Questions and Answers
What characterizes Type I diabetes in relation to insulin production?
Which of the following complications is most commonly associated with chronic uncontrolled diabetes?
What is a key physiological effect of chronic uncontrolled diabetes on metabolism?
Which statement about Type II diabetes is true?
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What is a common symptom of diabetic neuropathy?
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Which factor is a significant environmental trigger for Type I diabetes?
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During diabetic ketoacidosis, which electrolyte is typically monitored due to its changes from insulin treatment?
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What is a primary management strategy for diabetic ketoacidosis?
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What is a serious complication associated with diabetic ketoacidosis (DKA)?
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What distinguishes Hyperosmolar Hyperglycemic State (HHS) from diabetic ketoacidosis (DKA)?
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What is the recommended treatment for hyperglycemia when glucose levels exceed 13.5 mmol/l?
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Which tissue type can utilize glucose without requiring insulin?
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Which chronic complication of diabetes is often linked to prolonged hyperglycemia and results in impaired vision?
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Which symptom is NOT commonly associated with diabetic ketoacidosis (DKA)?
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Which of the following symptoms indicates mild hypoglycemia?
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In the case of Addison's disease, what leads to the impairment of glucose metabolism?
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What treatment method is essential for managing diabetic ketoacidosis?
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What plays a key role in impaired wound healing in diabetic patients?
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What is a common consequence when Addison’s disease is stressed?
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Which symptom is primarily characteristic of nonketotic hyperosmolar hyperglycemia?
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Which of the following is NOT a symptom of severe hypoglycemia?
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What is a common oral complication of uncontrolled diabetes mellitus?
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After surgery, when should a patient ideally start consuming calories orally?
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Which condition is indicated by high levels of cortisol that alter metabolism?
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In which patient population is nonketotic hyperosmolar hyperglycemia most commonly seen?
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What signifies an adrenal crisis in individuals with Addison’s disease?
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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.
