ENDOCRINE - Diabetes

1. DM is a serious health problem throughout the world

2. 5th leading cause of death by disease in the Philippines

3. Increased risk of complications RT DM

4. Staggering cost involved in diabetes

5. Diabetic care warrants sound knowledge base

Significance of diabetes

Long, tapered, lobular soft gland

Structure of the pancreas

Behind the stomach ; anterior to the 1st and 2nd lumbar vertebrae

Location of the pancreas

Both endocrine and exocrine function

What does the pancreas perform?

Islet of Langerhans (pancreas)

Endocrine function usually happens in the?

Alpha cells, beta cells, and delta cells

Types of cells

Glucagon

Alpha cells secrete

Insulin

Beta cells secrete

Gastrin, somastatin

Delta cells secrete

Insulin

Hormone secreted by beta cells of the islets of langerhans in the pancreas

1 - insulin

2 - beta cells

3 - islets of langerhans

4 - pancreas

COMPLETE THE SENTENCE

(1) is a hormone secreted by (2) of the (3) in the (4)

1 - released

2 - bloodstream (in small amounts)

3 - bolus

4 - food is ingested

COMPLETE THE SENTENCE

Insulin is continuously (1) in the (2) with increased release (3) when (4)

1 - lowers blood glucose

2 - approx 70 - 100 mg/dL

COMPLETE THE SENTENCE

Release of insulin (1) facilitates a stable normal blood glucose range (2)

70 - 100 mg/dL

Normal blood glucose

Approx 40-50 units

Amount of insulin secreted daily by an adult

8-10 AM in the morning

What is the highest secretion of the day of insulin?

1 - breakfast

2 - insulin is a physiologic rhythm

(1) is the most important meal of the day because (2)

Midnight to early morning

What is the lowest insulin release of the day?

Eat a light supper or dinner if you want to be healthy

No food intake — NOTHING AFTER 7 PM

Rules in eating at night if you want to stay healthy

Proinsulin

Once insulin is released in the bloodstream from beta cells

Liver

Proinsulin is routed through the?

1 - C-peptide chain

2 - Serum or urine

Insulin formed from proinsulin after cleavage of the (1)

The evidence of C-peptide cleavage is seen in (2)

A&B peptide chain

The remaining insulin (1) functions to promote transport across the cell membrane

1 - glucose

2 - source of energy

3 - body cells & tissues

(1) can now be utilized as a (2) for the (3)

Insulin Formation Function Pathway

IFFP means?

Absolute lack/Decrease insulin activity

Cause of diabetes

Pre receptor defect

Receptor defect

Post receptor defect

Three types of defects

Destruction of b cells

Pre receptor defect aka

Decreased binding of receptors

Receptor defect aka

Abnormal coupling of G+I

Post receptor defect aka

Infection

Intake of toxic substance (alcohol, nicotine, drug, meds)

Inherited (genes)

Conditions RT pre receptor defect

Intake of high fat (insulin is fat insoluble)

Sedentary lifestyle

Lack of physical activity

Obesity

Conditions RT receptor defect

Intake of high carbs

Sedentary lifestyle

Lack of physical activity

Conditions RT post receptor defect

Elevated blood glucose (hyperglycemia)

Clinical manifestations of DM

Insulin deficiency

Symptom of hyperglycemia

Glucose remains in the blood

What happens in insulin deficiency

Osmotic effect on intracellular and interstitial fluid compartment

Glucose in the blood produces what

3Ps - Polyuria, Polydipsia, Polyphagia

Fluid shift resultsin

3Ps - Polyuria, Polydipsia, Polyphagia + noticeable weight loss

Therefore, CM of DM is?

urine output above 1500 cc w/in 24 hours (double the amount of the normal)

Polyuria means?

Assess the intake

What do you do to assess for polydipsia & polyphagia?

1. Blood glucose studies

2. Urine studies

3. Specific function tests/profile

4. Specific tests

Diagnosis/Laboratory tests for DM

FBS

RBS

Postprandial blood sugar

Glycosylated HgB

Blood glucose studies include

10-12 hours NPO

FBS is taken

After a meal

PRBS is taken

Glycosylated Hgb (HgbA1c)

Ideal test for DM

1 - HgB

2 - Glucose

3 - 90 - 120 days

COMPLETE THE SENTENCE

(1) of RBC attracts a certain amount of (2). This remains attached to RBC for the life cycle of RBC that is (3)

Urinalysis,

urine culture & sensitivity,

24h collection

Urine specific gravity

Urine studies include

(+) sugar, (+) acetone

Urinalysis (+) of DM reveals

Glucose is a good culture medium for bacteria

DM patients prone to infections because

UTI, vaginal infections

Wounds that won't heal

DM patients are prone to what kinda infections

Liver profile tests/liver profile

Kidney function tests

Lipid profile

Electrolytes

Cardiac profile

Cardiac isoenzymes

Specific function tests/profile

SGPT, SGOT, HBsAg

Liver profile tests include

BUN, Crea, uric acid

Kidney function tests

LDL,HDL, Total cholesterol, triglycerides

Lipid profile

Na, K, Ca, Mg

Electrolytes

Fundoscopic exam

Neurologic exam

Specific tests include

1 - IDDM

2 - NDDM

Type 1 vs Type 2

1 - Pre receptor defect

2 - Receptor defect; Post receptor defect

Type 1 vs Type 2 - CAUSE

1 - juvenile onset (below 25 y/o diagnosed)

2 - adult onset (above 30 y/o)

Type 1 vs Type 2 - AGE OF ONSET

1 - asthenic

2 - heavy weight; obese

Type 1 vs Type 2 - NUTRITIONAL STATUS (body structure)

Asthenic

Small in body structure

1 - balance of three food groups (carbs, protein, fats)

2 - limit control intake of fats/proteins

Type 1 vs Type 2 - DIETARY MANAGEMENT

1 - necessary for insulin to be given (absolute lack)

2 - may or may not have insulin; usually given OHA (oral hypoglycemic agent)

Type 1 vs Type 2 - INSULIN

1 - 40-50% susceptibility among children

2 - 25-50% susceptibility

Type 1 vs Type 2 - GENETIC SUSCEPTIBILITY

Sulfonylureas

Biguanides

Two kinds of OHA usually given