Lecture 2/5

Cards (22)

  • Gestational Diabetes - resembles type II DM
    • presentation - symptoms of hyperglycemia occurs during pregnancy
    • onset - diagnosed during pregnancy
    • resolution - disappears after birth; however, mother is more prone to developing type II DM later in life
  • babies of mothers with gestational diabetes that are not treated are more likely to develop
    • hypoglycemia, hypocalcemia
    • respiratory distress syndrome
  • pathophysiology of DM
    • common
    • hyperglycemia
    • spillover of 180 mg/dl
    • plateaus at 300-500 mg/dL because spillover occurs at 180 mg/dL
  • pathophysiology of DM
    • type 1
    • tendency to generate ketones - metabolism of triglycerides results in _____
    • low insulin/high glucagon promotes lipolysis
    • low or absent C-peptide (proinsulin by pancreas is not being cleaved)
    • acidosis and hyperosmolality due to hyperventilation and ketosis
    • ketosis puts patient in metabolic acidosis; body tries to resolve this by getting rid of CO2 to drive buffer to neutral side
  • Pathophysiology of DM type II
    • rarely generates ketones - some glucose is being utilized
    • normal insulin levels suppress glycogenolysis and lypolysis
    • normal C-peptide levels as insulin is being secreted
    • hyperosmolality without ketosis (from elevated glucose and insulin increases concentration)
  • hypoglycemia
    • decreased plasma glucose levels
    • true hypoglycemia is rare
    • islet hyperplasia or insulinoma (beta cell tumor) - secrete too much insulin and cause glucose level to lower too much
    • usually drug induced - if transient
  • hyperplasia - growth in number of cells
  • hypertrophy - growth in cell size
  • Hypoglycemia
    • symptoms appear at 50-55 mg/dL
  • symptoms of early hypoglycemia - hunger, diaphoresis, nausea/vomiting, dizziness
  • symptoms of hypoglycemia: mental confusion, blurred vision, slurred speech, nervousness and shaking
  • hypoglycemia
    • see secretion of glucagon, epinephrine, cortison, and GH (growth hormone)
  • hypoglycemia can be induced by alcohol, as it mimics insulin
  • if hypoglycemia continues and gets too low, patient can die
  • Carbohydrate intolerance
    • enzyme deficiency - lactose not manufactured
    • lactose is the most common
    • lactose intolerance test -
    • pt comes in fasting; lactose solution given, blood drawn every 30 minutes; if glucose doesn't increase above 25 mg/dL, patient is lactose intolerant
    • patient is not metabolizing lactose to glucose and galactose
    • patient blows balloon; H2 gas produced by bacteria metabolizing glucose will be present
    • blows up balloon every 15 minutes for 2 hours
  • galactosemia
    • galactose accumulates in the body when patient lacks enzyme to convert it to glucose
    • if galactose not removed from diet, patient can get cataracts, CNS dysfunction, short lifespan
    • inherited condition, occurs in 1 out of 62,000 people
    • increased liver enzymes in blood, as well as bilirubin
    • urine will be positive for reducing sugars
  • G6PD - glucose 6 phosphate dehydrogenase (takes H)
  • phosphogluconolactone or phosphogluconate
  • monitoring
    • self-monitoring - most common; record on notebook
    • serum glucose - drawn at checkups
    • urinalysis - way to alert doctor something isn't right; patient isn't compliant with dietary restrictions
  • Glycosylated hemoglobin
    • normal is 4-7%; some texts say up to 8% is normal
  • Some type II diabetics, if they do not follow doctor orders, pancreas stops secreting insulin, becoming type I