Diabetes Mellitus Overview and Pathophysiology
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Questions and Answers

Which of the following is NOT a common risk factor for developing Diabetes Mellitus?

  • Having low blood pressure (correct)
  • Having a family history of diabetes
  • Being of Hispanic descent
  • Age greater than 45

    • What role does insulin play in the regulation of blood glucose levels?

  • It promotes glucose transport into cells (correct)
  • It increases gluconeogenesis
  • It increases blood glucose levels
  • It decreases protein synthesis

    • Which of the following hormones is considered counterregulatory to insulin?

  • Cortisol (correct)
  • Growth hormone (correct)
  • Insulin
  • Glucagon (correct)

    • What is the primary physiological consequence of the destruction of beta cells in Type 1 Diabetes?

    <p>Inability to produce insulin</p> Signup and view all the answers

    Which statement regarding the normal range of blood glucose levels is accurate?

    <p>Normal blood glucose range is approximately 70 to 120 mg/dL</p> Signup and view all the answers

    Which of the following best describes Type 1 Diabetes Mellitus?

    <p>It results from the autoimmune destruction of insulin-producing cells.</p> Signup and view all the answers

    What is a significant consequence of hyperglycemia in individuals with Diabetes Mellitus?

    <p>Increased risk of end-stage renal disease</p> Signup and view all the answers

    What effect does insulin have on gluconeogenesis?

    <p>Insulin inhibits gluconeogenesis</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with hyperglycemia?

    <p>Weight gain</p> Signup and view all the answers

    What is the medical definition of fasting as it relates to measuring Fasting Plasma Glucose (FPG)?

    <p>No caloric intake for at least 8 hours</p> Signup and view all the answers

    Which of the following A1C levels indicates diabetes according to diagnostic criteria?

    <p>6.5%</p> Signup and view all the answers

    What characterizes Type 2 Diabetes Mellitus?

    <p>Gradual onset due to insulin resistance</p> Signup and view all the answers

    What is the A1C goal recommended for patients with diabetes by the ADA?

    <p>7.0%</p> Signup and view all the answers

    Which of the following is a typical blood glucose level for diagnosing diabetes through a random plasma glucose test?

    <p>200 mg/dL</p> Signup and view all the answers

    How are prediabetes conditions defined?

    <p>Elevated glucose levels without symptom presence</p> Signup and view all the answers

    Which of these conditions is NOT included as a part of the diagnostic criteria for prediabetes?

    <p>Normal fasting glucose level</p> Signup and view all the answers

    What is a potential risk factor for developing gestational diabetes during pregnancy?

    <p>Being obese</p> Signup and view all the answers

    Which diagnostic test measures the average glucose levels over the past three months?

    <p>Hemoglobin A1C</p> Signup and view all the answers

    What indicates the presence of diabetes according to fasting plasma glucose levels?

    <p>Fasting glucose over 126 mg/dL</p> Signup and view all the answers

    Why should insulin be stored at specific temperatures?

    <p>To avoid degradation of the insulin molecule</p> Signup and view all the answers

    What does the presence of glucose in urine commonly indicate?

    <p>Fat cell ketosis</p> Signup and view all the answers

    When should women with average risk for gestational diabetes be screened?

    <p>At 24 to 28 weeks of gestation</p> Signup and view all the answers

    Which condition can protein castings in urine indicate?

    <p>Damage to kidneys</p> Signup and view all the answers

    What is the recommended storage duration for opened insulin vials at room temperature?

    <p>4 weeks</p> Signup and view all the answers

    What is the primary treatment for the Somogyi effect?

    <p>Bedtime snack and reducing insulin dose</p> Signup and view all the answers

    What characterizes the dawn phenomenon?

    <p>Hyperglycemia upon waking</p> Signup and view all the answers

    Which statement about metformin is correct?

    <p>It reduces glucose production by the liver</p> Signup and view all the answers

    When should a-glucosidase inhibitors be taken for optimal effect?

    <p>With the first bite of each main meal</p> Signup and view all the answers

    What is a common consequence of increased insulin dosage in the presence of morning hyperglycemia?

    <p>Possible exacerbation of hypoglycemia</p> Signup and view all the answers

    How can one measure the effectiveness of a-glucosidase inhibitors?

    <p>By checking 2-hour postprandial glucose levels</p> Signup and view all the answers

    What typically occurs during the Somogyi effect?

    <p>Overnight hypoglycemia followed by morning hyperglycemia</p> Signup and view all the answers

    What should be adjusted to treat the dawn phenomenon?

    <p>Insulin dosage or administration time</p> Signup and view all the answers

    What is the primary mechanism of action for sulfonylureas?

    <p>Stimulates pancreatic cells to secrete more insulin</p> Signup and view all the answers

    Which of the following is a common side effect of meglitinides?

    <p>Hypoglycemia</p> Signup and view all the answers

    What dietary approach does MyPlate emphasize for diabetes management?

    <p>Adequate carbohydrates from starches and fruits</p> Signup and view all the answers

    What characterizes diabetic ketoacidosis (DKA)?

    <p>Severe insulin deficiency leading to hyperglycemia and ketosis</p> Signup and view all the answers

    Why do cells experience dehydration during diabetic ketoacidosis?

    <p>Increased osmolarity of extracellular fluid</p> Signup and view all the answers

    What is the main educational focus in nursing care for patients with diabetes?

    <p>Patient education regarding medication compliance and diet</p> Signup and view all the answers

    What drives the body to use fat cells for energy during hyperglycemia in DKA?

    <p>Lack of glucose in the cells due to insufficient insulin</p> Signup and view all the answers

    Which food groups should be prioritized to maintain a safe sugar range for diabetic patients?

    <p>Low carbs, lean meats, and vegetables</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus Overview

    • Chronic illness characterized by hyperglycemia due to impaired insulin production, insulin use, or both.
    • Leading cause of end-stage renal disease, adult blindness, and non-traumatic lower limb amputations.
    • Risk factors: Family history, previous glucose intolerance (gestational diabetes, prediabetes), Hispanic ethnicity, age over 45, obesity, giving birth to an infant over 9 pounds.

    Etiology and Pathophysiology

    • Type 1 or Type 2: Caused by genetic, environmental, or autoimmune factors, particularly in Type 1.
    • Insulin: A hormone produced by beta cells in the pancreas, regulating blood glucose levels.
    • Insulin's Role: Promotes glucose transport into cells for energy, inhibits glucose production by the liver, and increases protein synthesis.
    • Counterregulatory Hormones: Glucagon, epinephrine, growth hormone (GH), and cortisol work against insulin to maintain blood glucose levels.

    Type 1 Diabetes (Insulin-Dependent Diabetes Mellitus)

    • Autoimmune disorder where the body attacks insulin and/or pancreatic cells that produce insulin.
    • Destruction of beta cells in pancreas: Insulin production ceases.
    • Diagnosis: Usually diagnosed in early childhood or school age.
    • Signs and Symptoms: Polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger), fatigue/weakness, gastrointestinal (GI) symptoms (nausea, vomiting), weight loss.
    • Treatment: Requires exogenous insulin (insulin from an external source) for survival.

    Type 2 Diabetes (Non-Insulin Dependent Diabetes Mellitus)

    • Combination of inadequate insulin production and cellular resistance to insulin.
    • Gradual onset.
    • Diagnosis: Elevated blood glucose levels or A1c on routine lab testing.
      • A1c of 6.5% or higher: Indicative of diabetes; measures glycosylated hemoglobin (glucose attached to hemoglobin over previous 2-3 months).
      • Fasting plasma glucose (FPG) level of 126 mg/dL or greater: Fasting defined as no caloric intake for at least 8 hours.
      • 2-hour plasma glucose level of 200 mg/dL or greater: During an oral glucose tolerance test (OGTT) with a 75 gram glucose load.
      • Random plasma glucose level of 200 mg/dL or greater: In patients with classic hyperglycemia symptoms.

    Prediabetes

    • Increased risk of developing type 2 diabetes.
    • Impaired glucose tolerance (IGT) or impaired fasting glucose (IFG): Elevated glucose levels, but not meeting diagnostic criteria for diabetes.
    • IGT: 2-hour OGTT values between 140 to 199 mg/dL.
    • Usually asymptomatic.

    Gestational Diabetes

    • Develops during pregnancy.
    • Higher risk for Cesarean delivery.
    • Factors increasing risk: Obesity, advanced maternal age, family history of diabetes.
    • Screening: OGTT at 24-28 weeks of gestation for women with average risk.
    • Most cases resolve within 6 weeks postpartum.

    Diagnostics

    • Fasting plasma glucose: Over 126 mg/dL indicates diabetes.
    • Hemoglobin A1c: Provides an average of glucose levels over the past three months.
    • Estimated Average Glucose (eAG): Calculated conversion of HbA1c into blood glucose units (mg/dL).
    • Urine glucose, ketones, and protein levels: Glucose in urine indicates ketosis due to high blood glucose. Protein in urine can signify kidney damage.
    • Serum cholesterol: Testing for other risk factors like atherosclerosis.

    Types of Insulin

    • Rapid-Acting: Onset within 15 minutes, peak within 1 hour, duration 3-4 hours.
    • Short-Acting: Onset within 30 minutes, peak 2-3 hours, duration 5-7 hours.
    • Intermediate-Acting: Onset within 1-2 hours, peak 4-12 hours, duration 12-18 hours.
    • Long-Acting: Onset within 1-2 hours, no peak, duration 24 hours.

    Storage of Insulin

    • Refrigerate unopened insulin vials and pens.
    • Insulin in use can be left at room temperature for up to 4 weeks, avoiding extreme temperatures.
    • Prefilled insulin syringes: Store for 30 days if containing one type of insulin.

    Drug Therapy

    • Biguanides (Metformin): Reduces glucose production by the liver, causes moderate weight loss.
    • Alpha-Glucosidase Inhibitors (Glyset, Precose): Slows carbohydrate metabolism in the small intestine, delaying glucose absorption.
    • Sulfonylureas (Glucotrol, Glynase): Stimulates insulin secretion from the pancreas and increases sensitivity to insulin.
    • Meglitinides (Prandin): Stimulates rapid-acting insulin release from pancreatic islet cells.

    Interprofessional Care

    • Patient and caregiver education and follow-up programs.
    • Nutrition therapy:
      • MyPlate: USDA guidelines, including starch, bread, fruit, milk food groups which raise blood sugar.
      • Low-carbohydrate, lean meats, and vegetables: Good sources for maintaining a healthy diet and safe blood sugar levels.
    • Nursing care:
      • Patient education: Medication compliance, medication administration instructions, foot care, diet.

    Acute Complications of Diabetes

    • Diabetic Ketoacidosis (DKA): Serious condition with rapid onset; caused by severe insulin deficiency.
      • Hyperglycemia: Cells lack insulin, leading to fat breakdown for energy.
      • Ketoacidosis: Byproduct of fat breakdown.
      • Dehydration: Cells are starved, causing dehydration due to hyperosmolarity in the extracellular fluid (sugar overload). Excess sugar leads to vomiting to excrete it.

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    Diabetes Mellitus PDF

    Description

    Explore the fundamentals of Diabetes Mellitus, including its etiology and pathophysiology. Understand the different types of diabetes, risk factors, and the hormone insulin's crucial role in glucose regulation. This quiz is essential for anyone seeking to deepen their knowledge about this prevalent chronic illness.

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