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Val 307 > 3. Glucose and Carbohydrate Metabolism (Part III) > Flashcards

3. Glucose and Carbohydrate Metabolism (Part III) Flashcards

1
Q

What is the general age of onset for T2DM?

A

Over 40 years old

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2
Q

What are the two risk factors for T2DM?

A
  • Visceral obesity
  • Heredity
  • African, native American, Asian, Pacific Island, and Southern European origin
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3
Q

Why isn’t T2DM considered to be adult-onset diabetes anymore?

A

As an increase in adiposity in youth may trigger its onset as well

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4
Q

Why isn’t T2DM considered to be non-insulin-dependent diabetes mellitus anymore?

A

Because as the disease advances, even if the issue is with insulin sensitivity, a person may require exogenous insulin

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5
Q

What percentage of individuals with diabetes have T2DM?

A

90%

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6
Q

How many people will become diabetic by the year 2025?

A

300 million

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7
Q

How many Canadians have diabetes? How many will have diabetes by the end of the decade?

A
  • 2 million

- 3 million

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8
Q

Why is diabetes underestimated?

A

As it is a late-onset disease

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9
Q

What factors are causing the increased rate of diabetes?

A
  • Population is aging
  • Obesity rates are rising
  • Canadian lifestyles are increasingly more sedentary
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10
Q

What are the symptoms of T2DM?

A
  • Glucosuria
  • Ketonuria
  • Dehydration
  • Weight loss
  • Increased appetite (polyphagia)
  • Hyperglycemia
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11
Q

What is the renal threshold for glucose?

A

10 mM/L

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12
Q

What are the symptoms of diabetic ketoacidosis?

A
  • Drowsiness
  • Lethargy
  • Nausea
  • Vomiting
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13
Q

Why does dehydration particularly affect the elderly?

A

Since people don’t tend to listen to their thirst signals as much as they get older

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14
Q

Why does severe T2DM lead to weight loss?

A

Because glucose is not used, but spilled in the urine

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15
Q

What is the FIRST symptom of T2DM?

A
  • Increased insulin
  • Peripheral tissues are not sensitive to insulin
  • Pancreas continually secretes insulin to get the high blood glucose into cells
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16
Q

When does fasting blood glucose rise in T2DM?

A
  • AFTER the rise of insulin levels

- After awhile, the pancreas must work harder to produce enough insulin to maintain euglycemia

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17
Q

What are the consequences of hyperglycemia?

A
  • Increased infections
  • Decreased blood flow
  • Decreased wound healing
18
Q

What is administered in the ICU to decrease complications and infections?

A

Insulin

19
Q

What becomes resistant in T2DM?

A

GLUT4, which is normally insulin-mediated, becomes insulin resistant

20
Q

What does the hyperstimulation of B-cells in T2DM cause?

A

Exhausts B-cell, which may no longer sustain the high insulin production, resulting in the requirement for exogenous insulin

21
Q

What metabolic effects are caused by insulin resistance?

A
  • Binding of insulin to receptor are decreased
  • Less GLUT4 synthesized and transported to the surface (decreases glucose uptake)
  • Decreased anabolic response within the cell
  • Blunted protein synthesis response
22
Q

How is the inflammatory nature of obesity linked to insulin resistance?

A
  • Excess fatty acids are metabolized in cells that do not have glucose, which sets up a disequilibrium in cell metabolism
  • Causes ER stress
  • Cell cannot cope with the lack of homeostasis
23
Q

What is exacerbating the hyperinsulin state?

A

The high rate of gluconeogenesis, while blood glucose is already high

24
Q

What are the effects of diabetes in GLUT4 peripheral tissues?

A
  • Decreased glucose uptake
  • Fat-based economy
  • Accumulation of Acetyl-CoA
  • Increase in muscle proteolysis
  • High rate of gluconeogenesis
25
Q

What are the effects of diabetes in the liver?

A
  • Increased glucose uptake increases glycogenesis and lipogenesis
  • Increased VLDL and LDL (atherosclerosis)
  • Non-alcoholic fatty liver disease (NAFLD)
26
Q

How is atherosclerosis increased in T2DM?

A
  • High glucose uptake by the liver induces lipogenesis

- Synthesis of VLDL, which increases LDL and causes the invasion of artery walls

27
Q

What are the effects of diabetes in non-GLUT4 peripheral tissues?

A
  • Increased glucose uptake

- Results in damaging effects of the hyperglucose state

28
Q

What effects link diabetes and cardiovascular disease?

A
  • Increased lipogenesis
  • Increased VLDL secretion
  • Increased oxidation and glycation of LDL
29
Q

How does higher LDL promote atherosclerosis?

A
  • LDL is more likely to be damaged
  • Uptake by the liver and LDLR receptor is lower
  • Increases plaque formation and atherosclerosis
30
Q

What are the functions of metformin?

A
  • Decrease hepatic gluconeogenesis
  • Increase peripheral insulin sensitivity
  • Increase GLUT4-mediated glucose uptake
  • Increase fatty acid oxidation
31
Q

What are the four net effects of metformin?

A
  • Decreases hepatic steatosis
  • Increases liver insulin sensitivity
  • Decreases plasma glucose
  • Decreases plasma triglycerides
32
Q

What is metformin’s mechanism of action?

A
  • Increased phosphorylation activates AMPK
  • Decreases SREBP-1 activity
  • Increases hepatic fatty acid oxidation and decreases fatty acid synthesis
33
Q

What is the function of sulphonylureas?

A

Increases insulin production and release

34
Q

What is the function of Toujeo?

A
  • Made of long-acting insulin microcrystals

- Allows insulin to act over a period of 24-hours, providing a basal insulin level

35
Q

What are incretins? Give an example.

A
  • SGLT2 inhibitors

- Farxiga

36
Q

What was recommended in the 1930s for diabetes? Why did it change?

A
  • Low-carb, high-fat diet

- They realized that excess fat synthesis is responsible for many of the symptoms observed in diabetes

37
Q

What is the AMDR for protein? How much is recommended in diabetics? Are we thinking of changing the amount?

A
  • 10 to 35%
  • 15% recommendation
  • As protein metabolism may also be resistant to insulin, the recommendations should be increased
38
Q

What is the key to management of T2DM?

A
  • Weight management and activity

- Decrease in 10% of an individual’s body weight over a period of 6 months is enough to increase insulin sensitivity

39
Q

How may surgery influence diabetes?

A
  • The stress reaction may exacerbate diabetes

- Increased insulin resistance (hyperglycemia and protein breakdown)

40
Q

What aids in the loss of body protein?

A

Nutrition support

41
Q

What aids in the neuroendocrine response causing insulin resistance and hyperglycemia?

A

Epidural (analgesia)

42
Q

How does loss of body protein negatively influence the response to surgery?

A
  • Immunosuppression (delayed wound healing)

- Muscle wasting (delayed convalescence)

Val 307 (15 decks)

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