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Diabetes Chapter 1: Disease State


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The exocrine pancreas is responsible for secreting ______________ that are important for digestion. The endocrine pancreas is responsible for secreting______________.
enzymes, hormones
Diabetes is a _________________ disorder involving the ________________ pancreas. Diabetes affects ____________, lipid, and protein metabolism and results from a _____________ in the ability of target organs to respond to insulin.
metabolic, endocrine, carbohydrate, decrease
Acinar cells secrete digestive juices into the ________________.
True or False? Pancreatic hormones are involved in regulating the body’s metabolic processes.
secrete glucagon
alpha cells
secrete insulin and amylin
beta cells
secrete somatostatin
delta cells
help regulate release of pancreatic digestive enzymes
pancreatic polypeptide cells
True or False? Insulin is comprised of 37 amino acids.
False. Insulin is comprised of 51 amino acids
Why is the endocrine system slower to act than the nervous system?
The endocrine system is slower to act than the nervous system because it relies on the bloodstream to deliver hormones to their target cells
Endocrine hormones have widespread effects. Give yourself one point for each effect you write down (6 possible).
"1) Control and regulate homeostasis, 2) Regulate cellular proliferation and differentiation, 3) Regulate growth and body maturation 4) Affect reproductive function, 5) Affect behavior, 6) Regulate metabolism
Catabolism, or degradation, is the process by which nutrients are broken down so as to salvage their components or to generate _____________, or both.
True or False? Glycogen is the primary storage form of glucose.
What is the body’s main source of fuel?
In the presence of adequate glucose and insulin, liver and muscle cells convert excess glucose to a complex carbohydrate known as ___________________.
The a cells of the pancreas secrete ________________.
The half-life of GLP-1 is _________________, which is attributable to rapid metabolism.
60-90 seconds
GLP-1 has been shown to ________________________.
Stimulate insulin release from b cells in a glucose-dependent fashion.
What is the most powerful stimulant of insulin release?
Insulin is made up of two interconnected polypeptide chains, consisting of _______ amino acids (A chain) and ______ amino acids (B chain).
21, 30
The half-life of insulin is about _____ minutes and about _____ of secreted insulin is degraded by the liver and kidneys.
5, 80%
When the blood glucose rises, the pancreas releases ______________, which stimulates the uptake of glucose by the cells to be either used or stored. When the blood glucose decreases, the pancreas releases ______________, which stimulates the release of g
insulin, glucagons
What is the most powerful regulator of insulin?
When blood glucose levels decrease below _____ mg/dL, insulin secretion decreases.
Eating stimulates insulin secretion, and causes up to a 10-fold increase of insulin levels. How many minutes later do these insulin levels peak?
30-40 minutes after food intake
True or false? Insulin inhibits glycogenolysis.
Insulin promotes glucose entry into muscle cells by facilitating its diffusion across cell ______________.
The primary means by which glucose enters muscle cells is via glucose transport ______________.
As a result of insulin binding to its receptor on the cell membrane, signaling occurs inside the cell to stimulate glucose transport proteins to come to the surface of the cell, form a_____________, and facilitate glucose entry into the cell.
Depending on insulin concentrations, glucose is either used by the cells as a source of energy or stored as _____________.
True or false? Insulin increases the transport of fatty acids and glucose into adipose cells. In these fat cells, insulin also promotes the storage of glucose as glycogen.
False. Fat is stored as triglycerides.
It is estimated that _________ million Americans have diabetes, including about 206,000 people under the age of ________.
18.2, 20
What percent of diabetes patients have type 2 diabetes?
In type 1 diabetes, the body’s immune system destroys _________________cells.
pancreatic b
True or false? Diabetic nephropathy is a progressive disease that takes several years to develop.
True or false? Patients with type 2 diabetes have absolute insulin deficiency.
False. Patient with type 1 diabetes have absolute insulin deficiency and patients with type 2 diabetes have insulin resistan
True or false? It is believed that someone with insulin resistance may have a defect in the signaling cascade that prohibits the glucose transport proteins to come to the cell surface thereby inhibiting glucose entry into the cell.
List the 3 factors that increase the risk of type 2 diabetes. (3 points possible)
age, obesity, sedentary lifestyle
True or false? Hyperglycemia is the defining characteristic of all types of diabetes mellitus.
The pathogenesis of type 2 diabetes involves both impaired insulin secretion and insulin _____________________in the liver and peripheral tissues, particularly fat and muscle.
True or false? Ketoacidosis is common in patients with type 2 diabetes
False. It is very rare, presumably because these patients have enough circulating insulin to suppress the production of excessive ketone bodies.
Define Hyperglycemia.
Hyperglycemia is a state of increased blood glucose concentrations
What are the 3 classic symptoms of diabetes? (3 points possible)
polyuria (excessive urination), polydipsia (excessive drinking), and polyphagia (excessive desire to eat)
What elements of the body are lost as a result of excess glucose and body water in the urine?
sodium, potassium, nitrogen, bicarbonate, hydration
Give examples of microvascular complications
retinopathy, nephropathy, neuropathy
Give examples of macrovascular complications
cardiovascular disease, cerebrovascular disease
What percent of Americans afflicted with the disease will develop a serious foot ulcer during their lifetime.
True or false? Type 1 diabetes strikes only during childhood.
What is the “honeymoon phase”?
attacking immune cells, such as immune killer cells
Approximately 1 in every _______ to _______children and adolescents have type 1 diabetes.
400, 500
Although type 1 diabetes is associated with antibodies directed against the b cells and against insulin itself, the actual destruction of the b cells is caused by:
autoimmune attack on pancreatic islets, particularly b cells
True or false? Rates of type 1 diabetes are high in African, Asian, and American Indian populations.
False. They are high in Caucasian and Northern European populations
True or false? Generally, the further populations are from the equator, the greater the risk of developing type 1 diabetes.
Type 1 diabetes is strongly associated with genes located in or near the human leukocyte antigen (HLA) _______ location on chromosome _____.
HLA-D, 6
Name at least 5 symptoms of type 1 diabetes (5 points possible)
1) Unexplained rapid weight loss, 2) Blurred vision, 3) Weakness and extreme fatigue due to loss of protein, water, and electrolytes, 4) Irritability, 5) Dry, itchy skin, 6) Infections or wounds that are slow to heal, 7) Sweet-smelling breath due to ketone overproduction
Type 2 diabetes can be described as a complex metabolic disease due to a relative insulin _________________on the background of peripheral insulin__________________, particularly involving fat, muscle, and liver.
deficiency, resistance
In genetically susceptible individuals prone to develop type 2 diabetes, and usually in concert with a _________________lifestyle and obesity, insulin resistance develops over a period of years, and well before the diagnosis of diabetes is established.
Type 2 diabetes usually develops after age ____.
Name at least 4 of the risk factors associated with type 2 diabetes (4 points possible).
Age 40 years or older, Obesity, especially abdominal, Sedentary lifestyle, Family history of diabetes, Being of Hispanic, African, Asian, or Native-American origin, History of gestational diabetes, Previous diagnosis of IGT
What percent of type 2 diabetes patients are obese?
The metabolic syndrome can be diagnosed if 3 out of 5 conditions are present that put individuals at great risk of cardiovascular disease and for developing diabetes. List all 5 characteristics of the metabolic syndrome. (5 points possible)
High blood pressure (>130/85), Elevated fasting serum triglycerides (>150 mg/dL), Serum HDL Cholesterol <40 mg/dL (male) or 50 mg/dL (female), Increased abdominal circumference >102 cm (male) or >88 cm (female), Impaired fasting glucose (>110 mg/dL).
List factors associated with type 1 diabetes
Usually abrupt onset, Islet-Cell Antibody present at diagnosis, Symptoms at onset may include thirst, polyuria, polyphagia, fatigue, Ketosis is common, Oral medications are ineffective
List factors associated with type 2 diabetes
Islet-Cell Antibody is not observed, Patients are often insulin resistant, rather than insulin deficient, Onset is gradual, Vascular or neurologic complications are often present at time of diagnosis, Frequently no symptoms at onset, or mild
True or false? The majority of patients with diabetes are seen by endocrinologists.
False. They are seen most often by primary care physicians (PCPs).
Name at least 5 types of health care professionals who may be Certified Diabetes Educators
Physicians, Diabetes educators, Nurses, Nurse practitioners, Physician assistants, Dietitans/Nutritionists, Pharmacists, Podiatrists, Psychologists, Social workers, Psychologists, Exercise physiologists.
True or False? The diagnosis of diabetes is based on blood glucose levels.
This test can be performed any time of the day without regard to mealtime.
Random Plasma Glucose test
In this test, 75 g of glucose in water is administered at hourly intervals over two hours.
Oral Glucose Tolerance Test
With this test, if any value is over 200 mg/dL and there are symptoms present, diabetes is confirmed.
Random Plasma Glucose test
In this test, if the plasma glucose exceeds 126 mg/dL, diabetes is suspected and can be confirmed by repeating the same test.
Fasting Plasma Glucose test
Why is it important to diagnose microalbuminuria early?
It is important to diagnose microalbuminuria early because it may lessen the progression to kidney failure.
Type 2 diabetes is associated with a risk of coronary heart disease that is 2 to 4 times that of people who do not have diabetes. Why?
Type 2 diabetes is associated with a risk of coronary heart disease that is 2 to 4 times that of people who do not have diabetes possibly because the result of the abnormal lipid levels (dyslipidemia) and types of lipid problems found in diabetes meals
List the three components of a diabetes meal plan (3 points possible).
quantity (calculation of calorie intake), food types, and timing of meals
True or false? Since patients with type 1 diabetes are usually thin, one goal of dietary modification is to keep weight levels as low as possible.
False. One goal of dietary modification is to maintain body weight
Besides maintaining a healthy weight, patients with type 2 diabetes should also aim to do which of the following? Select all that apply.
"Improve blood lipid levels and lower blood pressure (if high)
Dietary carbohydrates provide ____________of an individual’s energy requirements.
50% to 60%
True or false? Exercise lowers fasting and postprandial insulin levels and improves tissue insulin sensitivity.
Explain briefly why vigorous exercise can increase the risk of hypoglycemia during and after exercise.
Exercise potentiates the action of insulin
True or false? The use of basal/bolus insulin therapy is the preferred way to treat type 1 diabetes.
Jet injectors are not used routinely because of their higher cost, pain, brusing, and _______________________.
bleeding upon injection
Insulin pumps are typically used for which of the following patients?
patients who require greater scheduling flexibility
List the two primary goals of diabetes treatment (2 points possible).
"Goal #1: Maintaining blood glucose levels as close to normal as possible in order to help prevent or delay the onset of both the short- and long-term complications of diabetes. Goal #2: Provide therapy that is compatible with the lifestyle and desires of the patient, while achieving the best possible glycemic control.
The AACE recommends a value of _____ for people with diabetes.
< 6.5%
True or false? The A1C measures the amount of hemoglobin (oxygen-carrying protein in the white blood cell that has glucose bound to it.
False. It measures the oxygen-carrying protein in the red blood cell that has glucose bound to it
The normal life of the red blood cell is about ______________days. Therefore, A1C reflects the average exposure to glucose over _____________months.
120, 2-3
True or false? The peak postprandial plasma glucose goal recommended by the ADA is <180 mg/dL (<10.0 mmol/l).
What is the major difference between the DCCT and the UKPDS?
The DCCT trial studied patients with type 1 diabetes. The UKPDS studied patients with type 2 diabetes
True or false? The DCCT was terminated early because its results were so striking.
In the DCCT, intensive therapy reduced the risk of progression of retinopathy by ______.
True or false? Good blood control lowered the risk of myocardial infarction in the DCCT.
What is one explanation that macrovascular diseases were uncommon among the study population in the DCCT?
These complications were uncommon because the subjects were relatively young (ranging in age from 13 to 39).
True or false? The implication of the DCCT results is that appropriate insulin regimens lead to improved glycemic control.
The UKPDS recruited _______newly diagnosed type 2 patients in 23 centers within the United Kingdom between 1977 and 1991. Patients ranged in age from ____ to 65 years with a median age of _____ years.
5102, 25, 54
In the UKPDS study, retinopathy was decreased by ______and nephropathy by ______. Epidemiological analysis showed a continuous relationship between the risks of microvascular complications and glycemia, such that for every percentage point decrease in A1
21%, 33%, 35%
The use of insulin in the UKPDS, associated with improved outcomes with improved glycemic control helped dispel perceptions that long-term insulin administration is _______________.
List the steps of the patient flow analysis (5 points possible)
diet and exercise, mono orals, multiple orals, orals and insulins, insulin
In general, patients with type 2 diabetes are first instructed on ____________ and _____________.
diet and exercise
How is human insulin manufactured?
Human insulin is manufactured through recombinant DNA technology, in which bacteria or yeast are genetically altered to produce the insulin
Commercially available insulins differ on which two key characteristics? (2 points possible)
Time-action profile and Human or analog of human insulin
True or false? The time-action profile of insulins is used to determine their overall potency.
False. The time-action profile of insulins is used to determine their therapeutic use
True or false? The rapid and short-acting insulins mimic the (physiological) postprandial peak responses (pulsatile increases in insulin secretion stimulated by elevated blood glucose after a meal).
They bind to blood proteins and are more prone to being dislodged by other medications that bind to the same proteins.
“S1” or 1st generation Sulfonylureas
They do not bind to circulating proteins. They are less likely to cause hypoglycemia.
“S2” or2nd generation Sulfonylureas
Indicated as an adjunct to diet and exercise when hyperglycemia cannot be controlled by diet alone.
“M” or Meglitinides
Contraindicated in patients with cirrhosis and hypersensitivity.
“AGI” or Alpha Glucosidase Inhibitors
Activate one of the PPARg receptors. The result is improved insulin sensitivity and transport of glucose and fatty acids into peripheral tissues.
“TZD” or Thiazolidinediones
Often used as the first-line therapy in obese individuals with type 2 diabetes, as they may cause a modest weight loss.
“B” or Biguanides (metformin)
These agents should be taken before each meal because they have such a short duration of action.
“M” or Meglitinides
Act in gastrointestine to block breakdown of complex carbohydrates, resulting in less glucose breakdown absorption into the blood.
“AGI” or Alpha Glucosidase Inhibitors
They do not stimulate the secretion of insulin, but act by decreasing the formation and output of glucose from the liver.
“B” or Biguanides (metformin)
May cause potentially fatal lactic acidosis when used in an inappropriate patient.
“B” or Biguanides (metformin)
Very rapid onset and short duration of action.
“M” or Meglitinides

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