES MELLITUS: Clinical Manifestations
-What is polyuria?

Answer 13

Excessive urine output

Question 14

TYPE 1 DIABETES MELLITUS: Clinical Manifestations
-What is polydipsia?

Answer 14

Excessive thirst & drinking

Question 15

TYPE 1 DIABETES MELLITUS: Clinical Manifestations
-What is polyphagia?

Answer 15

Increased appetite

Question 16

TYPE 1 DIABETES MELLITUS: Diabetic Ketoacidosis
-Why does ketoacidosis happen?

Answer 16

Free fatty acids (FFAs) are transformed into ketones bc the cells can’t use glucose

Question 17

TYPE 1 DIABETES MELLITUS: Diabetic Ketoacidosis
-What kinds of respirations occur?
-Describe them.

Answer 17

-Kussmaul respirations
-Deep, labored respriations that are “fruity”

Question 18

TYPE 1 DIABETES MELLITUS: Diabetic Ketoacidosis
-Ketoacidosis occurs as a result of increased ____ & conversion to ____ ____

Answer 18

-lipolysis
-ketone bodies

Question 19

TYPE 1 DIABETES MELLITUS: Diabetic Ketoacidosis
-EXCESSIVE ketones result in what?
-What is this?

Answer 19

-Metabolic acidosis
-Decrease in pH & bicarbonate levels

Question 20

TYPE 1 DIABETES MELLITUS: Diabetic Ketoacidosis
-Ketoacidosis MAY occur with what else?
-When?

Answer 20

-Type 2 DM
-Under severe stress, sepsis, stroke, or MI

Question 21

TYPE 1 DIABETES MELLITUS: Diabetic Ketoacidosis
-What may also occur?

Answer 21

Acidosis-induced HYPERKALEMIA & compensatory HYPERventilation

Question 22

TYPE 2 DIABETES MELLITUS
-What is this characterized by?

Answer 22

Relative lack of insulin

Question 23

TYPE 2 DIABETES MELLITUS: Pathophysiology
-What do people have?
-What dysfunctions?

Answer 23

-Insulin resistance & impaired insulin secretion
-B cells

Question 24

TYPE 2 DIABETES MELLITUS: Pathophysiology
-Describe what is suspected in Type 2 DM

Answer 24

A decreased number of insulin receptors OR abnormal translocation of glucose transporters

Question 25

**TYPE 2 DIABETES MELLITUS**: *Pathophysiology* -As the disease progresses, what may be imparied?

Answer 25

Pancreatic insulin

Question 26

**TYPE 2 DIABETES MELLITUS** -Who is disproportionately affected?

Answer 26

Non-Caucasians & the elderly

Question 27

**TYPE 2 DIABETES MELLITUS** -What are 4 risk factors?

Answer 27

1. Female 2. Obesity 3. Aging 4. Sedentary lifestyle

Question 28

**TYPE 2 DIABETES MELLITUS**: *Clinical Manifestations* -What are they?

Answer 28

1. Polyuria 2. Polydipsia 3. Polyphagia 4. **WEIGHT LOSS**

Question 29

**TYPE 2 DIABETES MELLITUS** -What is uncommon?

Answer 29

Ketoacidosis

Question 30

**TYPE 2 DIABETES MELLITUS** -What can develop? -Who does it most commonly develop in? -What does it mean?

Answer 30

-Nonketotic hyperglycemic hyperosmolar coma -olderadults -Severe hyperglycemia with NO or SLIGHT ketosis and dehydration

Question 31

**DM SCREENING** -Who should be screened?

Answer 31

-All adults with a BMI > 25 -Asian Americans with a BMI > 23 -Have at least one other risk factor **regardless** of their age

Question 32

**ACUTE COMPLICATIONS** -What are they?

Answer 32

-DKA -Hypersomolar hyperglycemic state (HHS) -Hypoglycemia

Question 33

**CHRONIC MICROVASCULAR COMPLICATIONS** -What does this consist of?

Answer 33

-Retinopathy -Nephropathy -Neuropathy

Question 34

**CHRONIC MICROVASCULAR COMPLICATIONS** -What are the two types of neuropathy complications?

Answer 34

1. Autonomic complications 2. Sensory Dysfunction

Question 35

**CHRONIC MICROVASCULAR COMPLICATIONS** -What are autonomic complications?

Answer 35

1. GI disturbances 2. Bladder dysfunction 3. Tachycardia 4. Postural hypotension 5. Sexual dysfunction

Question 36

**CHRONIC MICROVASCULAR COMPLICATIONS** -What are sensory dysfunction?

Answer 36

1. Carpal tunnel syndrome 2. Paresthesias (lack of sensation in feet & lower legs)

Question 37

**CHRONIC MACROVASCULAR COMPLICATIONS** -What are they?

Answer 37

1. Atherosclerosis 2. CAD 3. Stroke 4. PAD