glycosuria – n. 糖尿
spill – v. 溢出，流
cystitis – n. 膀胱炎
facilitate – v. 促进，帮助，便利
polyphagia – n. 多食
polydipsia – n. 多饮，烦渴
tonicity – n. 张力，弹性，紧张性
lipolysis – n. 脂（肪水）解
ketosis – n. 酮病
ketone – n. 酮
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Loss of Blood Glucose Control 血糖失控
When an insufficient amount of insulin is released or insulin receptors are no longer responding, several metabolic changes occur, beginning with hyperglycemia, or increased blood sugar. Hyperglycemia results in glycosuria: Sugar is spilled into the urine because the concentration of glucose in the blood is too high for complete reabsorption. Because this sugar-rich urine is an ideal environment for bacteria, cystitis is a common finding. The patient experiences fatigue because the body’s cells cannot use the glucose that is there; they need insulin to facilitate transport of the glucose into the cells. Polyphagia (increased hunger) occurs because the hypothalamic centers cannot take in glucose; thus the cells sense that they are starving. Polydipsia (increased thirst) occurs because the tonicity of the blood is increased owing to the increased glucose and waste products in the blood and the loss of fluid with glucose in the urine. The hypothalamic cells that are sensitive to fluid levels sense a need to increase fluid in the system, which in turn causes the patient to feel thirsty.
Lipolysis, or fat breakdown, occurs as the body breaks down stored fat into FFAs for energy because glucose is not usable. The patient experiences ketosis as metabolism shifts to the use of fat for energy. Ketones are produced that cannot be removed effectively. Acidosis also occurs because the liver cannot remove all of the waste products (acid being a primary waste product) that result from the breakdown of glucose, fat, and proteins. Muscles break down because proteins are being broken down for their essential amino acids. The breakdown of proteins results in an increase in nitrogen wastes, which is manifested by an elevated blood urea nitrogen concentration and sometimes by protein in the urine. Patients with hyperglycemia do not heal quickly, because of this protein breakdown, as well as the lack of a stimulus to initiate protein building. All of these actions eventually contribute to development of the complications associated with chronic hyperglycemia or diabetes.
1. Blood sugar is well controlled when Hemoglobin A1C is:
A. Below 7%
B. Between 12%-15%
C. Less than 180 mg/Dl
D. Between 90 and 130 mg/dL
2. Which of the following measures does not help to prevent diabetes complications?
A. Controlling blood glucose
B. Controlling blood pressure and blood lipids
C. Eliminating all carbohydrates from the diet
D. Prompt detection of diabetic eye and kidney disease
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答案 Answers 1. A. Below 7% Rationale: A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes. 2. C. Eliminating all carbohydrates from the diet Rationale: There is no evidence that eliminating all sugar from the diet benefits people with diabetes. It is more important for diabetics to manage and control total carbohydrate intake so that their blood glucose levels remain on target. Controlling blood glucose, blood pressure, and blood lipid levels can aid in the prevention of complications associated with diabetes.
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