Final Exam Diabetes Mellitus Type 1 o Causes Insulin Deficiency glucose cannot move into cells therefore glucose retains in the blood hyperglycemia Idiopathic loss of function of beta cells Autoimmune or viral damage to beta cells autoammune Glut 4 cannot be activated 5 10 of all diagnosed diabetes cases Requires exogenous insulin adding insulin to the body o Symptoms Hyperglycemia Polyuria and Polydipsia increased urine and thirst Ketoacidosis Excrete more electrolytes in order to buffer o Treatment The overall goal is to stabilize blood glucose levels Insulin injection 3 injections day Diet Reduce CHO intake overall energy intake and timing of eating Type 2 o Causes older age o Treatment Insulin resistance and Beta cell failure increases due to obesity Body produces insulin but it cannot respond 90 95 of cases Endogenous insulin levels may be normal depressed or elevated Progressive disease hyperglycemia develops gradually and may not cause the classic symptoms of type 1 diabetes Risk Factors obesity physical inactivity diet family history Reduce energy intake increase energy expenditure Exercise can cause weight loss and may promote tissues to rebuild their sensitivity to insulin Medications Metformin Suppresses hepatic glucose production glucophage Insulin secretagogues sulfonylureas promote insulin secretion by beta cells glucotrol Thiazolidinediones decreases insulin resistance in peripheral tissues avandia Insulin restores glycemia Gestational Diabetes o Glucose intolerance with onset or first recognition during pregnancy o Generally diagnosed during 2nd or 3rd trimester of pregnancy o Diagnoses Fasting glucose more than 92 mg dL 1 hour glucose more than 180 mg dL 2 hour glucose more than 153 mg dL o Occurs in about 7 of pregnancies Excessive weight gain or obese women have high incidences o Women in GDM have 40 60 chance of developing diabetes over the o 75g glucose given orally and blood glucose level measured 2 hours later o Autonomic or adrenergic symptoms shakiness sweating anxiety o Neuroglycopenic symptoms slow performance difficult concentration next 5 10 years Diagnoses of DM Fasting plasma Glucose Casual Plasma glucose any time of the day Oral glucose tolerance test Hemoglobin A1c 5 7 is normal o Reflects what happens over 3 months Blood Glucose Values Normal Fasting 60 100mg dL Diabetes 126 mg dL or 6 5 Hypoglycemia occurs in diabetics or non diabetics Symptoms confusion Causes o More insulin or medication than food o Inadequate food intake o Increase physical activity o Alcohol with no food o Match insulin medication with meals o Have snack before exercise Prevention Treatment o 15 15 rule cup fruit juice 2 3 glucose tablets 506 pieces of candy Hyperglycemia Diavetic Ketoacidosis DKA BG 200 mg dL but 600 mg dL Symptoms polyuria polydipsia hyperventilation dehydration DKA is life threatening but reversible by replacing insulin food and electrolytes Dawn phenomenon insulin declines before dawn or overnight hepatic glucose production increases so insulin decreases and glucagon increases Somogyi effect hypoglycemia followed by a rebound hyperglycemia caused by excessive exogenous insuliun hepatic glucose production stimulated Long Term Effect Macrovascular Diseases dyslipidemia and hypertension Microvascular Diseases o Neuropathy Peripheral Damage to sensory motor or autonomic nerves Decreased feeling in hands and feet numbness burning sensations weakness no coordination GIT and bladder issues Complications reduces feeling sores and bruises infection o Retinopathy Damage to blood vessels in the back of the retina Spots of darkness blurred vision fluctuating vision disordered color vision Non proliferative Blood vessels in the retina are weak Microaneurysms Bulges protruding from the vessel walls leaking fluid into the retina Small vessels close while large vessels dilate Nerve fibers swell Macular edema central vision is compromised Proliferative New capillaries form to compensate for decreased blood and O2 flow Fragile and prone to bleeding Scar tissues retinal detach Glaucoma increased pressure in the eye o Nephropathy decreased kidney function Persistent albuminura 300 mg d or 200ug min Progressive decline in the glomerular filtration rate Elevated arterial blood pressure Can lead to kidney failure Dialysis Both types filter your blood to rid your body of harmful wastes extra salt and water When kidney function decreases to 10 15 of normal 3 4 hours 3 4 times a week o Types of Dialysis Hemodialysis AV fistula joins arteries at wrist and bypass one AV graft Catheter Peritoneol passive diffusion of toxins through peritoneum Diet Diabetes and Dialysis o Diabetes continue with CHO controlled o Dialysis Fluids beverage soup ice cream veggies etc Na K Ne 8 10oz protein Atherosclerosis hardening of arterial walls and decreased blood flow Primarily affects o Coronary supply heart muscle o Vessels of lower extremities Leads to Coronary Artery Disease Plaque formation o Endothelium Damage single layer of cells lining lumen o LDL penetrate endothelium o Aggregation of platelets monocytes T lymphocytes Macrophages take up LDL foam cell Growth factors released from platelets and macrophages Growth factors stimulate smooth muscle cell growth and attract more macrophages Smooth muscle cells accumulate LDL as foam cells Foam cells increase so their lipid content accumulate fatty streaks o Arterial narrowing Decreased blood flow Increased blood pressure o Vessel compensate by vasodilation o Increased pressure causes crack in plague more endothelial damage Platelet aggregation o Platelet aggregation Continued narrowing of vessels If loose blood clot can get stuck in narrowed vessels o Total blockage by plague Myocardial infarction Stoke Poor circulation in lower extremeties This is the order it all happens fatty streaks early plaque arterial narrowing localized slowing of blood cracks in plaque platelet recruitment blood clot cut off oxygen supply myocardial infarction o When it gets super narrow a stent can be entered into the vessel This allows the opening of the vessel for blood flow in that area o Another surgery is CABG Coronary Artery Bypass Graft Causes of Endothelial damage Foam cells erupts Oxidized LDL damaged LDL more likely to deposit cholesterol on arteries High Blood pressure especially when foam cells are already present Cigarette smoking o Increased endothelial cell death o Accelerates atherosclerotic lesion formation o Source of free radicals o Decreased NO2
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