Dialysis and Diabetes Overview
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Questions and Answers

What is a significant disadvantage of using dialysis catheters?

  • They can be used immediately for dialysis.
  • They are less prone to infections compared to AV grafts.
  • They may cause long-term damage to the veins. (correct)
  • They require less maintenance than AV grafts.

Which statement is true regarding AV grafts compared to dialysis catheters?

  • AV grafts are less prone to infections.
  • AV grafts typically have a shorter maturation time. (correct)
  • AV grafts are easier to maintain than dialysis catheters.
  • AV grafts require more than one operation to place.

What is a common requirement if a dialysis catheter becomes infected?

  • It requires complete removal and prolonged antibiotics. (correct)
  • It requires temporary removal and no antibiotics.
  • It needs to be replaced with a new catheter.
  • It must be cleaned weekly to prevent infection.

What is a potential risk associated with the use of dialysis catheters over time?

<p>They can lead to frequent clotting that requires treatment. (D)</p> Signup and view all the answers

Which statement accurately reflects the longevity of AV grafts?

<p>AV grafts last shorter than other permanent access methods. (D)</p> Signup and view all the answers

Which of the following conditions is primarily characterized by impaired insulin secretion and variable degrees of insulin resistance?

<p>Diabetes mellitus (B)</p> Signup and view all the answers

What is the first phase of insulin release triggered by?

<p>Increased blood glucose levels (D)</p> Signup and view all the answers

What crucial role do muscle and fat cells play in relation to insulin?

<p>They stimulate glucose uptake (C)</p> Signup and view all the answers

What is the primary method for diagnosing diabetes mellitus?

<p>Measuring plasma glucose (A)</p> Signup and view all the answers

Which of the following conditions is NOT a complication associated with diabetes mellitus?

<p>Hyperthyroidism (B)</p> Signup and view all the answers

What happens to insulin release when blood glucose levels return to normal physiological values?

<p>Insulin release slows or stops (C)</p> Signup and view all the answers

Which of the following processes is initiated by insulin binding to its receptor?

<p>Glycolysis and fatty acid synthesis (C)</p> Signup and view all the answers

What is the main storage form of glucose in the human body?

<p>Glycogen (C)</p> Signup and view all the answers

What is the primary mechanism of action for sulfonylureas?

<p>Stimulate pancreatic β-cell insulin secretion (C)</p> Signup and view all the answers

Which of the following classes of oral anti-diabetic drugs is mainly known for its insulin-sensitizing effects?

<p>Thiazolidinediones (C)</p> Signup and view all the answers

For patients with type 2 diabetes who don’t respond to lifestyle changes, which is a recommended therapeutic approach?

<p>Adding oral anti-diabetic drugs (A)</p> Signup and view all the answers

Which mechanism is primarily attributed to biguanides?

<p>Decrease hepatic glucose production (A)</p> Signup and view all the answers

What effect do thiazolidinediones potentially have beyond lowering blood glucose?

<p>They reduce serum lipids (A)</p> Signup and view all the answers

What role do α-glucosidase inhibitors play in diabetes management?

<p>Compete with dietary carbohydrates at digestion (A)</p> Signup and view all the answers

How do dipeptidyl peptidase-4 inhibitors contribute to diabetes management?

<p>Blocking the action of glucagon (D)</p> Signup and view all the answers

What underlying condition is associated with macrovascular disease in diabetes?

<p>Hyperinsulinemia (C)</p> Signup and view all the answers

What causes the vascular complications in Non Proliferative Diabetic Retinopathy (NPDR)?

<p>Leaky blood vessels and exudate formation (C)</p> Signup and view all the answers

What is the primary cause of vision loss in patients with Diabetic Retinopathy?

<p>Macular Edema from leaky vessels (C)</p> Signup and view all the answers

What is a significant risk factor for the progression of Proliferative Diabetic Retinopathy (PDR)?

<p>Untreated fragile neovascularized blood vessels (A)</p> Signup and view all the answers

Which treatment method is utilized to manage leaking blood vessels in diabetic retinopathy?

<p>Laser Photocoagulation Treatment (C)</p> Signup and view all the answers

What is the primary underlying mechanism of diabetic neuropathy?

<p>Oxidative stress and microvascular injury (B)</p> Signup and view all the answers

What complication arises if the abnormal vessels in PDR are not treated?

<p>Severe loss of vision due to vitreous hemorrhage (D)</p> Signup and view all the answers

What is diabetic neuropathy primarily characterized by?

<p>Loss of sensory and motor nerve fibers (C)</p> Signup and view all the answers

Which of the following is NOT a manifestation of diabetes mentioned in the content?

<p>Alzheimer's disease (A)</p> Signup and view all the answers

What is the fasting plasma glucose (FPG) level indicative of diabetes?

<p>Greater than or equal to 126 mg/dL (B)</p> Signup and view all the answers

Which treatment is most commonly recommended for type 1 diabetes mellitus?

<p>Insulin therapy (D)</p> Signup and view all the answers

What is the recommended age to aim for an HbA1c level of less than 7%?

<p>All age groups (D)</p> Signup and view all the answers

What complication is very likely in the presence of diabetes mellitus?

<p>Diabetic neuropathy (A)</p> Signup and view all the answers

Which of the following conditions indicates impaired glucose regulation based on an oral glucose tolerance test (OGTT)?

<p>140 to 199 mg/dL (D)</p> Signup and view all the answers

Which of the following is not typically part of the treatment options for managing diabetes?

<p>High sugar diets (B)</p> Signup and view all the answers

What is the primary treatment goal regarding blood glucose levels during the day for individuals with diabetes?

<p>80 to 120 mg/dL (C)</p> Signup and view all the answers

Which of the following statements about islet cell antibodies in diabetes is correct?

<p>They are present in type 1 diabetes but not in type 2 diabetes (D)</p> Signup and view all the answers

What triggers the autoimmune destruction of pancreatic β-cells in Type 1 diabetes mellitus (DM)?

<p>Environmental exposure in genetically susceptible individuals (B)</p> Signup and view all the answers

What is a common characteristic of Type 2 diabetes mellitus (DM) regarding insulin levels?

<p>Plasma insulin levels may vary from low to elevated depending on insulin resistance. (B)</p> Signup and view all the answers

Which statement accurately describes the onset of Type 1 and Type 2 diabetes mellitus?

<p>Type 1 DM develops predominantly in childhood or adolescence, while Type 2 DM usually occurs in adults. (B)</p> Signup and view all the answers

What condition is commonly associated with insulin resistance in Type 2 DM?

<p>Obesity and weight gain (B)</p> Signup and view all the answers

In what way does Type 2 diabetes mellitus typically manifest in childhood due to recent trends?

<p>It has become increasingly common due to childhood obesity. (B)</p> Signup and view all the answers

What outcomes are characterized by Type 1 diabetes mellitus as it progresses?

<p>Progressive destruction of β-cells leading to insufficient insulin levels. (C)</p> Signup and view all the answers

What distinguishes Type 2 diabetes mellitus's response to insulin from that of Type 1 diabetes mellitus?

<p>Type 2 DM manifests with initially high insulin levels that become inadequate due to resistance. (A)</p> Signup and view all the answers

What factors contribute to the high prevalence of Type 2 diabetes mellitus in older adults?

<p>Increasing age and obesity rates. (A)</p> Signup and view all the answers

Flashcards

What is diabetes mellitus?

Diabetes mellitus (DM) is a chronic disease characterized by high blood sugar levels due to either insufficient insulin production or the body's inability to effectively use insulin.

What are some early symptoms of diabetes?

Early symptoms of diabetes include excessive thirst (polydipsia), increased hunger (polyphagia), and frequent urination (polyuria).

What is insulin?

Insulin is a hormone, produced by the pancreas, that regulates blood sugar levels by allowing glucose (sugar) to enter cells.

Where is insulin produced?

The pancreas contains clusters of cells called islets of Langerhans. These islets contain beta cells that produce insulin.

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How is insulin released?

Insulin release from beta cells occurs in two phases: a quick response to high blood sugar and a sustained, slow release independent of sugar levels.

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How does insulin work?

Insulin binds to its receptor on cells, triggering a cascade of events that promote glucose uptake, storage, and utilization.

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What are the primary target cells for insulin?

Muscle cells and fat cells are the main targets of insulin, playing a crucial role in energy storage and utilization.

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How is diabetes diagnosed?

Diabetes diagnosis is typically made by measuring blood glucose levels, either fasting or after a glucose challenge test.

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Type 1 Diabetes (T1D)

A condition where the body's immune system mistakenly attacks and destroys pancreatic beta cells, leading to inadequate insulin production.

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Type 2 Diabetes (T2D)

Characterized by the body's inability to properly use insulin, leading to high blood sugar levels. This can occur due to insulin resistance or inadequate insulin production.

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Insulin Resistance

A measure of how sensitive the body's cells are to the effects of insulin. Resistance means the cells don't respond well to insulin, leading to higher blood sugar levels.

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Hepatic Glucose Production

Process in the liver that releases glucose into the bloodstream, potentially contributing to high blood sugar.

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Juvenile-Onset Diabetes

A form of diabetes that develops in children and adolescents. It is the most common form diagnosed before age 30, though it can occur in adults.

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Adult-Onset Diabetes

A form of diabetes that usually develops in adulthood, hence the name. However, it is increasingly common in children due to rising obesity rates.

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Insulin

A hormone produced by the pancreas that helps regulate blood sugar by allowing glucose to enter cells.

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Pancreatic Beta Cells

Specialized cells within the pancreas that are responsible for producing insulin.

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Glomerulopathy

A type of kidney disease characterized by damage to the filtering units of the kidneys (glomeruli).

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Hemodialysis

A blood purification technique that removes waste products and excess fluid from the blood using a machine.

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Dialysis Catheter

A type of dialysis catheter that is inserted directly into a vein, allowing immediate dialysis without the need for surgery.

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AV Graft

A surgical connection between an artery and a vein, creating a pathway for blood flow during dialysis.

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Graft Maturation

The period of time required for a newly created AV graft to mature and become ready for use in dialysis.

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Classes of Oral Anti-Diabetics

Oral anti-diabetic drugs can be grouped into different classes based on their mechanism of action.

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How do Sulfonylureas work?

Sulfonylureas stimulate the pancreas to release more insulin.

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What are Island Cell Antibodies?

These antibodies indicate an attack by the body's immune system on the cells that produce insulin.

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How do Biguanides work?

Biguanides decrease the production of glucose by the liver.

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What does it mean when islets are smaller?

Smaller islets in the pancreas suggest that the cells that produce insulin are being destroyed.

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How do Thiazolidinediones work?

Thiazolidinediones (TZDs) improve the body's sensitivity to insulin, allowing it to use glucose effectively.

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Why are complications of diabetes more likely when insulin production is low?

The inability of the body to produce enough insulin leads to high blood sugar levels, increasing the risk of complications.

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How do Alpha-glucosidase inhibitors work?

Alpha-glucosidase inhibitors prevent the breakdown of carbohydrates in the intestines, reducing glucose absorption.

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What happens when the body doesn't respond to insulin?

The body is resistant to the effects of insulin, meaning it cannot effectively use the insulin it produces.

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Why might oral antidiabetic medication not be helpful?

Medication can help manage blood glucose levels, but they may not be effective if insulin production is significantly reduced.

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How do Dipeptidyl peptidase-4 inhibitors work?

Dipeptidyl peptidase-4 inhibitors block glucagon, a hormone that raises blood sugar levels, enhancing the effects of insulin.

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What is the diagnostic criterion for diabetes?

A fasting blood glucose level above 126 mg/dL indicates diabetes.

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What are microvascular complications of Diabetes?

The most common and serious complications of diabetes include damage to small blood vessels, leading to eye, nerve, and kidney problems.

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What are macrovascular complications of Diabetes?

Diabetes can also lead to atherosclerosis, where plaque builds up in the arteries, increasing risk of heart attack and stroke.

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What is an Oral Glucose Tolerance Test (OGTT)?

It's a test involving drinking a sugary drink and then measuring blood glucose levels at 2 hours.

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What is Diabetic Retinopathy?

A condition that affects the blood vessels in the retina (the back of the eye) causing them to leak and form deposits called exudates. This leads to swelling of the retina known as macular edema, which is the most common cause of vision loss in diabetics.

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What is Non-Proliferative Diabetic Retinopathy (NPDR)?

The early stage of diabetic retinopathy, characterized by leaky blood vessels in the retina forming deposits called exudates, leading to retinal swelling (macular edema).

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What is Proliferative Diabetic Retinopathy (PDR)?

The advanced stage of diabetic retinopathy, characterized by abnormal new blood vessel growth (neovascularization) in the retina that are fragile and prone to bleeding.

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What is Laser Photocoagulation?

A medical procedure that uses laser beams to seal leaky blood vessels in the retina and prevent further damage. This is often used to treat diabetic retinopathy.

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What is Diabetic Neuropathy?

A complication of diabetes that affects the nerves throughout the body due to a lack of blood flow and damage to the nerves. This can lead to tingling, numbness, pain, and weakness.

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What is the pathophysiology of Diabetic Neuropathy?

The process of progressive loss of nerve fibers in diabetic neuropathy, likely due to oxidative stress, high glucose levels within nerve cells, and impaired cellular metabolism.

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What is Peripheral Artery Disease (PAD)?

Narrowing of arteries due to build up of plaque, often a complication of diabetes. This reduces blood flow, leading to pain, numbness, and even amputation in severe cases.

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What is Diabetic Peripheral Neuropathy?

A type of diabetic neuropathy that specifically affects nerves in the legs and feet. It can cause numbness, tingling, burning, and pain.

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Study Notes

Diabetes Mellitus (DM) Definition

  • Diabetes mellitus (DM) is characterized by impaired insulin secretion and varying degrees of peripheral insulin resistance leading to hyperglycemia.
  • Early symptoms include polydipsia, polyphagia, and polyuria, all related to hyperglycemia.
  • Later complications include vascular disease, peripheral neuropathy, and increased susceptibility to infection.
  • Diagnosis involves measuring plasma glucose levels.
  • Treatment options include diet, exercise, and medications that lower glucose levels, such as insulin and oral antihyperglycemic drugs.
  • Prognosis varies depending on the degree of glucose control.

Insulin - The Key to Diabetes

  • Insulin is synthesized within the beta cells (β-cells) of the islets of Langerhans in the pancreas.
  • The endocrine portion of the pancreas makes up only 2% of its total mass.
  • There are typically one to three million pancreatic islets within the pancreas.
  • Insulin release occurs in two phases: a rapid initial phase triggered by increased blood glucose levels, and a later sustained, gradual release independent of current blood sugar levels.
  • When glucose levels return to normal, insulin secretion from beta cells slows or stops.
  • Insulin's primary role is the stimulation of glucose uptake, primarily in muscle and fat cells.
  • Muscles utilize glucose for movement and other bodily functions, while fat cells store excess glucose for future use.
  • Muscle and fat tissues combined account for approximately two-thirds of all cells in a human body.

Insulin's Mode of Action

  • Insulin binds to its receptor, initiating a cascade of protein activation.
  • This cascade triggers glucose translocation and influx into cells through the plasma membrane.
  • Insulin also promotes glycogen synthesis, the storage form of glucose.
  • Furthermore, insulin stimulates glycolysis and fatty acid synthesis, thereby increasing lipid synthesis.

Circadian Rhythm of Insulin

  • Insulin levels and blood glucose levels follow a diurnal pattern.
  • Blood glucose levels typically peak after consuming a meal, and insulin levels tend to follow these peaks in order to help with the absorption of glucose.
  • Blood glucose levels (and insulin levels) naturally fluctuate throughout the day, influenced by eating patterns.

Type 1 and Type 2 Diabetes

  • Type 1 DM: Characterized by an absolute absence of insulin production due to autoimmune destruction of pancreatic beta cells, potentially from environmental exposure in susceptible individuals.
  • Type 1 generally manifests during childhood or adolescence, though it can occur at any age.
  • Type 2 DM: Characterized by inadequate insulin secretion as well as peripheral insulin resistance and increased hepatic glucose production, which leads to elevated glucose levels.
  • Type 2 generally develops in adulthood, but is becoming increasingly common in children due to rising rates of childhood obesity.

General Characteristics of Type 1 and Type 2 DM

  • Type 1: Typically diagnosed before age 30; marked by severe insulin deficiency; often associated with the presence of detectable islet cell antibodies; and rarely associated with obesity.
  • Type 2: Typically diagnosed after age 30; mainly characterized by peripheral insulin resistance and occasionally by moderately low or normal insulin levels; often associated with obesity.

Diagnostic Criteria for Diabetes Mellitus

  • Fasting Plasma Glucose (FPG): Normal <100mg/dL, Impaired Glucose Regulation 100-125 mg/dL, Diabetes ≥ 126 mg/dL
  • Oral Glucose Tolerance Test (OGTT): Normal <140 mg/dL, Impaired Glucose Regulation 140-199 mg/dL, Diabetes ≥200 mg/dL

Treatment Options and Goals

  • Treatment options for both types of diabetes generally include diet, exercise, and medication.
  • For Type 1, insulin is essential.
  • Type 2 may be treated with oral antihyperglycemics, and even insulin may be necessary in some cases.
  • Treatment goals are to maintain blood glucose levels within a specific range throughout the day.
  • Aim for HbA1c levels below 7% to optimize long-term health outcomes.

Oral Anti-Diabetic Drugs

  • Oral anti-diabetic drugs work through varied mechanisms, which include enhancing pancreatic insulin secretion, increasing peripheral tissue sensitivity to insulin, and decreasing glucose absorption from the gastrointestinal tract.

Diabetic Microvascular and Macrovascular Disease

  • Microvascular diseases: lead to complications in small blood vessels. Examples include retinopathy, nephropathy, and neuropathy.
  • Diabetic Neuropathy: Nerve damage due to ischemia (due to microvascular dz), excess glucose effects on neurons, or intracellular metabolic changes impairing nerve function. Sensorial and motor symptoms result.
  • Macrovascular disease: affect large blood vessels, contributing to other complications like angina pectoris, transient ischemic attacks, strokes, and peripheral arterial disease.

Diabetic Retinopathy

  • Diabetic retinopathy involves damage to the blood vessels in the retina.
  • Early stages are non-proliferative (NPDR), where blood vessels leak and form deposits.
  • Later stages, proliferative retinopathy (PDR), involve abnormal blood vessel growth, which is fragile and can lead to vision loss.

Diabetic Nephropathy

  • Diabetic nephropathy causes kidney damage, often beginning with mild increases in blood pressure and albuminuria.
  • The pathophysiology is complex and likely involves oxidative stress, excess glucose, and microvascular damage.
  • Diabetic nephropathy stages can range from hyperfiltration and glomerular hypertrophy to severe kidney failure.

Diabetic Treatments & Complications Pathways

  • Hemodialysis and peritoneal dialysis are treatments for patients with chronic kidney disease, which can be due to diabetes.
  • Different surgical pathways for diabetes and complications are used for pancreas, kidney and for obesity, such as gastric banding and gastric bypasses.
  • Other options may include simultaneous kidney and pancreas transplantation, which offers a potential treatment solution.

Other Diagnoses Associated with Kidney Transplants

  • Kidney transplants are performed for various medical reasons, with diabetes accounting for a significant portion of cases.

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Description

This quiz covers important aspects of dialysis catheters and AV grafts, alongside key concepts related to diabetes and insulin metabolism. It addresses the risks, benefits, and functions of these medical interventions. Test your knowledge on these critical health topics.

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