Type 1 Diabetes and Complications

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Questions and Answers

AJ is a 19 year-old woman who comes into your community pharmacy. She would like to get Ensure or another high-calorie nutritional supplements. You sense something may be off and after some questioning, she tells you that she loses weight despite eating a lot, and has difficulty exercising because she feels fatigued and her performance decreases. You noticed that she had fruity breath. She also states that she tries not to go out much especially to places where there are no restrooms available. Based on the symptoms presented, which disease state does the 19-year-old patient most likely suffer from?

  • Diabetes Insipidus
  • Type 2 Diabetes Mellitus
  • Type 1 Diabetes Mellitus (correct)
  • Hypothyroidism

AJ is a 19 year-old woman who comes into your community pharmacy. She would like to get Ensure or another high-calorie nutritional supplements. You sense something may be off and after some questioning, she tells you that she loses weight despite eating a lot, and has difficulty exercising because she feels fatigued and her performance decreases. You noticed that she had fruity breath. She also states that she tries not to go out much especially to places where there are no restrooms available. Considering the patient's likely condition, which statement about her disease is most likely true?

  • Her alpha-cells in the Islets of Langerhans are not functioning properly.
  • The cause of her disease is likely an autoimmune disorder. (correct)
  • She is showing signs of insulin resistance.
  • She has a surplus of insulin.

What is a characteristic of ketoacidosis that a pharmacist should explain to a patient with type 1 diabetes?

  • There is formation of ketone bodies. (correct)
  • It is seen mostly in patients with type 2 diabetes.
  • There is inhibition of lipolysis in the liver. (correct)
  • It can cause metabolic alkalosis.

A patient with type 1 diabetes begins exercising regularly after starting insulin therapy. If she presents with symptoms of paleness, tachycardia, and sweating, what is she most likely experiencing?

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

Why does the patient experience fruity breath?

<p>Production of ketone bodies (C)</p> Signup and view all the answers

What is the most likely reason for the patient’s fatigue and decreased exercise performance?

<p>Inefficient protein synthesis and muscle loss (C)</p> Signup and view all the answers

Why is it imperative to warn patients about the possible consequences of not adhering to their insulin regimen?

<p>Elevated risk of hyperglycemia, ketoacidosis, and coma (D)</p> Signup and view all the answers

Which of the following is the most important counseling point for a newly diagnosed type 1 diabetic who wants to start exercising?

<p>Monitor blood glucose levels closely before, during, and after exercise (D)</p> Signup and view all the answers

Besides cramping and muscle weakness, which additional symptoms would suggest hypocalcemia?

<p>Excessive thirst and frequent urination (D)</p> Signup and view all the answers

What is the most likely underlying pathogenesis of osteoporosis in the patient's mother?

<p>Primary hyperparathyroidism leading to accelerated bone resorption (B)</p> Signup and view all the answers

How does the luteinizing hormone (LH) surge primarily induce ovulation?

<p>By permitting final oocyte maturation and release from the dominant follicle (C)</p> Signup and view all the answers

Where is testosterone (T) produced, considering its initial precursor?

<p>In Leydig cells of the testes, using cholesterol as a precursor (B)</p> Signup and view all the answers

Which statement accurately describes hormone production in theca and granulosa cells?

<p>In theca cells, LH stimulation leads to the production of androstenedione and testosterone (D)</p> Signup and view all the answers

Which hormone or protein is essential for supporting spermatogenesis?

<p>Testosterone (T), which acts on sperm maturation (D)</p> Signup and view all the answers

Given the thyroid function tests (TFTs) showing high TSH and low T4 and T3 levels, what is the most appropriate diagnosis?

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

Which of the following thyroid hormones is the most physiologically active?

<p>T3 (Triiodothyronine) (B)</p> Signup and view all the answers

Which of the following characteristics is typically associated with Type 1 Diabetes Mellitus?

<p>Presence of autoantibodies (C)</p> Signup and view all the answers

Which hormone function pair is incorrect concerning glucose regulation?

<p>Amylin: increase glucose production (C)</p> Signup and view all the answers

Considering the initial precursor molecule, where is testosterone (T) primarily synthesized in males?

<p>In Leydig cells within the testes, using cholesterol as the precursor. (D)</p> Signup and view all the answers

Concerning hormone production within ovarian cells, which statement accurately describes the interplay between theca and granulosa cells during follicle maturation?

<p>In theca cells, LH stimulation produces androstenedione and testosterone. (C)</p> Signup and view all the answers

Which hormone or protein is indispensable for sustaining spermatogenesis within the seminiferous tubules?

<p>Testosterone (T) (acting on sperm maturation). (A)</p> Signup and view all the answers

Considering AJ's symptoms of weight loss despite increased appetite, fatigue, fruity breath, and frequent restroom visits, which underlying metabolic disturbance is most likely contributing to her condition?

<p>Autoimmune destruction of pancreatic beta-cells, resulting in inadequate insulin production and subsequent hyperglycemia. (D)</p> Signup and view all the answers

Given thyroid function tests (TFTs) indicating high TSH and low T4 and T3 levels, what is the most appropriate diagnosis regarding thyroid dysfunction?

<p>Primary hypothyroidism. (A)</p> Signup and view all the answers

Given AJ's diagnosis of type 1 diabetes, which statement regarding the pathophysiology of her condition is most accurate?

<p>Her body's immune system has mistakenly attacked and destroyed the insulin-producing beta cells in her pancreas. (D)</p> Signup and view all the answers

Which of the following best describes the significance of ketone body formation in the context of ketoacidosis?

<p>Ketone bodies are byproducts of fatty acid breakdown and, when produced in excess, can lead to metabolic acidosis. (C)</p> Signup and view all the answers

Which characteristic distinguishes Type 1 Diabetes Mellitus from Type 2?

<p>Presence of autoantibodies targeting pancreatic beta cells. (B)</p> Signup and view all the answers

In a Type 1 diabetic patient on insulin, what is the combined effect of muscle and liver response to insulin?

<p>Stimulate protein synthesis from amino acids in skeletal muscle. (A)</p> Signup and view all the answers

Upon starting an exercise regimen alongside insulin therapy, a type 1 diabetic patient experiences paleness, tachycardia, and sweating. What is the most likely physiological explanation for these symptoms?

<p>Increased insulin sensitivity due to exercise leads to excessive glucose uptake by cells, causing hypoglycemia. (A)</p> Signup and view all the answers

In a patient with type 1 diabetes, what is the primary mechanism by which a lack of insulin leads to decreased exercise performance and persistent fatigue?

<p>The absence of insulin impairs the transport of glucose into muscle cells, limiting the availability of fuel for energy production. (C)</p> Signup and view all the answers

Why is patient education regarding the consequences of insulin non-adherence particularly crucial in type 1 diabetes management?

<p>Skipping insulin doses can lead to rapid and life-threatening complications such as diabetic ketoacidosis (DKA) and coma. (B)</p> Signup and view all the answers

A 70-year-old woman experiences muscle weakness and cramping. Besides these symptoms, which additional signs or symptoms would most strongly suggest the presence of hypocalcemia?

<p>Tingling or numbness around the mouth and in the fingers and toes, along with muscle spasms. (B)</p> Signup and view all the answers

Flashcards

Type 1 Diabetes Mellitus

An autoimmune disease where the pancreas produces little to no insulin.

Symptoms of Type 1 Diabetes

Symptoms include weight loss, fatigue, frequent urination, and fruity breath.

Ketoacidosis

A serious complication of diabetes where the body produces excess ketones leading to acidosis.

Insulin Resistance

A condition where cells in the body don't respond properly to insulin.

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Signs of Hypoglycemia

Symptoms of low blood sugar include pale skin, sweating, and rapid heartbeat.

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Islets of Langerhans

Clusters of cells in the pancreas that include insulin-producing beta cells.

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Autoimmune Disorder

A condition where the immune system attacks the body's own cells, like in Type 1 Diabetes.

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Exercise and Blood Sugar

Exercise increases glucose uptake by cells, which can lower blood sugar levels.

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Prevention of Osteoporosis

Adequate calcium intake and Vitamin D supplementation can help prevent osteoporosis.

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Symptoms of Hypocalcemia

Signs include fatigue, muscle pain, excessive thirst, frequent urination, and spasms.

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Cause of Osteoporosis in Mother

Primary hyperparathyroidism leads to accelerated bone resorption and decreased bone formation.

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LH Surge Function

The LH surge triggers ovulation by allowing oocyte release from the dominant follicle.

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Follicle Composition

Follicles consist of granulosa cells, theca cells, and an egg (ova).

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Active Thyroid Hormones

T3 is the most potent thyroid hormone, while T4 is produced in greater quantity.

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Cells that Build Bone

Osteoblasts are responsible for bone formation.

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Insulin Function in Liver

Insulin increases glucose uptake for glycogen synthesis and triglyceride storage in the liver.

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Type 1 Diabetes Characteristics

Type 1 diabetes features gradual onset and presence of autoantibodies.

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Hypothyroidism Diagnosis

High TSH and low T4 and T3 indicate primary hypothyroidism.

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Type 1 Diabetes Symptoms

Common symptoms include weight loss, fatigue, and fruity breath.

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Cause of Type 1 Diabetes

An autoimmune disorder that attacks beta cells in the pancreas.

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Diabetic Ketoacidosis

A complication where excessive ketone production leads to metabolic acidosis.

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Effects of Hypoglycemia

Symptoms include pale skin, sweating, and rapid heartbeat during low blood sugar.

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Insulin and Exercise

Exercise increases glucose uptake into cells, lowering blood sugar levels.

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Hyperglycemia Symptoms

Signs include excessive thirst, fatigue, and frequent urination.

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Calcium Intake Importance

Increased calcium intake can prevent osteoporosis and strengthen bones.

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Vitamin D Role

Vitamin D is essential for calcium absorption and bone health.

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Pathogenesis of Osteoporosis

Involves primary hyperparathyroidism causing bone loss and decreased formation.

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Function of LH Surge

Triggers ovulation by promoting oocyte release from the dominant follicle.

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Inhibitory Role of Inhibin

Inhibin negatively regulates FSH and LH to maintain hormonal balance.

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Role of Testosterone in Spermatogenesis

Testosterone is crucial for sperm maturation; others support it.

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Granulosa Cells Role

Granulosa cells convert androgens to estrogens via aromatase.

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Character of Type 1 Diabetes

Gradual onset and presence of autoantibodies, unlike Type 2.

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Physiologically Active Thyroid Hormones

TRH, TSH, T3, and T4 regulate metabolism; T3 is most active.

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Osteoblasts Function

Cells that build bone and promote bone formation.

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Insulin's Effect in the Liver

Insulin promotes glucose uptake for glycogen synthesis and triglyceride storage.

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Study Notes

Type 1 Diabetes Mellitus

  • Age: Young (19 years old) is a risk factor
  • Symptoms: Frequent urination, excessive eating despite weight loss, fatigue, decreased exercise performance, fruity breath (ketoacidosis), increased thirst.
  • Pathophysiology: Autoimmune disorder where the body attacks and destroys the insulin-producing beta cells in the pancreas
  • Complication: Hyperglycemia can lead to ketoacidosis and even coma
  • Characteristics: Gradual onset is not a characteristic, presence of autoantibodies is a characteristic and is often associated with this disorder.
  • Important Note: This condition is often associated with weight loss despite increased food intake and the fruity breath is a result of accumulation of ketones.

Ketoacidosis

  • Cause: Accumulation of ketone bodies due to insufficient insulin leading to high blood sugars.
  • Effect: Metabolic acidosis (a dangerous drop in blood pH)
  • Association with Type 1 Diabetes: More common in type 1, although it can occur in type 2.
  • Management: Requires immediate medical attention and insulin administration

Hypoglycemia

  • Cause: Excess insulin or insufficient food intake leading to lower than normal blood glucose levels
  • Symptoms: Pale skin, tachycardia (fast heartbeat), sweating, tremors, and confusion.

Osteoporosis Prevention in Elderly Patient

  • Calcium Intake: Increase calcium intake (milk, fortified foods)
  • Vitamin D Supplementation: Consider vitamin D supplementation depending on blood levels. Vit D is important for calcium absorption.
  • Bisphosphonates: Prescription bisphosphonates is not necessarily recommended without a prior diagnosis of osteoporosis. It is crucial to first determine if the bone loss warrants such treatment.
  • Fall Prevention: Important to reduce the risk of falls, such as improving home safety, vision checks and balance training

Hypocalcemia Symptoms

  • Symptoms: Muscle cramps, weakness, fatigue, stridor (a high-pitched breathing sound), spasms, seizures, arrhythmias (irregular heart beats), tetany (muscle spasms), and convulsions.

Pathogenesis of Osteoporosis

  • Accelerated bone resorption: Bone breakdown occurs faster than bone building. More bone breakdown than building.
  • Decreased bone formation: Bone building is slower than bone breakdown. Fewer cells building bone.

Ovulation and the LH Surge

  • Mechanism: The LH surge, triggered by high estrogen levels via a positive feedback loop, stimulates ovulation by releasing the mature egg from the dominant follicle.

Hormone Production

  • Testosterone Production: Occurs in Leydig cells in the testes from cholesterol.
  • Testosterone to Dihydrotestosterone: Conversion happens with 5-alpha reductase. Testosterone is converted to dihydrotestosterone (DHT).

Follicle Structure

  • Components: Follicles are made up of granulosa cells, theca cells, and an ovum (egg).
  • Location: Located in the ovaries.
  • Endometrium: Endometrium is the uterine lining, crucial during the menstrual cycle.

Spermatogenesis Support

  • Testosterone (T): Essential for sperm maturation.
  • Inhibin: Regulates FSH and LH (negative feedback).
  • ABP: Androgen-binding protein increases T availability in the seminiferous tubules.
  • FSH: Acts on Sertoli cells to produce nutrients for developing sperm.

Hypothyroidism Diagnosis

  • High TSH, low T3 and T4: Indicates primary hypothyroidism. This means the thyroid gland is not producing enough thyroid hormone.

Thyroid Hormones

  • Active Hormones: T3 is the most active thyroid hormone. T4 is an inactive hormone and needs to be converted into T3 in the body.

Bone Formation

  • Cells: Osteoblasts are the bone-building cells.

Type 1 Diabetes Characteristics

  • Gradual Onset: Not a characteristic.
  • HHS (Hyperglycemic Hyperosmolar State) and Obesity: Not characteristics of Type 1, these are seen in type 2.
  • Autoantibodies: Present in type 1.

Insulin Functions in the Liver

  • Glucose Uptake: Insulin increases glucose uptake by the liver for glycogen synthesis (storage).

Hormone Function Pairs

  • Insulin/Glucose and Lipid Storage: Correct.
  • Glucagon/Increased Glucose Production: Correct.
  • Epinephrine/Increase Glucose Production: Correct.
  • Amylin/Inhibit Glucose Production: Correct. Amylin inhibits glucagon (a hormone that raises blood sugar), decreasing glucose release from the liver.

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