NURSE-UN 240 NURSE-UN 240 A&E I– FINAL EXAM STUDY GUIDE WEEK 8 –DIABETES MELLITUS,100% CORRECT
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NURSE-UN 240 NURSE-UN 240 A&E I– FINAL EXAM STUDY GUIDE WEEK 8 –DIABETES MELLITUS
- Glucose – efficient fuel – when metabolized in presence of O2, breaks down to form carbon dioxide and water – brain & nervous system rely almost exclusively on glucose as fuel
o Brain cannot synthesize n...
nurse un 240 nurse un 240 aampe i– final exam study guide week 8 –diabetes mellitus
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NURSE-UN 240 NURSE-UN 240 A&E I– FINAL EXAM STUDY GUIDE WEEK 8 –
DIABETES MELLITUS
- Glucose – efficient fuel – when metabolized in presence of O2, breaks down to form
carbon dioxide and water – brain & nervous system rely almost exclusively on glucose
as fuel
o Brain cannot synthesize nor store more than a few min’s supply of glucose needs
continuous supply
from circulation to maintain normal cerebral fxn
o Body tissues obtain glucose from the blood – glucose that is not needed for
energy is removed from the blood and stored in the liver as glycogen or
converted to fat.
- Pancreas – endocrine fxn for blood glucose regulation, controlled by 2 types of islet cells
o Alpha cells – secrete glucagon
▪ Glucagon prevents hypoglycemia by triggering release of glucose from cell stora
sites
o Beta cells – produce insulin
▪ Insulin prevents hyperglycemia by allowing body cells to take up, use and store
carbs, fat, protein
o Need specific carrier proteins and insulin to move glucose into cells
▪ Insulin binds to insulin receptors in order to change membrane permeability to
glucose
▪ Insulin stimulates glucose uptake in skeletal muscle and heart
muscle; suppresses gluconeogenesis (liver production of
glucose)
o Insulin levels increase as blood glucose levels increase; insulin decreases
when blood glucose levels decline – insulin secreted at low levels during
fasting and at increased levels after eating
Diabetes Mellitus (DM)
- DM – a group of metabolic diseases characterized by hyperglycemia resulting from
defects in insulin secretion, insulin action, or both.
o In the absence of insulin, cells are prevented from using glucose for energy, so
they begin breaking down fat and protein. Glucose builds up in the blood,
causing high blood glucose levels (hyperglycemia).
, Because glucose, like sodium, has a high pull for water, hyperglycemia causes fluid
and electrolyte imbalances, leading to the classic manifestations of diabetes:
▪ Polyuria is frequent and excessive urination and results from an osmotic
diuresis caused by excess glucose in the blood and urine. With diuresis,
electrolytes are excreted in the urine and water loss is severe.
Dehydration results, and polydipsia (excessive thirst) occurs. Because the
cells receive no glucose, cell starvation triggers polyphagia (excessive
eating).
▪ Dehydration with diabetes leads to hemoconcentration, hypovolemia,
poor tissue perfusion, and hypoxia. Hypoxic cells do not metabolize
glucose efficiently, the Krebs’ cycle is blocked, and lactic acid increases,
causing more acidosis.
▪ Excess acids cause by absence of insulin increase hydrogen ion and carbon
dioxide levels in the blood. These products trigger the brain to increase
the rate and depth of respiration in an attempt to “blow off” carbon
dioxide and acid; this type of breathing is known as Kussmaul respiration.
▪ Insulin facilitates the transport of potassium into cells, so insulin lack
initially causes potassiumdepletion, as it is excreted in the urine. High
serum potassium levels may occur in acidosis because of the shift of
potassium from the inside of cells into the blood.
- Involves improper metabolism of carbohydrates, fats and proteins
- The chronic hyperglycemia of diabetes is associated with long-term damage,
dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart,
and blood vessels.
DM Facts:
- Increasingly affects all age groups
- Shortens average life expectancy by 15 years
- Especially prevalent in American Indian, African and Hispanic Americans
- 34.2 million people in the US (10.5% population)
- 34.1 million diagnosed, 7.3 million undiagnosed adults
, The disease is classified by the underlying problem causing a lack of insulin or its action and
the severity of the insulin deficiency:
Type 1 Type 2
A.K.A. Juvenile-Onset DM Adult-Onset DM
Prevalenc 10% of diabetes cases 90% of diabetes cases
e
Age Usually younger than 40, occurs at any age Peaks in 50s, may occur earlier
Etiology Associated with a cell-mediated autoimmune Not well understood; we become less
reaction (Type IV hypersensitivity): we sensitive to the action of insulin or
develop autoantibodies that decrease production of insulin.
destroy beta cells in the pancreas, which are
responsible for the production of insulin. We
don’t know what causes this.
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