Diabetes Mellitus Overview

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Questions and Answers

What primarily characterizes Diabetes Mellitus?

Acute fluctuations in blood sugar levels unrelated to insulin

Chronic hyperglycemia due to abnormal insulin production or utilization (correct)

Normal insulin production with excessive glucose in the cells

Increased glucose utilization due to excessive insulin production

Which of the following groups is most predisposed to developing diabetes according to risk factors?

Individuals under 25 who are physically active

Healthy individuals with a normal BMI

Individuals over 35, particularly those who are obese (correct)

Individuals who consume a high protein diet and exercise regularly

What role does insulin play in glucose metabolism?

Inhibits glucose production in the liver

Enhances glucose transport across cell membranes into cells (correct)

Converts blood glucose directly to fat without cellular involvement

Stimulates the release of glucagon to increase blood sugar

Which of the following hormones oppose the effects of insulin in glucose regulation?

Glucagon Signup and view all the answers

What is the normal range of stabilized glucose levels in the bloodstream?

70 to 120 mg/dL Signup and view all the answers

Which condition is characterized by the destruction of beta cells in the pancreas leading to an absence of insulin production?

Type 1 diabetes Signup and view all the answers

What is the primary process through which glucagon increases glucose levels in the bloodstream?

Glycogenolysis Signup and view all the answers

What typically indicates impaired glucose tolerance when assessed during a 2-hour oral glucose tolerance test (OGTT)?

2-hour OGTT values between 140 and 199 Signup and view all the answers

Which symptom is least likely to be associated with Type 2 diabetes during its slow onset?

Nausea and vomiting Signup and view all the answers

Which of the following statements about cortisol is true?

Cortisol levels rise in the morning and with stress. Signup and view all the answers

What is the primary purpose of an insulin pump?

To provide a continuous subcutaneous insulin infusion. Signup and view all the answers

Which factor contributes to the Somogyi effect?

Rebound hyperglycemia due to excess insulin. Signup and view all the answers

Which treatment is recommended for hypoglycemia when a patient is awake?

Provide 15 grams of carbohydrates and observe after 15 minutes. Signup and view all the answers

What is a significant risk associated with the use of an insulin pump?

Infection at the infusion site leading to sepsis. Signup and view all the answers

Which of the following best describes lipodystrophy?

Changes in subcutaneous tissue due to repeated injection sites. Signup and view all the answers

What characterizes the Dawn Phenomenon?

Hyperglycemia present upon awakening. Signup and view all the answers

Which complication is characterized by hyperglycemia, ketosis, acidosis, and dehydration?

Diabetic ketoacidosis (DKA). Signup and view all the answers

How should the insulin injection site be prepared before self-injection?

Wash the area with soap and water. Signup and view all the answers

What is the ideal angle for injecting insulin?

45 to 90 degrees. Signup and view all the answers

Which of the following is a common treatment for allergic reactions to insulin?

Low-dose antihistamine administration. Signup and view all the answers

Study Notes

Diabetes Mellitus

Chronic multisystem disease with hyperglycemia caused by abnormal insulin production (type 1), impaired insulin utilization (type 2), or both.
8th leading cause of death in the US.
Leading cause of end-stage renal disease, adult blindness, and non-traumatic lower limb amputations.

Risk Factors

Family history
Gestational diabetes
Minority groups (American Indians, African Americans, Hispanics, Asian Americans)
Age over 35
Obesity (BMI over 30)
Having given birth to an infant over 9 lbs
Inactivity

Etiology and Pathophysiology

Combination of genetic, autoimmune, and environmental factors.
Primarily a disorder of glucose metabolism related to insufficient or ineffective insulin.
Insulin, produced by beta cells in the islets of Langerhans, promotes glucose transport into cells.
Counterregulatory hormones like glucagon, epinephrine, growth hormone, and cortisol work against insulin, increasing glucose levels.

Prediabetes

At risk for type 2 diabetes.
Defined as impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both.
IGT is diagnosed with a 2-hour oral glucose tolerance test (OGTT) value of 140-199 mg/dL.
IFG is diagnosed with a fasting glucose level of 100-125 mg/dL.
Usually asymptomatic.

Type 1 Diabetes

Insulin-dependent (abnormal insulin production).
Result of destruction of beta cells in the pancreas, the only cells that produce insulin.
Signs and symptoms: polydipsia, polyuria, polyphagia, fatigue/weakness, nausea/vomiting.
Treatment requires both long-acting and short-acting insulin.

Type 2 Diabetes

Insulin-resistant (impaired insulin utilization).
Combination of inadequate insulin secretion and insulin resistance.
The pancreas usually produces some insulin, but it may not be enough or used effectively.
Signs and symptoms: slow onset with possible polyuria and polydipsia.

Insulin Therapy

Usually available as U100 insulin (1 mL contains 100 units of insulin).
Inject at a 45-90-degree angle.
Wash injection sites with soap and water, not alcohol swabs.

Insulin Pump

Delivers continuous subcutaneous insulin infusion through a small device.
Delivers short-acting insulin.
Preprogrammed to deliver varying hourly basal rates.
Ideal candidates are individuals who have failed other regimens, pregnant women, or those wanting flexibility.
Expensive, with a risk for infection at the site.
Infusion site needs to be changed every 24-48 hours.

Problems with Insulin Therapy

Hypoglycemia: Treatment includes administering glucagon and carbohydrates.
Allergic Reaction: Local inflammatory reactions may occur around the injection site.
Lipodystrophy: Changes in subcutaneous tissue may occur with frequent use of the same injection site.
Somogyi Effect: Rebound hyperglycemia in the morning due to a high insulin dose at night.
Dawn Phenomenon: Hyperglycemia on awakening due to counterregulatory hormones.

Acute Complications

Diabetic Ketoacidosis (DKA): Serious condition caused by a profound insulin deficiency. Characterized by hyperglycemia, ketosis, acidosis, and dehydration.

### Hyperparathyroidism

Most common disease of the parathyroid glands.
Characterized by excess parathyroid hormone (PTH) and high blood calcium levels.
Most commonly caused by a benign tumor called an adenoma on a parathyroid gland.
Symptoms: kidney stones, abdominal pain, bone and joint pain, fragile bones, irritability, depression, anxiety, heart palpitations, arrhythmias.

### Diagnostic Studies (Hyperparathyroidism)

Serum PTH: Increased
Serum Calcium: Increased (8.5-10 mg/dL)
Serum Phosphate: Decreased (2.5-4.5 mg/dL)
Urine Calcium: Increased
Bone Density: Decreased

### Management (Hyperparathyroidism)

Surgical: Partial or complete removal of the parathyroid glands.
Non-surgical: Monitoring of lab values, exercise, increased fluids, moderate calcium intake, medications like calcimimetic agents, bisphosphonates, and phosphate.
Severe: IV sodium chloride, loop diuretics, IV bisphosphonates.

### Nursing Management (Hyperparathyroidism)

Patient education.
Postoperative monitoring for pain, bleeding, and tetany (due to sudden decrease in calcium).

### Hypoparathyroidism

Very rare condition characterized by inadequate circulating PTH.
Most commonly caused by iatrogenic factors (accidental removal or damage during neck surgery).

Symptoms (Hypoparathyroidism)

Due to hypocalcemia: tetany, tingling lips, stiffness of limbs, muscle spasms, Trousseau's sign, Chvostek's sign.

### Diagnostic Studies (Hypoparathyroidism)

Serum PTH: Decreased (10-65 pg/mL)
Serum Calcium: Decreased
Serum Phosphate: Increased (2.5-4.5 mg/dL)

### Management (Hypoparathyroidism)

Calcium supplements, vitamin D, magnesium, high calcium diet.
Treatment goals are to treat acute complications, maintain normal calcium levels, and prevent long-term complications.
Give IV calcium slowly with ECG monitoring.

Thyroid Gland

Located in the front of the neck.
Produces thyroid hormone, which controls metabolic rate, metabolism, and growth/development.
Thyroid hormones: calcitonin (regulates calcium), T3 (regulates metabolism), T4 (regulates metabolism).
Iodine deficiency can prevent the thyroid from secreting sufficient thyroid hormone.
TSH (thyroid stimulating hormone) is released from the pituitary gland, stimulating the thyroid to release T3/T4.

### Hypothyroidism

Condition in which the thyroid gland produces inadequate amounts of thyroid hormone.
Primary hypothyroidism: Thyroid gland malfunction. Causes: insufficient iodine, Hashimoto's disease, surgical removal, therapeutic radiation, atrophy, tumors.
Secondary hypothyroidism: Related to pituitary tumors or disorders, affecting the hypothalamic-pituitary axis.

### Clinical Manifestations (Hypothyroidism)

Fatigue, weight gain, cold intolerance, constipation, dry skin, thinning hair, periorbital edema.

### Myxedema Coma

Severe hypothyroidism with loss of brain function due to prolonged low thyroid hormone.
Life-threatening.

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Description

Explore the intricate details of Diabetes Mellitus, including its causes, risk factors, and impact on health. Understand the differences between type 1 and type 2 diabetes, along with their etiology and pathophysiology. This quiz sheds light on the seriousness of this chronic disease and its complications.