Type I Diabetes Overview

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Questions and Answers

What characterizes Type I diabetes in relation to insulin production?

Insulin levels remain constant throughout the patient's life.

Insulin is produced in varying amounts.

There is a complete or almost complete absence of insulin. (correct)

Insulin production typically increases with age.

Which of the following complications is most commonly associated with chronic uncontrolled diabetes?

Nephropathy (correct)

Diabetic foot ulcers

Coronary heart disease

Retinal hemorrhages

What is a key physiological effect of chronic uncontrolled diabetes on metabolism?

Decreased fat oxidation

Preservation of protein stores

Shifting to fat metabolism (correct)

Increased reliance on carbohydrate metabolism

Which statement about Type II diabetes is true?

Some insulin is produced but insulin resistance is a major factor. Signup and view all the answers

What is a common symptom of diabetic neuropathy?

Tingling sensation Signup and view all the answers

Which factor is a significant environmental trigger for Type I diabetes?

Congenital rubella virus Signup and view all the answers

During diabetic ketoacidosis, which electrolyte is typically monitored due to its changes from insulin treatment?

Potassium Signup and view all the answers

What is a primary management strategy for diabetic ketoacidosis?

Fluid replacement with isotonic fluids Signup and view all the answers

What is a serious complication associated with diabetic ketoacidosis (DKA)?

Cerebral edema Signup and view all the answers

What distinguishes Hyperosmolar Hyperglycemic State (HHS) from diabetic ketoacidosis (DKA)?

HHS is characterized by the absence of ketoacidosis. Signup and view all the answers

What is the recommended treatment for hyperglycemia when glucose levels exceed 13.5 mmol/l?

Use a sliding scale insulin Signup and view all the answers

Which tissue type can utilize glucose without requiring insulin?

Brain Signup and view all the answers

Which chronic complication of diabetes is often linked to prolonged hyperglycemia and results in impaired vision?

Retinopathy Signup and view all the answers

Which symptom is NOT commonly associated with diabetic ketoacidosis (DKA)?

Peripheral neuropathy Signup and view all the answers

Which of the following symptoms indicates mild hypoglycemia?

Weakness Signup and view all the answers

In the case of Addison's disease, what leads to the impairment of glucose metabolism?

Lack of cortisol and aldosterone Signup and view all the answers

What treatment method is essential for managing diabetic ketoacidosis?

Intravenous insulin infusion Signup and view all the answers

What plays a key role in impaired wound healing in diabetic patients?

Ketoacidosis effect on granulocytes Signup and view all the answers

What is a common consequence when Addison’s disease is stressed?

Hypoglycemia Signup and view all the answers

Which symptom is primarily characteristic of nonketotic hyperosmolar hyperglycemia?

Severe dehydration and neurological signs Signup and view all the answers

Which of the following is NOT a symptom of severe hypoglycemia?

Full consciousness Signup and view all the answers

What is a common oral complication of uncontrolled diabetes mellitus?

Xerostomia Signup and view all the answers

After surgery, when should a patient ideally start consuming calories orally?

Within 3 hours after surgery Signup and view all the answers

Which condition is indicated by high levels of cortisol that alter metabolism?

Secondary adrenal insufficiency Signup and view all the answers

In which patient population is nonketotic hyperosmolar hyperglycemia most commonly seen?

Older patients with Type II diabetes Signup and view all the answers

What signifies an adrenal crisis in individuals with Addison’s disease?

Severe hypotension and confusion Signup and view all the answers

Study Notes

Type I Diabetes Mellitus (IDDM)

Accounts for approximately 10% of diabetic patients, typically diagnosed in childhood or young adulthood.
Characterized by symptoms such as polyuria, polydipsia, polyphagia, weight loss, and incontinence.
Results from complete or almost complete lack of insulin, leading to ketoacidosis if untreated.
Associated with a weak genetic link and autoimmune response targeting pancreatic beta cells.
Environmental triggers include infections like congenital rubella, CMV, mumps, hepatitis, and coxsackie virus.

Type II Diabetes Mellitus (NIDDM)

Primarily occurs in adults over the age of 40, often with slight weight fluctuations and nocturnal awakenings to urinate.
Insulin production occurs, but ketoacidosis is rare; hyperosmolar hyperglycemic state (HHS) is more common.
Strong genetic predisposition with factors such as increased insulin resistance and decreased receptor activity.
Progresses to decreased insulin secretion over time, leading to excess glucagon release due to changes in alpha/beta cell ratios.
Strongly linked to obesity.

Complications of Chronic Uncontrolled DM

Cortisol secretion due to uncontrolled diabetes leads to protein breakdown and loss through urine.
Body metabolizes fat, resulting in increased levels of acetoacetic acid and beta-hydroxybutyric acid, which may result in ketoacidosis.
Failure of respiratory and renal regulators leads to acidotic states.

Chronic Complications of Type I Diabetes

Retinopathy results in retinal hemorrhages due to hypertension.
Neuropathy manifests as a stocking-glove distribution, causing impotence and neurogenic bladder issues.
Nephropathy is linked to 25% of new cases of end-stage renal disease (ESRD).
Vascular complications manifest as non-healing foot ulcers and increased risk of lower extremity amputations.
Coronary disease primarily due to atherosclerosis and hypertension.
Enteropathy leads to decreased gastrointestinal motility.

Micro/Macro-Angiopathy

Ketoacidosis in Type I leads to hyperglycemia (>27), metabolic acidosis, and ketonemia.
Type II can cause hyperosmolar hyperglycemic nonketotic coma.
Long-term complications include diabetic retinopathy leading to blindness, cataracts, diabetic nephropathy, and renal failure.
Accelerated atherosclerosis increases risks of coronary heart disease, stroke, and foot ulcerations.

Management of Diabetic Ketoacidosis (DKA)

Requires aggressive IV fluid replacement with isotonic solutions, alongside insulin administration.
Potassium monitoring is crucial since levels drop after insulin therapy.
Bicarbonate therapy is used for severe acidosis.
Physical examination is essential to identify underlying causes.

Symptoms of Diabetic Ketoacidosis

Rapidly evolving symptoms over 24 hours include N/V, polyuria, altered mental status, dehydration, and Kussmaul respiration.
A pH below 7.0 risks acidotic coma and death.

Nonketotic Hyperosmolar Hyperglycemia

Predominantly seen in older Type II diabetes patients with high mortality rates.
Symptoms include severe dehydration and neurological signs without anion-gap metabolic acidosis.

Oral Complications of Uncontrolled Diabetes

Commonly results in xerostomia, poor healing, increased infections, and periodontal disease.
Oral fungal infections and enamel hypoplasia may occur.

Infection and Wound Healing

Hyperglycemia impairs immune response, decreasing chemotaxis and phagocytosis.
Impaired wound healing can arise from ketoacidosis, vascular changes, and reduced blood flow.

Tissues Utilizing Glucose Independently of Insulin

Brain, intestinal mucosa, renal cortex, lens, and red blood cells can utilize glucose without insulin.
Muscle, fat, and liver tissues require insulin for glucose uptake.

Insulin Types and Administration

Rapid-acting insulins cover immediate meal needs; regular insulin is used for meals consumed shortly after injection.
Intermediate insulins cover daily needs; long-acting insulins provide coverage for an entire day.

Hypoglycemia

Mild symptoms include hunger, pallor, weakness, sweating, and tachycardia.
Severe cases can lead to unconsciousness, hypotension, and seizures, requiring immediate attention.

Addison's Disease

Involves adrenal insufficiency due to cortex destruction, leading to multiple hormonal deficiencies.
Symptoms may include nausea, dehydration, hypotension, and cardiac instability, especially during stress.
Untreated adrenal crises can lead to severe health complications, including potential death.

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Description

Explore the features and characteristics of Type I Diabetes Mellitus (IDDM), which accounts for 10% of diabetic patients. This quiz covers its causes, symptoms, and the autoimmune response affecting beta cells, mainly occurring in children and young adults.