1a Diabetes Mellitus

Question 1

Describe the normal response to feeding?

Answer 1

1. Eat a meal
2. Glucose levels in the blood are elevated
3. Pancreas releases insulin
4. Insulin binds to insulin receptor
5. This causes GLUT4 receptors to move to the plasma membrane of the cells
6. Therefore glucose is able to pass into the muscle or fat cell

Question 2

Where are GLUT 4 receptors found?

Answer 2

muscle or adipose tissue

Question 3

How does GLUT 4 respond to insulin?

Answer 3

It is highly insulin responsive

Question 4

Where is GLUT 4 found before moving to the cell membrane?

Answer 4

Found in vesicles -moves from vesicles to membrane in the presence of insulin

Question 5

What does insulin act as a signal of?

Answer 5

Insulin is a signal you have been fed

Question 6

What happens to gluconeogenesis when insulin levels are high?

Answer 6

Gluconeogenesis is turned off

Question 7

What happens to glycogen levels when insulin is released?

Answer 7

Glycogen levels increase as the glucose is stored as glycogen

Question 8

Why is triglycerides the most useful energy store?

Answer 8

It is fully reduced therefore is the mot efficient energy store

Question 9

What are NEFAs?

Answer 9

Non-esterified fatty acids

Question 10

How do triglycerides form?

Answer 10

They form through an esterification reaction of three NEFA’s and a glycerol molecule

Question 11

What is the purpose of adipocytes?

Answer 11

To store energy

Question 12

What does lipoprotein lipase do?

Answer 12

Breaks down triglycerides => glycerol and NEFA molecule

Question 13

What affect does insulin have on lipoprotein lipase?

Answer 13

Insulin switches on lipoprotein lipase

Question 14

What happens to the glycerol in adipose cells from the breakdown of the triglyceride?

Answer 14

Can be converted into glucose - via gluceoneogenesis by conversion into dihydroxyacetone phosphate and then into GALP

Question 15

What is increased due to the effects of insulin in the fed state? - 3

Answer 15

INCREASED:
- Glycogen store
- Lipogenesis
- protein synthesis

Question 16

What is the brains main energy substrate?

Answer 16

Glucose

Question 17

Can the brain use ketone bodies or fatty acids as a source of energy?

Answer 17

Can use ketone bodies as a last resort, but not fatty acids

Question 18

Why can fatty acids not be used in the brain as a source of fuel?

Answer 18

The fatty acids cannot pass the blood brain barrier

Question 19

What happens to insulin levels during starvation?

Answer 19

They fall

Question 20

What happens to glucose uptake in cells during starvation?

Answer 20

It falls

Question 21

What happens to hepatic glucose output?

Answer 21

it rises

Question 22

What happens to lipolysis when insulin levels are low?

Answer 22

Lipolysis is switched on

Question 23

What happens in lipolysis?

Answer 23

Non esterified fatty acids are released

Question 24

What happens to the NEFA’s that are released during lipolysis?

Answer 24

They are converted into ketones

Question 25

What happens to blood pH when ketones are made and why?

Answer 25

Blood pH starts to fall - this is because ketones are slightly acidic

Question 26

What happens to gluconeogenesis when insulin levels are low?

Answer 26

The liver turns on gluconeogenesis

Question 27

What is hepatic glycogenolysis?

Answer 27

The generation of glucose from stored glycogen in the liver

Question 28

What effect does low insulin levels have on beta oxidation?

Answer 28

Increases beta oxidation

Question 29

What is produced in beta oxidation?

Answer 29

acetyl coa which is then used to produce ketone bodies in the starving state

Question 30

What are the three ketone bodies?

Answer 30

Acetone Acetoacetate 3-beta hydroxybutyrate

Question 31

Starving for a long period of time results in a sweet, strong smell that you can detect. Why?

Answer 31

Starving state = increased gluconeogenesis, meaning the oxaloacetate which would normally be used in the TCA cycle is being used to make glucose, therefore excess of acetyl CoA - converted into ketone bodies via ketogenesis

Question 32

What happens in myocytes when insulin levels are low?

Answer 32

no glucose is pumped into muscle cells, so the onboard stores of glycogen are used to make glucose, which then undergoes glycolysis and Krebs cycle to make ATP

Question 33

What happens to proteolysis when insulin levels are low?

Answer 33

It increases - proteins are broken down into amino acids

Question 34

What happens to hepativ glucose output when inculin levels are low

Answer 34

It increases

Question 35

What happens to ketogenesis when insulin levels are low?

Answer 35

It increases

Question 36

What type of disease is Diabetes Mellitus?

Answer 36

An autoimmune condition

Question 37

What is destroyed in T1DM

Answer 37

The ISLET cells

Question 38

What word is used to describe the glucose levels of those with T1DM?

Answer 38

Hyperglycemia

Question 39

Why does ketone production occur in T1DM?

Answer 39

There is a lack of insulin, therefore your body will behave as if it starving, and will increase ketone body production for energy

Question 40

What is ketoacidosis?

Answer 40

When you have very large amounts of ketone bodies so they become acidic

Question 41

If you have the presence of ketone, which type of diabetes do you have?

Answer 41

Type 1

Question 42

What is the pH range for patients with ketoacidosis?

Answer 42

A pH less than 7.3

Question 43

What are some complications of ketoacidosis?

Answer 43

Patients with ketoacidosis experience low pH in the blood as the ketones are acidic - a low pH is associated with decreased brain function, which can make the patient unconscious, and experience a low mood, and can also lead to death

Question 44

What are some osmotic symptoms of T1DM?

Answer 44

Polyuria, polydipsia and nocturia

Question 45

What is polyuria?

Answer 45

A lot of urine

Question 46

What is polydipsia?

Answer 46

Drinking a lot of water as you are thirsty often

Question 47

What is nocturia?

Answer 47

Waking up at night because you have to urinate

Question 48

What level does resting glucose have to be in order to be diagnosed with T1DM?

Answer 48

>11.1mmol/L

Question 49

What level does fasting glucose have to be in order for a diagnosis of T1DM to be made?

Answer 49

>7.0mmol/L

Question 50

Above what value is HbA1c considered high?

Answer 50

>48mmol/mol

Question 51

How many positive tests do you require for the diagnosis of T1DM?

Answer 51

2 Positive tests or 1 positive test and osmotic symptoms

Question 52

Why is measuring C-peptide a useful diagnostic test?

Answer 52

C peptide is cleaved from pro-insulin along with insulin. Therefore little c peptide indicates little insulin in pancreas

Question 53

What antibodies can be tested for a T1DM diagnosis?

Answer 53

GAD and IA2

Question 54

How do you treat T1DM?

Answer 54

Replace insulin through injections at a specific dose relative to the meal you are going to eat

Question 55

What happens if you inject insulin without eating food?

Answer 55

Insulin results in more glucose being absorbed, so much so that you become hypoglycaemic

Question 56

What is hypoglycaemia?

Answer 56

When blood sugars are very low

Question 57

What happens to the brain during hypoglycaemia?

Answer 57

Since insulin is present, ketone production is stopped. But you have no fuel for brain now, so brain cannot function - results in confusion and unconsciousness

Question 58

What four things increase to counter act hypoglycaemia?

Answer 58

Glucagon, catecholamines, cortisol and growth hormone

Question 59

What happens to the hepatic glucose output when the body induces the counter regulatory response to hypoglycaemia?

Answer 59

It increases with glycogenolysis and gluconeogenesis

Question 60

What is impaired awareness of hypoglycaemia?

Answer 60

The reduced ability to recognize symptoms of hypoglycaemia due to loss of counter regulatory response which leads to recurrent hypo.

Question 61

What might someone who is having a hypo feel?

Answer 61

Confused, aggressive, irrational

Question 62

Autonomic symptoms of hypoglycaemia? - 3

Answer 62

Sweating, pallor, palpitations and shaking

Question 63

What is the definition of severe hypoglycaemia?

Answer 63

An episode in which a person requires third party assistance to treat

Question 64

What are some neuroglycopenic symptoms of hypoglycaemia? - 5

Answer 64

Slurred speech, poor vision, confusion, seizures and loss of consciousness

Question 65

What can you give a patient suffering with unconsciousness due to a hypo?

Answer 65

1mg glucagon injection

Question 66

What can be given to patients suffering from an acute hypo episode?

Answer 66

Jelly babies, lucozade, glucogel

Question 67

What is T2DM?

Answer 67

Where you have insulin resistance in the liver, muscle and adipose issue, however enough insulin to suppress ketogenesis and proteolysis

Question 68

Will you ever find ketoacidosis in patients with T2DM?

Answer 68

No

Question 69

What are some signs and symptoms of T2DM? - 4

Answer 69

Hyperglycaemia >7 mmol/L overweight Hypertension (135/80 mmHg) Dyslipidaemia

Question 70

Which type of diabetes is associated with weight gain and loss respectively?

Answer 70

Gain = T2 Loss = T1

Question 71

Why does T1DM result in polyuria?

Answer 71

The excess glucose ends up in the urine, which draws more water into the urine via osmosis, hence the volume of urine increases

Question 72

What are the risk factors for T2DM? - 6

Answer 72

Age, PCOS, High BMI, family history, ethnicity, inactivity

Question 73

What are the four ways to manage T1DM?

Answer 73

Education Technology Exogenous insulin Self monitoring of insulin

Question 74

What is the basal bolus regime for insulin?

Answer 74

Basal (long acting) insulin is given once for long actin Bolus is given throughout day before meals in order to manage the rises in glucose after meals

Question 75

What four ways can T2DM be managed?

Answer 75

Education Diet Exercise Oral medication - to stimulate the pancreas to increase insulin production

Question 76

What other microvascular systems can be affected due to diabetes?

Answer 76

Retinopathy Neuropathy Nephropathy

Question 77

What macro vascular systems can be affected by T2DM?

Answer 77

Cardiopathy eg heart attack

Question 78

What is dyslipidemia?

Answer 78

Disturbances in fat metabolism cause changes in the lipid concentration in the blood

Question 79

What is diabetic retinopathy?

Answer 79

High glucose levels in the blood result in damage to the blood vessels which supply the retina

Question 80

By how much do GLUT-4 transporters increase glucose uptake?

Answer 80

7-fold

Question 81

how quickly are carbohydrate stores depleted

Answer 81

within 1 day

Question 82

why is Lipoprotein Lipase (LPL) so important?

Answer 82

allows triglycerides that they can leave circulation and enter into the adipocyte for storage

Question 83

what is decreased due to the effect of insulin in fed state?

Answer 83

DECREASED: - Proteolysis - gluconeogenesis

Question 84

what is hepatic glycogenolysis?

Answer 84

the generation of glucose from stored glycogen in the liver

Question 85

what happens to insulin-to-glucagon ratio in the fasted state?

Answer 85

it is low

Question 86

what increases in the fasted state? - 4

Answer 86

INCREASED: proteolysis lipolysis HGO from glycogen and gluconeogenesis ketogenesis when prolonged

Question 87

what happens to amino acid levels in the fasted state

Answer 87

decreases

Question 88

what energy store do muscles use in the fasted state

Answer 88

lipid

Question 89

what does HGO stand for

Answer 89

Hepatic Glucose Output

Question 90

what is the insulin to glucagon ratio in the fed state

Answer 90

high