Chapter 3 Diabetes
Which of the following is/are risk factors of metabolic syndrome? A. abdominal obesity B. elevated triglycerides C. elevated HDL B only is correct A and B are correct A and C are correct A, B and C are all correct
A and B are correct
Complications of diabetes include which of the following? A. coronary artery disease B. retinopathy C. aneurysm A and B only are correct A and C only are correct B and C only are correct A, B and C are all correct
A and B only are correct
The laboratory test(s) commonly used to diagnose diabetes include which of the following? A. oral glucose tolerance test B. fasting serum creatinine test C. fasting blood glucose test A only is correct A and B are correct A and C are correct B and C are correct
A and C are correct
4. List six factors underwriters need to consider when assessing the mortality and morbidity risk of individuals with diabetes.
type of diabetes treatment degree of blood sugar control duration of the disease presence or absence of diabetic complications co-morbidities
Assessing the mortality and/or morbidity risk for individuals with diabetes involves a careful evaluation of the following factors:
type of diabetes treatment degree of blood sugar control duration of the disease presence or absence of diabetic complications co-morbidities
Acute complications are more common
with type 1 diabetes due to the challenge of adjusting the insulin dosage to match the body's needs.
7. A disorder of the nerves that can result from diabetes mellitus is: 1. retinopathy 2. nephropathy 3. gammopathy 4. neuropathy
4. neuropathy
It is estimated that in 2017 approximately ______ individuals worldwide have diabetes.
425 million
Acute complications of type 1 diabetes include which of the following? A. hypoglycemia B. ketosis C. nephropathy A only is correct A and B are correct B and C are correct A, B and C are all correct
A and B are correct
6. Complications of diabetes can include which of the following: A. coronary artery disease B. retinopathy C. hepatitis 1. A and B only are correct. 2. A and C only are correct. 3. B and C only are correct. 4. A, B, and C are correct.
1. A and B only are correct.
Which of the following is/are effective in preventing the onset of type 2 diabetes? A. weight loss B. exercise C. insulin A only is correct A and B are correct B and C are correct A, B and C are all correct
A and B are correct
8. Name the five risk factors for metabolic syndrome and indicate how many of them need to be present for the diagnosis to be made.
1. abdominal obesity 2. elevated triglycerides 3. low HDL cholesterol 4. elevated blood pressure 5. elevated fasting blood sugar.
Metabolic syndrome is diagnosed when at least three of the following five factors are present:
1. abdominal obesity 2. elevated triglycerides 3. low HDL cholesterol 4. elevated blood pressure 5. elevated fasting blood sugar.
Worldwide, up to ____ of those with diabetes are undiagnosed
1/2
The American Diabetes Association estimates that in the U.S., up to _____ of those with type 2 DM are unaware that they have it.
1/3
The vast majority (around 90%) of individuals with diabetes have type
2
These individuals have an increased risk of developing type __diabetes.
2
3. The laboratory tests used to diagnose diabetes include which of the following? A. oral glucose tolerance test B. fasting serum creatinine test C. fasting blood glucose test 1. A only is correct. 2. C only is correct. 3. A and C only are correct. 4. A, B, and C are correct.
3. A and C only are correct.
2. All of the following statements regarding ketoacidosis are correct EXCEPT: 1. It can result from uncontrolled type 1 diabetes. 2. Its symptoms include dehydration and nausea. 3. It leads to a hypoglycemic state. 4. It is caused by excessive breakdown of fat molecules.
3. It leads to a hypoglycemic state
1. The best test for monitoring blood sugar is the: 1. glucose tolerance test 2. random blood glucose 3. glycohemoglobin 4. fasting blood sugar
3. glycohemoglobin
9. Describe the three types of treatment for diabetes and the type of diabetes with which each is most commonly associated.
A proper diet and exercise is important for all diabetics, and for some with type 2 diabetes, this can be the only treatment required. Some type 2 diabetics, and all type 1 diabetics, require insulin. frequent self-monitoring of blood sugar levels. This is especially important for type 1 diabetics to enable them to adjust their insulin dosages throughout the day to avoid hypo- and hyperglycemia.
Ways to monitor the degree of blood sugar control
A random blood glucose test (one that is drawn when the person has not been fasting) can be done but does not provide a reliable estimate of degree of blood sugar control, since blood glucose levels fluctuate widely depending on what has been eaten recently. A fasting blood glucose is more reliable but is still subject to some fluctuation.
Microvascular complications are important to note because
they are the earliest indicators of vascular disease. In addition to serving as a marker for advanced atherosclerosis, both nephropathy and retinopathy each have significant mortality and/or morbidity implications.
Ways to treat diabetes include which of the following? A. diet B. oral medications C. insulin injections A only A and B only B and C only A, B and C are all correct
A, B and C are all correct
Which of the following is/are hormones of the pancreas? A. glucagon B. insulin C. somatostatin B only is correct A and B are correct A and C are correct A, B and C are all correct
A, B and C are all correct
Which of the following is/are risk factors for developing type 2 diabetes? A. pre-diabetes B. family history C. gestational diabetes A only is correct A and B are correct B and C are correct A, B and C are all correct
A, B and C are all correct
Which of the following is/are symptoms of type 1 diabetes? A. numbness of toes B. increased thirst C. blurred vision A only is correct A and C only is correct B and C only is correct A, B and C are all correct
A, B and C are all correct
Risk factors for developing gestational diabetes include which of the following? A. high cholesterol B. family history of diabetes C. race/ethnicity B only is correct A and C are correct B and C are correct A, B and C are all correct
B and C are correct
5. Describe the difference between microvascular and macrovascular diabetic complications. List at least two examples of each complication.
Common chronic complications can be further subdivided into macrovascular complications (those that result from atherosclerotic disease and damage to the large arteries) and microvascular complications (those that result from atherosclerotic disease and damage to small vessels and other tissues). Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Microvascular complications include nephropathy (i.e., kidney disease) and retinopathy, a disorder of the blood vessels in the retina of the eye.
Macrovascular complications can be revealed by
EKGs, exercise stress tests, echocardiograms, angiography, carotid Doppler, and other tests.
degree of blood sugar control -
If possible, the evaluation of blood sugar control should be based on more than just a single test result. It is preferable to review the average blood sugar level over a period of several years. The A1c level is the preferred test to indicate blood sugar control. The better the blood sugar control, the fewer the complications and the less damage from hyperglycemia at both the cellular and organ level. Compliance with medical treatment is vital to achieving good blood sugar control and avoiding complications. Self-monitoring of blood glucose levels and regular follow up with a physician are good indicators of compliance.
treatment -
If the type of diabetes is not stated, some assumptions can be made based on the treatment. However, this should be done cautiously, as there are some type 2 diabetics who can require insulin therapy. Those type 2 diabetics on insulin can present a greater risk than those on oral medications alone, as this can imply a condition that is more difficult to control.
The prevalence of diabetes in both the U.S. and Canada differs based on race/ethnicity.
In the U.S., Native Americans, particularly those in the southwestern U.S., have the highest percentage of individuals with diabetes. Non-Hispanic blacks and Hispanic/Latino Americans also have a higher prevalence of diabetes than non-Hispanic whites and Asians.12 In Canada, aboriginal populations are three to five times more likely than the general population to develop type 2 diabetes.
GDM
It can lead to health complications for both the mother and the baby. High glucose levels can result in large babies, leading to high rates of cesarean section. Babies born with high birth weight have an increased risk of future obesity and glucose intolerance.
All of the following statements regarding ketoacidosis are correct EXCEPT: It can result from uncontrolled type 1 diabetes Its symptoms include dehydration and nausea. It is not life-threatening It is caused by excessive breakown of fat molecules.
It is not life-threatening
All of the following statements about insulin are correct EXCEPT: It slows absorption of nutrients. It increases glucose transport into cells. It increases amino acid and fatty acids transport into cells. It increases conversion of excess glucose to glycogen.
It slows absorption of nutrients.
duration of the disease -
Longer durations generally result in higher risk, as the effects of the disease accumulate over time.
presence or absence of diabetic complications -
Microvascular complications are often the first to be detected. Retinopathy noted during an eye exam or protein found on a routine urinalysis may indicate the presence of generalized atherosclerosis.
All of the following statements regarding type 2 diabetes are correct EXCEPT: It occurs when the body's cells become resistant to insulin. Onset is usually sudden. Many individuals are unaware they have it. Symptoms can include frequent urination.
Onset is usually sudden.
Risk Factors of GDM
Risk factors for developing GDM include obesity, family history of diabetes, and race/ethnicity, with higher risk among Native Americans, African Americans, Hispanic/Latino Americans, Asians/Pacific Islanders, and aboriginal populations
10. List the risk factors for developing gestational diabetes. At what point during pregnancy is a female tested for it?
Risk factors for developing GDM include obesity, family history of diabetes, and race/ethnicity, with higher risk among Native Americans, African Americans, Hispanic/Latino Americans, Asians/Pacific Islanders, and aboriginal populations.4,5 It is recommended that all pregnant women be screened for GDM between the 24th and 28thweeks of pregnancy, or earlier if at high risk.
After effects of GDM
Some females who develop GDM during pregnancy do not return to normal blood glucose levels after delivery and are diagnosed with diabetes, usually type 2. Those with GDM whose glucose levels do return to normal after delivery have a 35-60% chance of developing diabetes in the next 10-20 years.
Symptoms of Type II diabetes
Symptoms of type 2 DM are similar to those of type 1, except the onset is more gradual, and symptoms often are unnoticed or attributed to other causes.
glycohemoglobin test, also called hemoglobin A1c, or simply the A1c test, to diagnose diabetes.
The A1c reading represents the average blood glucose level over the prior three months. A normal A1c level is below 5.7%. A level of 5.7-6.4% represents prediabetes, while an A1c level of 6.5% or greater on two separate occasions is diagnostic of diabetes.
Pre-diabetes
The condition in which an individual has blood sugar levels that are higher than normal, but not high enough to be diagnostic of diabetes,
All of the following statements regarding chronic complication of diabetes are correct EXCEPT: It can arise with any type of diabetes. The onset is rapid. It is more common in those who have had diabetes for many years. It can include neuropathy
The onset is rapid.
Diabetic nephropathy is a leading cause of renal failure.
The presence of nephropathy can be detected by checking the serum creatinine level on the blood profile or by testing for the presence of protein and/or microalbumin on a urinalysis. Treatment with one of a class of medications called angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril, ramipril, enalapril) can slow the progression of kidney damage.
co-morbidities -
The presence of other impairments, such as hypertension, hyperlipidemia, obesity, and smoking, tend to accelerate the progression of complications, and thus increase the mortality/morbidity risk.
several factors have been identified that indicate an increased risk of developing type 2 diabetes.
These include pre-diabetes (IGT or IFG), history of gestational diabetes, obesity, and age. Family history of type 2 diabetes also appears to increase the risk of developing that disorder. It is not clear how much of this is due to genetic factors and how much is attributable to environmental or lifestyle factors that are similar among family members, such as eating or exercise habits.
Ketosis, or ketoacidosis.
This can occur when the body does not get enough insulin, such as happens with uncontrolled type 1 DM. When the body has insufficient insulin, it is unable to use the glucose in the bloodstream and instead begins to use fat for energy. Excessive breakdown of fat molecules results in the production of organic acids called ketones. Symptoms of ketosis can include dehydration and excessive thirst, fatigue, nausea, and mental confusion. The individual can have a fruity smell to the breath. Untreated ketosis can lead to coma and death.
type of diabetes
Type 1 diabetes has a greater mortality/morbidity risk than does type 2 and can be more difficult to control.
The acute complication of type 1 diabetes that occurs when the body does not get sufficient insulin is: neuropathy retinopathy metabolic syndrome ketosis
ketosis
The acute onset of type 1 DM can be
life-threatening if diagnosis and treatment are delayed. Since the body is unable to produce insulin, treatment requires daily injections of insulin. Onset of type 1 DM is usually in childhood or early adulthood, but it can occur at any age.
Gestational diabetes mellitus (GDM)
a form of diabetes that develops in some females during pregnancy and generally resolves after delivery. It is recommended that all pregnant women be screened for GDM between the 24th and 28thweeks of pregnancy, or earlier if at high risk, affects 2-10% of all pregnancies
One treatment that some have considered a cure for type 1 diabetes is
a pancreas transplant. This procedure has allowed a few individuals to reduce or eliminate their dependence on insulin, but the risks of tissue rejection and immunosuppression are still a concern, and the long-term benefits are uncertain. This is better described as a treatment rather than a cure.
A relatively frequent complication is hypoglycemia,
a state of low blood sugar that can occur if a higher dose of insulin than is necessary is taken or if caloric intake is inadequate. An acute hypoglycemic episode can result in seizures or loss of consciousness, which can cause injury and occasionally death.
Metabolic Syndrome
a term that can be seen in connection with insulin resistance. Metabolic syndrome (e.g., insulin resistance syndrome, or metabolic syndrome X) is not a disease, but rather a group of cardiac risk factors often seen together that cause an increased risk that is greater than the sum of the individual risk factors.
The most effective means of prevention at this time is
lifestyle change focusing on healthier eating habits, weight loss, and exercise.
Hyperglycemia - causes 2 major problems
a. Cells do not get the energy they need to function properly b. Excess glucose begins to damage tissues at the cellular level
Energy
a. Glucose is the source of energy for our cells. b. Glucose cannot pass from the blood into the cell on its own. c. The hormone insulin is needed to "unlock" the cell and allow glucose to enter.
Insulin
a. Produced in beta cells within the pancreas. b. Increase in blood sugar triggers a rise in insulin secretion. c. In a diabetic, the body is either unable to produce insulin or the body's cells are resistant to insulin. d. As blood glucose levels rise, excess glucose is excreted by the kidneys into the urine.
Since heart disease and stroke account for
about two-thirds of deaths among people with diabetes, it is important to recognize early signs of atherosclerosis. Peripheral arterial disease can result in lower extremity amputations.
Complications of diabetes can be categorized as
acute or chronic.
Non-insulin dependent diabetes (NIDDM) is also known as: pre-diabetes juvenile diabetes gestational diabetes adult onset diabetes
adult onset diabetes
Traditional blood glucose monitors require
an individual to prick a finger to obtain a drop of blood which is placed on a test strip. The test strip is inserted into a meter to read the blood glucose level.
The oral glucose tolerance test measures
an individual's blood glucose level after fasting and again two hours after drinking a high-glucose solution. Diabetes is diagnosed if the two-hour blood glucose level is 200 mg/dl or higher. A two-hour blood glucose level between 140-199 mg/dl is considered impaired glucose tolerance (IGT).
Continuous Glucose Monitor (CGM)
automatically tracks blood glucose levels around the clock. A tiny sensor inserted under the skin of the abdomen or arm measures the glucose level in the interstitial fluid between the cells. A wireless transmitter sends the information to a receiver. The data from the receiver can be downloaded to a computer or smart phone to show trends in glucose levels. Some models can provide an alarm if the blood sugar gets too low or too high, which can be very helpful for those that do not recognize the symptoms of low blood sugar, and also for parents of children with type 1 diabetes.
The level of fructosamine, a protein in the blood, provides an even better indication of blood sugar control, as it represents the
average blood glucose level over the prior three-week period. However, the best test for monitoring blood sugar control is the A1c. A level of 6-7% is optimal, although up to 8% is usually considered acceptable blood sugar control.
The type of cell that produces insulin is: alpha cell white blood cell beta cell glucose
beta cell
Retinopathy is a leading cause of
blindness. The microvascular changes in the blood vessels in the retina cause them to become fragile and they can bleed, which can result in blindness. Retinopathy can be described either as mild background retinopathy, which is mild damage to the retina, or as proliferative retinopathy, which is a more advanced condition involving the growth of new blood vessels in the retina. Proliferative retinopathy can be treated with laser therapy, which can prevent or delay blindness. The presence of retinopathy can be detected through regular ophthalmological exams.
Diabetes can be suspected based on the typical symptoms of the disease or from glucose in the urine, but ______ is required to confirm the diagnosis.
blood testing
Diabetes treatment options include all of the following EXCEPT: diet insulin injections blood transfusions pancreatic transplant
blood transfusions
Macrovascular complications include
coronary artery disease, cerebrovascular disease, and peripheral arterial disease.
Symptoms of Type I Diabetes Mellitus
symptoms develop quickly and can include hunger and weight loss, increased thirst (polydipsia) and urination (polyuria), blurred vision, and fatigue.
However, the greatest increases in prevalence of diabetes are expected to be in
developing countries.
Mortality/morbidity factors that should be considered when underwriting diabetes include all of the following EXCEPT: co-morbidities type of diabetes duration of disease family history
family history
Good ongoing care for diabetic individuals should include
frequent self-monitoring of blood sugar levels. This is especially important for type 1 diabetics to enable them to adjust their insulin dosages throughout the day to avoid hypo- and hyperglycemia.
The best test for monitoring blood sugar is the: glucose tolerance test random blood glucose glycohemoglobin A1c fasting blood sugar
glycohemoglobin A1c
Individuals with pre-diabetes include those with
impaired fasting glucose (IFG), in which the blood sugar is mildly elevated after an overnight fast, and those with impaired glucose tolerance (IGT), when the blood sugar is mildly elevated on a 2-hour oral glucose tolerance test.
The prevalence of diabetes in both countries is rising due to the
increasing age of the population, the trend toward sedentary lifestyles, and the increasing incidence of obesity.
Oral medications work by
increasing the production of insulin in the pancreas, decreasing the insulin resistance of the body's cells, or decreasing the body's ability to absorb glucose from the intestine when food is digested.
Type I diabtes mellitus
insulin dependent diabetes mellitus (IDDM) or juvenile diabetes Type 1 DM results when the beta cells in the pancreas have been either damaged or destroyed, and the pancreas is no longer able to produce insulin. the damage to the beta cells appears to be related to an autoimmune response
Not all injectable medications are
insulin preparations. There are also non-insulin injectable medications that may be used, typically for type 2 diabetes. These are often used in combination with other medications and have mechanisms of action similar to those of oral medications.
Some type 2 diabetics, and all type 1 diabetics, require
insulin.
The following are all associated with metabolic syndrome EXCEPT: elevated triglycerides low HDL abdominal obesity low blood sugar
low blood sugar
Common chronic complications can be further subdivided into
macrovascular complications (those that result from atherosclerotic disease and damage to the large arteries) and microvascular complications (those that result from atherosclerotic disease and damage to small vessels and other tissues).
For the majority of type 2 diabetics, however, medication is
needed to maintain the blood glucose level within an acceptable range
A microvascular complication of diabetes includes: nephropathy coronary artery disease cerebrovascular disease peripheral artery disease
nephropathy
Microvascular complications include
nephropathy (i.e., kidney disease) and retinopathy, a disorder of the blood vessels in the retina of the eye.
A disorder of the nerves that can result from diabetes is: retinopathy nephropathy gammopathy neuropathy
neuropathy
Some chronic complications do not fit neatly into the macrovascular or microvascular subdivisions. An example is
neuropathy, a disorder of the nerves that often presents as a painful sensation, or lack of sensation, in the toes and feet. Diabetic neuropathy can result in disability.
There are _______ for type 1 diabetes.
no clear risk factors
Type II diabetes
non-insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes mellitus (AODM) insulin injections typically are not required to treat type 2 DM, and onset is usually in adulthood. The pancreas of a person with type 2 DM usually still produces insulin, but the body's cells are not able to effectively use the insulin, a condition known as insulin resistance.
A fasting blood glucose test (i.e., fasting blood sugar, or FBS) is often done instead
of the glucose tolerance test, as it is easier, less expensive, and provides results more quickly. A fasting blood glucose of 126 mg/dl or more on two separate occasions is diagnostic of diabetes. A fasting blood glucose between 110 and 125 mg/dl is considered impaired fasting glucose (IFG).
Insulin is a hormone produced in the beta cells of the: kidney pancreas thyroid adrenal gland
pancreas
The gland where islets of Langerhans are located is: pituitary thyroid pancreas adrenal
pancreas
Chronic complications can arise with any type of diabetes, but are more common in those whose diabetes has been
poorly controlled and/or those who have had diabetes for many years.
A _____ and _____ is important for all diabetics, and for some with type 2 diabetes, this can be the only treatment required.
proper diet and exercise
Good diabetes care should also include
regular exams to follow blood sugar control and to check for the development of complications. A thorough exam will include blood testing, including the A1c level, urine testing to check for albumin, and a retinal exam to check for early signs of retinopathy.
Macrovascular complication of diabetes include all of the following EXCEPT: coronary artery disease cerebrovascular disease retinopathy peripheral vascular disease
retinopathy
Insulin is typically administered
several times daily by injection, usually into the skin of the abdomen, arms, thighs, or buttocks. Can be administered by using an insulin pump, a small device worn on the body that allows more frequent doses of insulin to be administered without multiple injections. contains a reservoir for the insulin and is connected to a needle under the skin via a thin tube. The pump is programmed to deliver fast acting insulin on a continuous basis at varying rates. The use of an insulin pump can reflect a high level of self-care and can result in improved blood glucose control.
Individuals with metabolic syndrome have an increased risk of developing
type 2 diabetes and cardiovascular disease.