NCMB 316 Midterms

Diabetes Mellitus

Formerly known as Diabetes Mellitus, a group of metabolic diseases characterized by hyperglycemia

Hyperglycemia

Elevation of glucose in blood, a key feature of diabetes

Insulin

Hormone secreted by the pancreas to control glucose levels in the body

Type I Diabetes

Pancreas doesn't make insulin, leading to insulin deficiency

Type II Diabetes

Body can't use insulin properly, resulting in insulin resistance

Gestational Diabetes

Glucose intolerance during pregnancy, managed with diet, exercise, and insulin

Latent Autoimmune Diabetes of Adults (LADA)

An autoimmune destruction of beta cells, leading to insulin dependency

Pancreas

Organ involved in diabetes, with both exocrine and endocrine functions

Exocrine Function

Production of digestive enzymes by the pancreas

Endocrine Function

Production of insulin and glucagon by the pancreas

Risk Factors

Age, HDL level, triglyceride level, family history, obesity, hypertension, and stress

Insulin Resistance

Decreased tissue sensitivity to insulin, leading to poor glucose uptake

Glucagon

Hormone released by the pancreas to increase blood glucose levels

Diabetic Ketoacidosis (DKA)

A serious complication of diabetes where the body produces excess ketones

Hypertension

High blood pressure, a common symptom associated with diabetes

Glycosuria

Presence of glucose in urine, indicating high blood glucose levels

Osmotic Diuresis

Increased urine output due to the presence of substances in the tubule reducing water reabsorption

Diabetes Classification

Categorization into Type I, Type II, Gestational, LADA, and other associated conditions

DKA Development

Occurs when the body lacks insulin to use blood sugar for energy, leading to ketone production

Insulin Production

Insufficient in Type I diabetes due to destruction of beta cells

Glucose Intolerance

Inability to absorb sugar properly, a key feature of diabetes

Insulin Dependency

Risk for patients with LADA, requiring external insulin

Osmotic Pressure

Pressure affecting water reabsorption in the tubule, leading to diuresis

Glycogenolysis

Breakdown of glycogen to release glucose, regulated by insulin

Gluconeogenesis

Generation of glucose from non-carbohydrate sources, influenced by insulin levels

3P's of Diabetes

Polyuria, polydipsia, polyphagia

PVD

Peripheral vascular disease with diminished pulses and claudication

Microvascular Diseases

Capillary basement membrane thickening

Macrovascular Diseases

Affect brain, heart, and peripheral arteries

Diabetic Retinopathy

Changes in blood vessels of the retina

Nephropathy

Kidney disease due to microvascular changes

Sensorimotor Neuropathy

Affects peripheral nerves causing paresthesia

Autonomic Neuropathy

Dysfunction affecting organ systems

Diagnostic Tests for Diabetes

Include RBS, FBS, and post-prandial blood sugar tests

Diabetic Foot

Complication with neuropathy and foot injuries

Oral Glucose Tolerance Test

Involves glucose ingestion and blood/urine samples

Glycated Hemoglobin

Measure of glucose levels bound to hemoglobin

Insulin Therapy

Exogenous insulin for type 1 diabetes

Atherosclerosis

Risk factor managed in diabetes treatment

Polyphagia

Excessive hunger and increased appetite in diabetes

Gangrene

Tissue death due to lack of blood supply

Microangiopathy

Capillary vessel changes in diabetes

Macroangiopathy

Changes in medium to large blood vessels

Retina

Eye area receiving and sending visual information

Numbness

Loss of sensation in feet due to neuropathy

Charcot's Joint

Joint deformity from lack of proprioception

Neuropathies

Diseases affecting peripheral, autonomic, and spinal nerves

Glycated Hgb

Result of glucose binding with hemoglobin

Type 2 Diabetes

May require exogenous insulin for control

Normal Glycated Hgb Range

4

-6

; insulin if diet/meds ineffective

Diet Management

Critical in diabetes; control caloric intake

Oral Antidiabetic Agents

Include Sulfonylureas, Biguanides, etc.

Insulin Dosing

Based on body's needs; monitor glucose

Proportion Diet

20

protein, 30

fats, 50

carbohydrates

Complex Carbohydrates

Inhibit glucose absorption in intestines

Rapid-Acting Insulin

Increases glucose uptake by muscles

Long-Acting Insulin

Basal insulin absorbed slowly, once daily

Insulin Onset/Peak/Duration

Key factors in insulin effectiveness

Insulin Storage

Refrigerate unused vials; room temp for in-use

Insulin Injection Sites

Rotate sites; abdomen, arms, thighs, hips

Hypoglycemia

<70 mg/dL blood glucose level; various causes

Sulfonylureas

Stimulate beta cells to release insulin

Biguanides

Metformin; improves insulin efficiency

Alpha-Glucosidase Inhibitors

Slows glucose formation from carbohydrates

Diabetic Ketoacidosis

Common in Type 1 diabetes; insulin deficiency

Polyuria

Osmotic diuresis due to increased glucose

Ketosis

Breakdown of fats into ketone bodies due to lack of insulin

Metabolic Acidosis

Acidic condition due to accumulation of ketone bodies

Dehydration & Electrolyte Loss

Clinical feature of high blood sugar levels

Retinal Damage

Caused by hyperglycemia, leading to blurred vision

Lipolysis

Breakdown of fats into fatty acids due to lack of insulin

Ketone Bodies

Produced from fatty acids by the liver in the absence of insulin

Acetone Breath

Manifestation of ketone body accumulation, causing a fruity odor

Kussmaul's Respiration

Rapid breathing to reduce metabolic acidosis

Diagnostic Tests for DKA

Include blood glucose, HCO3, pH, blood and urine ketones, BUN, Creatinine, Hematocrit, Na, K, and PCO2 levels

Insulin Deficiency

Leads to decreased glucose utilization by cells and increased glucose production by the liver

Nursing Management for DKA

Involves maintaining airway, fluid balance, and electrolyte levels; administering IV therapy; and monitoring potassium

Hyperosmolar Hyperglycemic Syndrome (HHS)

Serious complication of Type 2 diabetes with hyperglycemia and hyperosmolarity but no ketosis or acidosis

Thyroid Gland Functions

Regulates metabolism, influences cell replication, important in brain development

Triiodothyronine (T3) and Thyroxine (T4)

Thyroid hormones responsible for thermogenesis and vascular resistance

Calcitonin

Hormone released in response to high calcium levels, controlled by TSH

Negative Feedback Mechanism

Regulates hormone release based on internal conditions

Thyroid Diagnostic Tests

Include inspection, palpation, auscultation, serum TSH, T3, and T4 levels

Hypothyroidism

Decreased production of thyroid hormones, leading to metabolic slowdown

Hyperthyroidism

Excessive synthesis and secretion of thyroid hormones, leading to increased metabolism

Grave's Disease

Autoimmune disorder causing excessive thyroid hormone output

Radioactive Iodine Uptake (RAIU)

Measures iodine uptake by the thyroid gland, used in diagnosing hyperthyroidism

Iodine 123

Radioisotope used for thyroid scans

Toxic multinodular goiter

Enlarged thyroid with multiple nodules causing hyperthyroidism

Thyroiditis

Inflammation of the thyroid gland

Excessive TH ingestion

Overconsumption of thyroid hormone

Thyroid scan

Imaging test to evaluate thyroid function

Fine needle biopsy

Procedure to extract cells for analysis

Oligomenorrhea

Irregular menstrual cycles

Voracious appetite

Excessive hunger