Podcast
Questions and Answers
What is a common symptom that individuals with untreated hyperglycemia may experience?
Which factor is commonly noted in the pathophysiology of type 2 diabetes?
What characterizes the onset of type 2 diabetes?
What is the typical time frame for an individual with prediabetes to develop type 2 diabetes if no preventive measures are taken?
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Which medical condition is NOT typically associated with secondary diabetes?
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What is a common result of insulin resistance in body tissues?
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Which laboratory test result indicates diabetes based on random plasma glucose levels?
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Which of the following expresses a characteristic of adipokines in relation to diabetes?
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What is the normal fasting plasma glucose value?
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What best describes the change in beta cells in type 2 diabetes?
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What is a major complication often associated with diabetes?
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Type 1 diabetes is primarily characterized by which of the following?
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Which hormone counterregulates insulin action by increasing blood glucose levels?
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What does prediabetes indicate?
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Which body system is notably affected by insulin's action of promoting glucose transport?
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Secondary diabetes can arise from conditions that involve which of the following?
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What is the typical glucose range stabilized by normal insulin metabolism?
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Type 2 diabetes is mainly related to which issue in insulin function?
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Insulin not only transports glucose but also inhibits which process?
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Which statement about gestational diabetes is true?
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What are the classic symptoms of Type 1 Diabetes Mellitus?
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Which of the following statements about Type 1 Diabetes is accurate?
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At what age is the peak onset of Type 1 Diabetes commonly observed?
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What is the primary underlying issue in Type 2 Diabetes Mellitus?
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Which group has the highest prevalence of diabetes in the world?
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What is a common physiological response when the pancreas can no longer produce insulin effectively in Type 1 Diabetes?
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What major factor significantly contributes to the development of Type 2 Diabetes?
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Which of the following indicates a condition of prediabetes?
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Which hormone plays a role in opposing the effects of insulin?
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What might happen during the long preclinical period of Type 1 Diabetes?
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Study Notes
Insulin Resistance
- Body tissues do not respond to insulin
- Insulin receptors either unresponsive or insufficient in number
- Results in hyperglycemia
Pancreas ↓ ability to produce insulin
- β cells fatigued from compensating
- β -cell mass lost
Inappropriate glucose production from liver
- Liver’s response of release of glucose is haphazard
- Does not correspond to body’s needs
- Not considered a primary factor in development of type 2 diabetes
Alteration in production of hormones and adipose tissue (adipokines)
- Adipokines play a role in glucose & fat metabolism
- Contribute to pathophysiology of type 2 diabetes
Type 2 - Onset of Disease
- Gradual onset
- Person may go many years with undetected hyperglycemia
- Osmotic fluid/electrolyte loss from hyperglycemia may become severe
- Resulting in hyperosmolar coma
Prediabetes
- Individual is at increased risk for developing diabetes
- Blood glucose levels are not high enough for diabetes diagnosis
- Increased risk for developing type 2 diabetes
- If no preventive measure taken, diabetes usually develops within 10 years
- Long-term damage already occurring
- Heart, blood vessels - see a cardiologist
- Usually present with no symptoms
- Monitor for diabetes symptoms
- Polyuria
- Polyphagia
- Polydipsia
- Maintaining healthy weight, regular exercise, and a healthy diet reduces the risk of developing diabetes
Secondary Diabetes
- Results from another medical condition
- Cushing syndrome
- Hyperthyroidism
- Pancreatitis
- Parenteral nutrition
- Cystic fibrosis
- Hematochromatosis
- Treatment of medical condition that causes abnormal blood glucose level
- Corticosteroids (Prednisone)
- Thiazides
- Phenytoin (Dilantin)
- Atypical antipsychotics (clozapine)
- Usually resolves when underlying condition treated
Diagnostic Studies
-
Random plasma glucose
- Normal 70-120 mg/dL
- Diabetes ≥200 mg/dL
-
Fasting plasma glucose (no caloric intake for 8 hours)
- Normal 70-100 mg/dL
- Prediabetes 100-125 mg/dL
- Diabetes ≥126 mg/dL
Type 1 Diabetes Mellitus
- Formerly known as “juvenile onset” or “insulin dependent” diabetes
- Most often occurs in people under 30 years of age
- Peak onset between ages 11 and 13
- 5-10% of all diabetics
- Now occurring in younger children
Type 1- Etiology and Pathophysiology
- End result of long-standing process where body compensates for a long time
- Immune-mediated disease
- Body’s own T cells attack & destroy pancreatic beta (β)-cells, which are the source of insulin
- Autoantibodies to the islet cells cause a reduction of 80% to 90% of normal cell function before hyperglycemia manifestations occur
- Causes
- Genetic predisposition
- Related to human leukocyte antigens (HLAs)
- Exposure to a virus
- Idiopathic diabetes – not related to autoimmunity but strongly inherited
- Genetic predisposition
Type 1- Onset of Disease
- Long preclinical period before any symptoms
- Antibodies for βcell destruction present for months to years before symptoms occur
- Manifestations develop when pancreas can no longer produce insulin
- Rapid onset of symptoms
- Patient often presents at ER with ketoacidosis
- History of recent, sudden, weight loss
- Classic symptoms
- Polydipsia – excessive thirst
- Polyuria – production of abnormally large amounts of urine
- Polyphagia – Increased appetite
- Will require exogenous insulin to sustain life
Type 1 - Clinical Manifestations
- Classic symptoms
- Polyuria (frequent urination)
- Polydipsia (excessive thirst)
- Polyphagia (excessive hunger)
- Weight loss – body cannot get glucose and uses other energy sources such as fat
- Weakness & fatigue – body cells lack needed energy from glucose
- Nonspecific symptoms
- May have classic symptoms of type 2
- Fatigue 3 lethargic
- Recurrent infections
- Recurrent vaginal yeast infections
- Prolonged wound healing
- Visual changes
Type 2 Diabetes Mellitus
- Most prevalent type of diabetes - over 90% of patients with diabetes
- Usually occurs in people over 35 years of age
- 80% to 90% of patients are overweight
- Prevalence increases with age
- Genetic basis
- Greater in some ethnic populations
- African Americans, Asian Americans, Hispanic Americans, and Native Americans
- Native Americans and Alaskan Natives: Highest rate of diabetes in the world
Etiology and Pathophysiology
- Pancreas continues to produce some endogenous (self-made) insulin
- Insulin produced is either insufficient or poorly utilized by tissues or both
- Obesity (abdominal/visceral)
- Most powerful risk factor
- Genetic mutations
- Lead to insulin resistance
- Increased risk for obesity
Etiology and Pathophysiology
- Four major metabolic abnormalities
- Insulin resistance
- Decreased insulin secretion
- Increased hepatic glucose production
- Altered lipid metabolism
Diabetes Definition
- Chronic multisystem disease related to
- Abnormal insulin production
- Impaired insulin utilization
- Or both
- The long-term complications of diabetes make it a devastating disease. Diabetes is the leading cause of:
- Adult blindness
- End-stage renal disease
- Nontraumatic lower limb amputations
- Major contributing factor
- Heart disease
- Stroke
Etiology and Pathophysiology
- Two most common types
- Type 1
- Type 2
- Other types
- Gestational
- Prediabetes
- Secondary diabetes
Etiology and Pathophysiology
- Normal insulin metabolism
- Produced by the B cells (beta cells)
- Islets of Langerhans of the pancreas
- Released continuously into bloodstream in small increments with larger amounts released after food intake
- Stabilizes glucose range to 70 to 120 mg/dl
- Produced by the B cells (beta cells)
- Insulin
- Promotes glucose transport from bloodstream across cell membrane to cytoplasm of cell
- Decreases glucose in the bloodstream
Etiology and Pathophysiology
- Insulin involvement of many body systems
- Increased Insulin after a meal
- Stimulates storage of glucose as glycogen in liver and muscle
- Inhibits gluconeogenesis - the process of synthesizing glucose in the body from non-carbohydrate sources
- Enhances fat deposition
- Increased protein synthesis
Counterregulatory hormones
- Increase blood glucose levels by stimulating glucose production & output by the liver, & by decreasing the movement of glucose into the cells.
- Examples:
- Glucagon
- Epinephrine
- Growth hormone
- Cortisol
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Description
This quiz explores critical aspects of Type 2 Diabetes, including insulin resistance, the role of the pancreas, and factors influencing glucose metabolism. It covers the gradual onset of the disease and discusses prediabetes as a risk factor for diabetes development. Test your knowledge on these vital concepts related to diabetes pathology.
