Final Exam! Diabetes Mellitus- Type 1o Causes Insulin Deficiency- glucose cannot move into cells, therefore, glucose retains in the blood (hyperglycemia)- Autoimmune or viral damage to beta-cells- autoammune- Idiopathic: loss of function of beta cells- 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 buffero 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 2o Causes 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, older ageo Treatment 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 Diabeteso Glucose intolerance with onset or first recognition during pregnancyo Generally diagnosed during 2nd or 3rd trimester of pregnancyo Diagnoses Fasting glucose more than 92 mg/dL 1-hour glucose more than 180 mg/dL 2-hour glucose more than 153 mg/dLo Occurs in about 7% of pregnancies Excessive weight gain or obese women have high incidenceso Women in GDM have 40-60% chance of developing diabetes over the next 5-10 yearsDiagnoses of DM- Fasting plasma Glucose- Casual Plasma glucose (any time of the day)- Oral glucose tolerance testo 75g glucose given orally and blood glucose level measured 2 hours later- Hemoglobin A1c (<5.7% is normal)o Reflects what happens over 3 monthsBlood Glucose Values- Normal Fasting- 60-100mg/dL- Diabetes > 126 mg/dL or > 6.5%Hypoglycemia- occurs in diabetics or non-diabetics- Symptomso Autonomic or adrenergic symptoms- shakiness, sweating, anxietyo Neuroglycopenic symptoms- slow performance, difficult concentration, confusion- Causeso More insulin or medication than foodo Inadequate food intakeo Increase physical activityo Alcohol with no food- Preventiono Match insulin/medication with mealso Have snack before exercise- Treatmento 15/15 rule 2-3 glucose tablets ½ cup fruit juice 506 pieces of candyHyperglycemia (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 stimulatedLong-Term Effect- Macrovascular Diseases- dyslipidemia and hypertension- Microvascular Diseaseso 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, infectiono 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 wallsleaking 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 eyeo 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 weeko 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 Dialysiso Diabetes- continue with CHO controlledo Dialysis- Fluids (beverage, soup, ice cream, veggies, etc.) Na+, K+, Ne, 8-10oz proteinAtherosclerosis- hardening of arterial walls and decreased blood flow- Primarily affectso Coronary- supply heart muscleo Vessels of lower extremities- Leads to Coronary Artery Disease- Plaque formationo Endothelium Damage- single layer of cells lining lumeno LDL penetrate endotheliumo 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 streakso Arterial narrowing Decreased blood flow Increased blood pressureo Vessel compensate by vasodilationo Increased pressure causes crack in plaguemore endothelial damage Platelet aggregationo Platelet aggregation Continued narrowing of vessels If looseblood clot, can get stuck in narrowed vesselso Total blockage by plague Myocardial infarction Stoke Poor circulation in lower extremeties- This is the order it all happens: fatty streaksearly plaque arterial narrowinglocalized slowing of bloodcracks in plaqueplatelet recruitmentblood clotcut off oxygen supplymyocardial infarctiono 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 areao Another surgery is CABG (Coronary Artery Bypass Graft) Causes
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