Diabetes and Insulin Regulation Quiz

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Questions and Answers

What is a possible side effect of thiazolidinediones in women?

Resumption of ovulation (correct)

Lowering of blood pressure

Increased insulin secretion

Decrease in glucose absorption

Which complication occurs when blood glucose falls below 70 mg/dl?

Diabetic Keto Acidosis (DKA)

Hyperglycemic hyperosmolar Syndrome

Diabetic Neuropathy

Hypoglycemia (correct)

What is the recommended protocol for monitoring liver function in patients taking thiazolidinediones?

Liver function tests should be taken at baseline and monthly for 12 months (correct)

Liver function tests should be taken at baseline and monthly for 6 months

Liver function tests are not necessary

Liver function tests should be performed once every two years

What might cause hypoglycemia in diabetic patients?

Too much medication or too little food Signup and view all the answers

What is a primary function of meglitinides?

Stimulate insulin release from the pancreas Signup and view all the answers

What is the primary regulatory function of insulin in the body?

Facilitate glucose entry into cells Signup and view all the answers

Which of the following best describes a consequence of insulin deficiency?

Increased blood glucose levels Signup and view all the answers

Which of the following populations is disproportionately affected by diabetes mellitus?

Minority populations Signup and view all the answers

What stimulates the secretion of insulin from beta cells in the pancreas?

Hyperglycemia Signup and view all the answers

Which process does insulin inhibit to lower blood glucose levels?

Glycogenolysis Signup and view all the answers

Which type of tissue does not require insulin for glucose utilization?

Neural tissue Signup and view all the answers

What role does insulin play in glycogenesis?

Stimulates glucose uptake Signup and view all the answers

Which of the following statements about insulin is incorrect?

Insulin increases blood glucose levels. Signup and view all the answers

What is the primary function of basal insulin secretion?

To suppress hepatic glucose production between meals Signup and view all the answers

Which of the following describes prandial insulin secretion?

Represents about 50% of daily insulin needs Signup and view all the answers

What characterizes Type 1 Diabetes Mellitus?

It occurs due to an autoimmune destruction of beta cells Signup and view all the answers

Which of the following is NOT a cause of Type 2 Diabetes Mellitus?

Autoimmune destruction of beta cells Signup and view all the answers

When does prandial insulin secretion typically occur?

After eating meals Signup and view all the answers

What is the condition associated with impaired glucose homeostasis that increases the risk of diabetes?

Pre-diabetes Signup and view all the answers

Which population is most commonly associated with Type 2 Diabetes Mellitus?

Persons over age 30 Signup and view all the answers

What distinguishes Type 1 Diabetes from Type 2 Diabetes concerning insulin production?

Type 1 always involves insufficient insulin production Signup and view all the answers

What is the normal range for fasting blood glucose levels?

70-100 mg/dL Signup and view all the answers

Which fasting duration is required before conducting a fasting plasma glucose test?

6-8 hours Signup and view all the answers

What is a critical fasting blood glucose level indicating potential danger?

<blockquote> 400 mg/dL </blockquote> Signup and view all the answers

During an Oral Glucose Tolerance Test, how long should a patient fast prior to taking the test?

At least 10 hours Signup and view all the answers

What is the threshold level for random plasma glucose that indicates a possibility of diabetes if accompanied by symptoms?

200 mg/dL Signup and view all the answers

What is a primary symptom associated with delayed gastric emptying in patients?

Nausea Signup and view all the answers

Which dietary change is recommended for managing orthostatic hypotension?

Increase sodium intake Signup and view all the answers

What is a characteristic feature of coronary artery disease in diabetic patients?

Typical ischemic symptoms may be absent Signup and view all the answers

What condition is NOT a complication leading to diabetic foot?

Elevated blood pressure Signup and view all the answers

Which management strategy can help alleviate diabetic constipation?

High-fiber diet Signup and view all the answers

What complication of diabetes is characterized by urinary retention?

Autonomic neuropathy Signup and view all the answers

Which of the following is a sign of diabetic foot complications?

Swelling and redness Signup and view all the answers

What long-term duration and conditions increase the risk of diabetic foot?

History of smoking and anatomical deformities Signup and view all the answers

What is a common symptom of moderate hypoglycemia related to CNS function?

Inability to concentrate Signup and view all the answers

Which treatment should be administered to a conscious patient experiencing hypoglycemia?

15 gm of a fast-acting carbohydrate Signup and view all the answers

What aspect of diabetic ketoacidosis primarily leads to dehydration?

Polyuria Signup and view all the answers

Which of the following is NOT a symptom associated with severe hypoglycemia?

Nervousness Signup and view all the answers

What is a primary cause of diabetic ketoacidosis?

Decreased or missed dose of insulin Signup and view all the answers

What is the expected onset of action for glucagon when injected?

8-10 minutes Signup and view all the answers

Which symptom indicates that a patient with moderate hypoglycemia needs immediate treatment?

Tachycardia Signup and view all the answers

What method is recommended for the management of hypoglycemia after symptoms resolve?

A snack containing protein and starch Signup and view all the answers

Study Notes

Diabetes Mellitus

A group of diseases characterized by hyperglycemia.
Defects in insulin secretion, insulin action, or both.
Almost one-third of cases are undiagnosed.
Prevalence is increasing.
Minority populations and the elderly are disproportionately affected.

Hormones Regulating Blood Glucose

Hormone	Action(s)	Result on Blood Glucose
Insulin	Helps glucose enter cells, stimulates glycogenesis, stimulates glucose anabolism	Lowers
Glucagon	Stimulates glycogenolysis	Raises
Epinephrine	Stimulates glycogenolysis	Raises
Growth Hormone	Stimulates catabolism of fats, decreases carbohydrate utilization	Raises
ACTH	Stimulates secretion of glucocorticoids	Raises
Glucocorticoids	Mobilization of protein, stimulates gluconeogenesis, increases insulin resistance	Raises

Insulin

The chief glucose regulatory hormone.
Synthesized by beta cells (β-cells) in the islets of Langerhans in the pancreas.
Secretion is stimulated by hyperglycemia.
Attaches to receptors on the body's cells, acting as a gatekeeper for glucose entry into the cells.

Insulin Function

Decreases blood glucose levels.
Inhibits glycogenolysis (breakdown of stored glucose) in the liver.
Inhibits gluconeogenesis (production of glucose from amino acids and other substrates).
Transports glucose into muscle, liver, and adipose tissue.
Muscle, liver, and adipose cells require insulin activation at insulin receptors to facilitate glucose transport.
Neural tissue and erythrocytes do not require insulin for glucose utilization.
Once inside the cell, glucose can be oxidized.

Normal Physiologic Insulin Secretion

Insulin peaks immediately after meals (prandial insulin).
A constant supply of basal insulin is essential to maintain overall glycemic control.

Endogenous Basal and Prandial Insulin Secretion

Basal Insulin Secretion*
Occurs continuously.
Suppresses hepatic glucose production between meals and overnight.
Maintains a nearly constant level throughout the day.
Not appropriate for handling post-meal glucose increases.
Prandial Insulin Secretion*
Occurs in response to food intake or a meal.
Helps control hyperglycemia after meals.
Provides the remaining 50% of daily insulin requirement.

Classification of Diabetes Mellitus (DM)

Type 1 (Insulin-dependent DM...IDDM):

Beta cells in the pancreas are destroyed by an autoimmune process.
Requires insulin; little to no insulin is produced.
Onset is acute and usually before 30 years of age.
5-10% of people with diabetes.
Genetic causes.

Type 2 (Non-Insulin-dependent DM...NIDDM)

More common in people over 30 years old.
Causes include insulin resistance due to obesity, impaired insulin secretion (still some secretion), and hereditary factors.
Often treated initially with diet and exercise.
Oral hypoglycemic agents or insulin may be used.
Diabetic Ketoacidosis (DKA) is less common in type 2 diabetes because of sufficient insulin levels.

Gestational Diabetes Mellitus (GDM):

Occurs in about 2-5% of pregnancies.
Onset during pregnancy, usually in the second or third trimester.
Caused by hormones secreted by the placenta inhibiting insulin action.
Treated with diet and insulin (if needed) to strictly maintain normal blood glucose levels.

Pre-diabetes (Impaired Glucose Homeostasis):

Risk factor for DM.
Impaired glucose tolerance (IGT).
Impaired fasting glycemia (IFG).

Pathogenesis of Type 2 Diabetes

Impaired insulin secretion.
Gastrointestinal absorption of glucose.
Increased basal hepatic glucose production.
Decreased insulin-stimulated glucose uptake in muscle.

Risk Factors for Diabetes Mellitus

Type 1*
Genetic predisposition combined with immunological and possibly environmental (viral) factors.
Type 2*
Family history of diabetes, obesity, race/ethnicity, age over 45 years.
Previous impaired fasting glucose or impaired glucose tolerance, hypertension (≥ 140/90), HDL cholesterol ≤ 35, triglycerides ≥ 250, history of gestational diabetes or babies over 9 pounds.
Metabolic syndrome (obesity, hypertension, hypercholesterolemia).

Type 1 vs. Type 2

Feature	Type 1	Type 2
Age of onset	Usually < 30	Usually > 40
Body weight at onset	Normal to thin	80% overweight
Insulin production	None	Not enough
Insulin injections	Always	Sometimes
Management	Insulin, diet, exercise	Diet, exercise, sometimes oral hypoglycemics, insulin

Glucose Regulation

Fasting: Lowers blood glucose concentration
Eating: Raises blood glucose, Beta cells are stimulated to secrete insulin, blood glucose concentration decreases

Diagnostic Tests for Diabetes

Fasting plasma glucose (FPG or FBS): ≥ 126 mg/dL (7.0 mmol/L)
Random plasma glucose: > 200 mg/dL (11.1 mmol/L) plus symptoms of diabetes
Oral Glucose Tolerance Test (OGTT): ≥ 200 mg/dL during an OGTT
Glycosylated Hemoglobin Assays (HgA1C)

Fasting Blood Glucose

Measures blood glucose levels after fasting.
Normal: 70-100 mg/dL; Prediabetic: 100-126 mg/dL; Diabetic: > 126 mg/dL

Random Plasma Glucose

Performed regardless of when the patient last ingested food.
If symptoms (polydipsia, polyuria, and weight loss) are present, and blood glucose levels are ≥ 200 mg/dL, there's a possibility of having DM.

Oral Glucose Tolerance Test (OGTT)

75 grams of glucose dissolved in water (100 grams for pregnant women) given after fasting.
Blood samples taken at 30 minutes, 1 hour, 2 hours, and 3 hours.
No medications or strenuous activities 8-12 hrs before the test.
Diabetic level: 2hPG ≥ 200 mg/dL.

Glycosylated Hemoglobin Assays (HgbA1C)

Measures the percentage of glycosylated hemoglobin, reflecting average blood glucose levels over 2-3 months.
Non-diabetic: 4-6%; Diabetic (patient with diabetes): > 7%; Diabetic (patient without diabetes): > 6.4%

Type 1 & 2 Diabetes: Key Concepts

Minimizing diabetes complications requires early diagnosis, treatment, and maintaining HbA1C levels < 7%.
HbA1C < 7% requires control of post-prandial and fasting hyperglycemia.

Assessment of Diabetic Patients

History: hypo/hyperglycemia, glucose levels, complications, adherence to dietary, exercise, and pharmacological management.
Physical examination: BP, WT (BMI), check for complications (eye, foot, skin, renal, neurological, and oral).
Laboratory examination:
HbA1c (every 3 months), Microalbuminuria or 24-hour urine collection (annually), Fasting lipids (annually), serum creatinine level, and ECG.
Referrals to ophthalmologist and podiatry.

Treatment Goal

Normalize insulin activity and blood glucose levels.
Intensive control decreases vascular and neuropathic complications.

Management

Nutritional management, Exercise, Monitoring glucose and ketones, Pharmacologic therapy, Education

Dietary Management Goals

Provide optimal nutrition.
Maintain normal body weight, blood glucose levels, and lipid profile.
Prevent complications.
Address individual nutrition needs.
Promote eating pleasure.
Promote 1-2 pound weight loss per week (500-1000 calories less).

Role of the Nurse

Be knowledgeable about dietary management.
Communicate important information to the dietician or other management specialists.
Reinforce patient understanding.
Support dietary and lifestyle changes.

Meal Planning

Consider food preferences, lifestyle, eating times, and cultural background.
Review diet history (weight loss, gain, or maintenance).
Consider caloric needs and distribution throughout the day.
Emphasize whole grains, limiting 20%-30% of daily intake to fat, and less than 300mg of cholesterol.
Use non-animal protein (legumes, grains) to reduce saturated fat and cholesterol intake.
Increase fiber to lower cholesterol.

Glycemic Index

Describes how much a given food increases blood glucose.
Combining starchy food with protein and fat slows absorption and improves glycemic response.
Raw or whole foods have a lower response than cooked or processed foods.
Eating whole fruits decreases the glycemic response.
Adding food with sugars to foods slowly absorbed may reduce the response.

Other Dietary Concerns

Alcohol may inhibit gluconeogenesis, leading to hypoglycemia.
Nutritive sweeteners (fructose, sorbitol, xylitol) provide calories similar to sucrose but cause less elevation in blood glucose.
Non-nutritive sweeteners (saccharin) have minimal calories.
Reading labels carefully, as "sugar-free" or "dietetic" foods may provide calories.

Exercise

Lowers blood sugar by increasing glucose uptake.
Aids in weight loss.
Improves lipid Profile and raises HDL (high-density lipoprotein).
Lowers cardiovascular risk.
Decreases stress.

Exercise Precautions

Avoid exercise when blood sugar is elevated (>250mg/dL) and ketones are present in urine.
Insulin needs may decrease with exercise; patients taking exogenous insulin may need a carbohydrate snack before moderate exercise to prevent hypoglycemia.
Adjust insulin if exercising to control or reduce weight.
Monitor blood glucose levels.

Exercise Recommendations

Encourage regular, gradual increase in daily exercise.
Modify exercise regimens to patient's needs and presence of diabetic complications.
Exercise at the same time of day.
Assess feet daily, avoid trauma, and use proper footwear.
Avoid extreme temperatures (heat or cold) during exercise.
Consider exercise stress tests for patients older than 30 with two or more risk factors.

Monitoring

Self-Monitoring of Blood Glucose (SMBG): Enables people with diabetes to adjust treatment and detect hypo- or hyperglycemia. Disadvantages include need for good vision, fine motor coordination, and comfort with technology, with cost being a factor.
Candidates for SMBG include those with unstable diabetes, a tendency for severe ketosis or hypoglycemia, hypoglycemia without warning symptoms, and abnormal renal glucose threshold.
Frequency: 2-4 times per day (before meals and bedtime recommended).
Urine testing for glucose and ketones. Glucosylated hemoglobin (HgbA1c) should be assessed every 2-3 months.

Pharmacological Therapy (Insulin)

Insulin Therapy: Taken one or more times per day to control blood glucose levels.
Insulin Sources: Beef, pork, and human insulin, including different types based on onset, peak, and duration of action. Rapid-acting, short-acting, intermediate-acting, and long-acting insulins (Lispro, Humalog, Regular, NPH, Lente, Ultralente, Glargine [Lantus], 70/30).
Insulin types are important in managing fluctuating blood glucose.

Pharmacological Therapy (Oral Antidiabetic Agents)

Used for patients with type 2 diabetes not responding well to diet and exercise alone.
Includes numerous medications, each with potential side effects (e.g., hypoglycemia).
Nursing interventions include monitoring blood glucose, assessing for hypoglycemia, and patient teaching.

Sites of Action of Oral Antidiabetic Agents

Diagram illustrating how oral agents impact blood glucose levels, targeting different sites and mechanisms.

Education for Diabetic Patients

Patients should understand their condition and its associated complications well; learning about prevention strategies and monitoring techniques is essential.
Nutritional information is crucial, including medication effects and adjustments, exercise considerations, disease progression, and monitoring techniques.

Complications of Diabetes Mellitus

Acute: Hypoglycemia, Diabetic Ketoacidosis (DKA), Hyperglycemic Hyperosmolar Syndrome (HHS).
Chronic: Macrovascular (coronary artery disease, cerebrovascular disease, peripheral vascular disease), Microvascular (retinopathy, nephropathy, neuropathy).

Hypoglycemia

Blood glucose falls below 70 mg/dL.
Causes: Too much medication (insulin or hypoglycemic agents), too little food, or excessive exercise.
Often occurs before meals, when meals are delayed, or during the insulin peak.
Symptoms: range from mild (sweating, tremor, hunger) to severe (confusion, seizures, loss of consciousness).

Diabetic Ketoacidosis (DKA)

Absence of or markedly inadequate amount of insulin that results in disorders in CHO, protein, and fat metabolism.
Mostly associated with type 1 diabetes.
Main clinical features: Hyperglycemia, dehydration (polyuria), and electrolyte loss; metabolic acidosis.
Causes: Decreased or missed insulin doses, illness or infection.
Management: Rehydration, insulin infusion, and electrolyte correction.

Hyperglycemic Hyperosmolar Syndrome (HHS)

Hyperglycemia, high blood osmolarity, and alteration of awareness/consciousness with minimal or absent ketonemia or ketoacidosis.
Primarily associated with type 2 diabetes.
Causes / Risk Factors: lack of effective insulin, elderly patients (50+ years old or older) with mild type 2 DM, recent illness (pneumonia, CVA, etc), medications exacerbating hyperglycemia; hypokalemia.
Pathophysiology: Persistent hyperglycemia, dehydration, hypernatremia, and increased serum osmolarity.
Management: Rehydration, potassium correction (be mindful of serum potassium levels and timing of administration), and insulin treatment.

Retinopathy

Deterioration of the small blood vessels nourishing the retina, potentially leading to vision loss.
Stages: background, preproliferative, proliferative.
Symptoms: Painless vision changes (e.g., blurry vision, floaters, complete loss of vision).
Prevention/treatment: Management of hyperglycemia, argon laser photocoagulation.

Nephropathy

Renal disease resulting from diabetic microvascular changes in the kidneys.
Pathophysiology: Elevated blood glucose levels stress the kidneys, causing blood proteins to leak into the urine, increasing pressure within kidney blood vessels, eventually leading to nephropathy.
Diagnosis: Microalbuminuria (protein in the urine).
Prevention/treatment: Control of blood glucose levels.

Neuropathy

Group of diseases affecting all types of nerves (peripheral, autonomic, and spinal).
Pathophysiology: Associated with blood vessel damage (thickening of capillary basement membranes plus inflammation and demyelination); associated with hyperglycemia.
Types: Peripheral and autonomic.
Symptoms: Paresthesia, burning sensations, decreased pain or temperature perception, impaired reflexes, muscle problems, GI and/or bladder dysfunction, etc.
Management: Control blood glucose levels, specific treatments for specific symptoms.

Diabetic Foot

Complication resulting from interplay of neuropathy, vascular disease, and immunocompromise.
Risk Factors: Duration of diabetes (>10 years), age (>40 years), smoking, decreased peripheral pulses, decreased sensation, anatomical deformities, history of foot ulcers or amputations.
Prevention/treatment: Proper foot care (inspecting feet for sores, blisters, etc., wearing appropriate footwear, maintaining good circulation, managing hyperglycemia); managing any complications if they appear; consult physician.

Nursing Diagnosis of Newly Diagnosed DM

Risk for fluid volume deficit related to polyuria and dehydration.
Altered nutrition related to imbalance of insulin, food, and physical activity.
Knowledge deficit about diabetes self-care skills.
Potential self-care deficit related to physical impairment or social factors.
Anxiety related to loss of control and fear of inability to manage diabetes.

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Test your knowledge on diabetes, insulin, and thiazolidinediones with this quiz. Explore topics such as insulin regulation, complications of diabetes, and specific therapeutic agents in managing blood glucose levels. Perfect for students and healthcare professionals looking to enhance their understanding of diabetes management.