Term
|
Definition
-Glucose unable to travel into cell.
-BGLs >250.
-Causes dehydration, ketosis, electrolyte imbalance and acidosis. |
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Term
|
Definition
-Secreted by Beta-cells and insulin in response to nutrient intake.
-In the PP period, slows gastric emptying,
-suppresses Glucagon secretions, -lowers hepatic glucose production. |
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Term
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Definition
-Hormone produced by Alpha cells of Islets of Langerhans.
-Counter regulatory hormone to insulin.
-Results in an increase in circulating glucose levels by stimulating gluconeogenesis. |
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Term
|
Definition
-Increased AM BGL levels.
-Caused by NPH use at supper time resulting in peak effect during early hours and in AM.
-Most agreed upon reason for pts to get the CSII/Pump. |
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Term
DM 1
Stage 1: Genetic Predisposition |
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Definition
-Genetic Predisposition
-Related to combination of HLA-DQ coded genes that have DM susceptibility to those with DM resistance.
-Also HLA genotype. |
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Term
|
Definition
->25 yo,
-Obese,
-racial/ethnic background,
-Hx of abnormal glucose tolerance,
-1st degree relative with DM I |
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Term
|
Definition
-Macrosomia (>90th %)
-Higher risk for developing DM
-Shoulder dystocia, Brachial plexis, -ERB Palsy, Asphxia.
-Neo-Natal hypoglycemia BS <40.
-Respiratory distress syndrome
-Hyperbilirubinemia
-Increased BMI |
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Term
| GDM maternal complications |
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Definition
-HTN
-Polyhydramnios
-C-section |
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Term
|
Definition
-Nitrogen formed from mm Metabolism.
-Normal: 0.5-1.4
-Males have higher levels.
-Increases with Kidney function disease. |
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Term
|
Definition
-Blood Level of Urea.
-Byproduct of protein metabolism.
-Normal: 8-20
-Levels increase with Kidney Dx. |
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Term
|
Definition
-Hyperosmolar Hyperglycemia State:
-High BGLs + Dehydration
-BGL >600, yet Minimal Ketones.
-Primarily: Undiagnosed DM II, Elderly.
-More life threatening than DKA. |
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Term
|
Definition
-Complex CHO.
-Primary storage form of Glucose in Liver + Muscle. |
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Term
|
Definition
-Test at 27 weeks.
-Ingest 100 g Oral Glucose +:
>92 fasting
>196 1 hour
>171 2 hours
>140 3 hours |
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Term
|
Definition
-Ketones produced during DKA.
-Acetoacetate converts to acetone and is excreted by lungs.
-Causes fruit smell on breath. |
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Term
|
Definition
-Severe Hyperglycemia: BGL >600.
-Dehydration, Plasma Osmolality >320.
-Neurologic changes (mimic CVA).
-Absence of significant Ketones. |
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Term
|
Definition
|
|
Term
| Gestational Diabetes Disease Initiation |
|
Definition
-Glucose intolerance (4% pregnant women).
-Risk assessment completed at 1st prenatal visit.
-Those w/ clinical signs: glucose test.
-Negative high risk women should be retested at 24-28 weeks gestation. |
|
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Term
| Hgb A1c as diagnostic tool |
|
Definition
-Regular: <5.7%
-Pre-DM: 5.7-6.4%
-DM: >=6.5% |
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Term
| Type I DM, Pathophysiology |
|
Definition
-Stage 1: genetic predisposition.
-Stage 2: Environmental trigger.
-Stage 3: Active Auto-Immunity.
-Stage 4: Progressive Beta-Cell dysfunction.
-Stage 5: Overt DM |
|
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Term
|
Definition
| -Known genetic defects associated with glycogen synthase deficiency, and Mitochondrial DNA markers. |
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Term
| Pancreatic Disorders (DM) |
|
Definition
-Hemochromatosis
-Chronic Pancreatitis
-Pancreatectomy |
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Term
|
Definition
|
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Term
|
Definition
-Cystic Fibrosis
-Congenital Rubella Syndrome
-Down Syndrome |
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Term
| Drugs that "cause" Diabetes |
|
Definition
Steroids:
-Glucocorticoids |
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Term
Type 2 DM
Percent Risk w/ Family History |
|
Definition
-15% risk of DM
-30% risk of IGT
-Identical twins risk 90% if 1 twin w/ DM |
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Term
DKA Therapy
Providing Glucose |
|
Definition
-Once BGL lowers to 250, add 5-10% Dextrose to IVF.
-Starvation perpetuates Ketosis.
-Sudden drops in Glucose can be a/w cerebral edema. |
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Term
|
Definition
| -Failure to augment beta-cell insulin response to the insulin resistance. |
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Term
Incretin Hormones
Intestinal |
|
Definition
-Both make Beta-cells more sensitive to higher BGLs:
-GIP: Glucose dependent insulin releasing poly-peptide.
-GLP: Glucagon-like peptide. |
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Term
Type 2 DM
Risk Characterizations |
|
Definition
-Obesity, Sedentary lifestyle
-Hx HTN, Dislipidemia
-Family Hx of DM, Gestational Hx
-Ethnicity |
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Term
Islet Cell Antibody
Best Predictor of future DM I |
|
Definition
| GAD: Glutamic acid decarboxylase |
|
|
Term
Genetic Risk Factors for DM
vs
Lifestyle |
|
Definition
-Genetic factors important for DMII,
BUT
-Lifestyle largely regulates gene expression in determining DM development. |
|
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Term
|
Definition
-Result of Auto-Immune Beta-cell destruction.
-Absolute Insulin deficiency. |
|
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Term
|
Definition
-Multihormomal
-Involving a progressive insulin secretory defect +
-Insulin resistance and obesity |
|
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Term
| Progression/Prevalence of DM II |
|
Definition
* 90% of DM is type 2
* Elderly, Ethnic
* Asymptomatic when Diagnosed
* Endogenous Insulin may be Normal, yet have variable need of Exogenous insulin.
* Insulin resistance occurs early
* Not prone to Ketosis
* 50% men, 70% women are obese |
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Term
DM 1
Stage 2: Environmental triggers |
|
Definition
* Viral, Bottle Feeding.
* Sex steroids in puberty/pregnancy.
* Incidence of DM 1 increases in Spring and Fall.
- Long latency period makes finding cause harder. |
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Term
DM 1
Stage 3: Active Autoimmunity |
|
Definition
-Autoimmune attack of Beta-cells.
-Glutamic Acid Decarboxylase (GAD):
Best predictor.
-Immune attack on Insulin
-Beta cell destruction is slower in adults.
- Higher BGLs and S/S occur when >90% B-cells have been destroyed. |
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Term
DM 1
Stage 4: Progressing Beta-Cell Dysfunction |
|
Definition
-Quick clinical onset
-Can be brought upon by acute illness/stress 2/2 increased insulin demand.
-Higher BGLs will control until stress/illness resolved
-HoneyMoon Period: Non-insulin dependent. Lasts approx 3-12 months |
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Term
Hormones and Factors Influencing
Fuel Metabolism:
Peptide YY |
|
Definition
| Reduces food intake via brain receptors |
|
|
Term
Hormones and Factors Influencing
Fuel Metabolism:
Endocannabinoid System |
|
Definition
-Physiological regulation of energy balance, Food intake, Lipid and Glucose metabolism
-Over-activation = Obesity |
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Term
|
Definition
-Process of Glucose Production by the Liver
-Precursors: Lactate, Amino Acids |
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Term
DKA electrolyte imbalances:
Sodium |
|
Definition
| Dehydration causes profound loss of total body sodium that can't be measured |
|
|
Term
DKA electrolyte imbalances:
Potassium |
|
Definition
-Always depletes with DKA
-Lab values can be Iffy
-May be low before therapy as it enters the cell
-Check renal function
-Phosphate typically high, then decreases |
|
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Term
|
Definition
-Fat cell for storage of excess kcals
-Source of hormones and cytokins that control:
appetite
weight
inflammation
intermediary metabolism |
|
|
Term
| Latent Auto-Immune Diabetes of Adults |
|
Definition
-Slow progressive form of Type 1
-Frequently mistaken for Type 2
-May do with NO insulin for several years
-Beta cell deterioration |
|
|
Term
| Glutamic Acid Decarboxylase |
|
Definition
| -Protein that appears to be the best immunologic predictor of future type 1 Diabetes development. |
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