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Answer to #1
A
Answer to #2
The main goal of diabetes treatment is to maintain blood glucose levels within a desirable range to prevent or reduce the risk of complications. Several multicenter clinical trials have shown that intensive diabetes treatment, which keeps blood glucose levels tightly controlled, can greatly reduce the incidence and severity of some chronic complications. Therefore, maintenance of near-normal glucose levels has become the fundamental objective of diabetes care plans. Note that intensive therapy is recommended only if the benefits of therapy outweigh the potential risks. Intensive therapy involves blood glucose monitoring at least three times per day and three or more daily injections of glucose or an external insulin pump. Landmark studies conducted in the 1980s and 1990s suggested that keeping blood glucose levels as close to normal as possible offers clear advantages over less rigorous diabetes treatment. The participants undergoing intensive therapy had delayed onset and reduced progression of retinopathy, nephropathy, and neuropathy; however, they also experienced more frequent episodes of severe hypoglycemia and gained more weight.
Conventional therapy requires daily glucose monitoring, and one or two daily injections without dose adjustments. Conventional therapy is associated with fewer incidences of severe hypoglycemia and less weight gain, but it may lead to more rapid progression of neuropathy, nephropathy, and retinopathy.
Answer to #3
A
Answer to #4
Diabetic neuropathy most often involves the peripheral nerves (peripheral neuropathy) or nerves that control body organs and glands (autonomic neuropathy). Peripheral neuropathy-the most common form of neuropathy in diabetes-may be experienced as pain, numbness, or tingling in the hands, feet, and legs or weakness of the limbs. Pain and cramping in the legs are often severe during the night and may interrupt sleep. Peripheral neuropathy also contributes to the development of foot ulcers because cuts and bruises may go unnoticed until wounds are severe. Autonomic neuropathy may be evidenced by sweating abnormalities, disturbed bladder function, erectile dysfunction, delayed stomach emptying (gastroparesis), constipation, and cardiac arrhythmias. Neuropathy occurs in about 50 percent of patients with diabetes; the extent of nerve damage depends on the severity and duration of hyperglycemia.
Answer to #5
B
Answer to #6
A severe lack of insulin causes diabetic ketoacidosis. Without insulin, glucagon's effects become more pronounced, leading to the unrestrained breakdown of the triglycerides in adipose tissue and the protein in muscle. As a result, an increased supply of fatty acids and amino acids arrives in the liver, fueling the production of ketone bodies and glucose. Ketone bodies, which are acidic, can reach dangerously high levels in the bloodstream and spill into the urine. Blood pH typically falls below 7.30. Blood glucose levels usually exceed 250 mg/dL and rise above 1000 mg/dL in severe cases. The main features of diabetic ketoacidosis therefore include severe ketosis, acidosis, and hyperglycemia. The hyperosmolar hyperglycemic syndrome is a condition of severe hyperglycemia and dehydration that develops in the absence of significant ketosis. The hyperglycemia that develops in poorly controlled diabetes leads to polyuria, which results in substantial fluid and electrolyte losses. In the hyperosmolar hyperglycemic syndrome, patients are unable to recognize thirst or adequately replace fluids because of age, illness, sedation, or incapacity. The profound dehydration that eventually develops exacerbates the rise in blood glucose levels, which often exceed 600 mg/dL and may climb above 1000 mg/dL. Blood plasma may become so hyperosmolar as to cause neurological abnormalities, such as confusion, speech and vision impairments, muscle weakness, abnormal reflexes, and seizures; about 10 percent of patients lapse into coma. Hypoglycemia is the most frequent complication of type 1 diabetes and may occur in type 2 diabetes as well. It is due to the inappropriate management of diabetes rather than to the disease itself, and is usually caused by excessive dosages of insulin or antidiabetic drugs, prolonged exercise, skipped or delayed meals, inadequate food intake, or the consumption of alcohol without food.
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