NRS 322 Lecture Notes - Lecture 3: Radiation Therapy, Achlorhydria, Monosaccharide

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28 Jul 2015
Department
Course
Topic 3
Endocrine Problems
1. Define and describe the following terms:
Angiopathy: blood vessel disease
Diabetes mellitus (DM): a multisystem disease related to abnormal insulin secretion, impaired
insulin action, or both
Diabetic ketoacidosis (DKA): an acute metabolic complication of diabetes occurring when fats
are metabolized in the absence of insulin; characterized by hyperglycemia, ketosis, acidosis, and
dehydration
Diabetic retinopathy: refers to the process of microvascular damage to the blood vessels in the
retina as a result of chronic hyperglycemia, presence of nephropathy, and hypertension in
patients with diabetes mellitus
Euglycemia: the condition of having a normal concentration of glucose in the blood
Hyperosmolar hyperglycemic nonketotic syndrome (HHS): a life-threatening syndrome that
can occur in the patient with diabetes who is able to produce enough insulin to prevent diabetic
ketoacidosis but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular
fluid depletion
Impaired fasting glucose (IFG): see definition for “Prediabetes”
Impaired glucose tolerance (IGT): see definition for “Prediabetes”
Insulin resistance syndrome: see definition for “Metabolic syndrome”
Metabolic syndrome: also known as insulin resistance syndrome, is a cluster of abnormalities
that act synergistically to greatly increase the risk for cardiovascular disease; is characterized by
abdominal obesity, hypertension, dyslipidemia, insulin resistance and dysglycemia – patients
with metabolic syndrome are at significant risk for developing DM and cardiovascular disease
Prediabetes: also known as impaired glucose tolerance (IGT) or impaired fasting glucose
(IFG); is noted when fasting or a 2-hour plasma glucose level is higher than normal but lower
than that considered diagnostic for diabetes; places the individual at risk for developing diabetes
and its complications
Self-monitoring of blood glucose (SMG): performed by patients with diabetes mellitus to check
the level of glucose in their blood at a given point in time; a cornerstone of DM management –
by providing a “real-time” blood glucose reading, SMBG enables the patient to make self-
management decisions regarding diet, exercise, and medication. SMBG is also important for
detecting episodic hyperglycemia and hypoglycemia.
2. Review the pathophysiology and clinical manifestations of diabetes mellitus.
Diabetes mellitus is primarily a disorder of glucose metabolism related to absent or
insufficient insulin supply or poor utilization of the insulin that is available.
Type 1 DM results from progressive destruction of pancreatic β cells owing to an
autoimmune process in susceptible individuals. Autoantibodies to the islet cells cause a
reduction of 80-90% of normal β-cell function before hyperglycemia and other
manifestations occur.
In type 2 DM, the pancreas usually continues to produce some endogenous (self-made)
insulin. However, the insulin that is produced is either insufficient for the needs of the
body, is poorly utilized by the tissues, or both. In contrast, there is virtual absence of
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endogenous insulin in type 1 DM. The presence of endogenous insulin is the major
pathophysiological distinction between type 1 and type 2 DM.
Four major metabolic abnormalities have a role in the development of type 2 DM:
1) Insulin resistance in glucose and lipid metabolism, which is a condition in which
body tissues do not respond to the action of insulin.
oThis is owing to insulin receptors that are unresponsive to the action of
insulin, insufficient in number, or both.
oInsulin mediates glucose uptake into fat tissue and skeletal muscle through
GLUT4 glucose transporters  insulin resistance in fat cells is associated with
a decrease in the number of GLUT4 transporters and its activity in those with
type 2 DM
oWhen insulin is not properly used, the entry of glucose into the cell is
impeded  hyperglycemia
oIn the early stages of insulin resistance, the pancrease responds to high blood
glucose by producing greater amounts of insulin (if -cell function is normal) β
this creates a temporary state of hyperinsulinemia that coexists with the
hyperglycemia
2) The development of type 2 DM is a marked decrease in the ability of the pancreas to
produce insulin, as the cells become fatigued from the compensatory β
overproduction of insulin or when -cell mass is lostβ
3) Inappropriate glucose production by the liver. Instead of properly regulating the
release of glucose in response to blood levels, the liver does so in a haphazard way
that does not correspond to the bodys needs at the time.
4) Alteration in the production of hormones and cytokines by adipose tissue
(adipocytokines). Adipocytokines appear to play a role in glucose and fat metabolism
and are likely to contribute to the pathophysiology of type 2 DM.
3. Review the differences between Type 1 & 2 diabetes (insulin dependent and non-insulin
dependent diabetes.
Factor Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus
Age at onset More common in young
people but can occur at any
age
Usually  35 yr but can occur
at any age
Incidence is increasing in
children
Type of onset Signs and symptoms abrupt,
but disease process may be
present for several years
Insidious, may go
undiagnosed for years
Prevalence Accounts for 5-10% of all
types of diabetes
Accounts for 90% of all types
of diabetes
Environmental factors Virus, toxins Obesity, lack of exercise
Primary defect Absent or minimal insulin
production
Insulin resistance, decreased
insulin production over time,
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and alterations in production
of adipokines
Islet-cell antibodies Often present at onset Absent
Endogenous Minimal or absent Possible excessive; adequate
but delayed secretion or
reduced utilization; secretions
diminish over time
Nutritional status Thin, normal or obese Obese or normal
Symptoms Thirst, polyuria, polyphagia,
fatigue, weight loss
Frequently none, fatigue,
recurrent infections
Ketosis Prone at onset or during
insulin deficiency
Resistant except during
infection or stress
Nutritional therapy Essential Essential
Insulin Required for all Required for some
Oral antihyperglycemic
agents
Not indicated Usually beneficial
Vascular and neurological
complications
Frequent Frequent
4. Review factors that can increase one’s risk for the development of Type 2 diabetes.
Obesity (abdominal and visceral adiposity)
Membership in a high-risk population (e.g., people of Aboriginal, Hispanic, South Asian,
Asian, or African descent)
History of IGT or IFG
Presence of complications associated with DM
Vascular disease
History of GDM
History of delivery of a macrosomic infant
Hypertension
Dyslipidemia
Polycystic ovary syndrome (PCOS)
Acanthosis nigricans
5. Review the role of nutrition and exercise in the role of diabetes prevention and
management.
Nutrition
Although nutritional therapy is the cornerstone of care for the person with DM, it is also
its most challenging aspect.
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