8/29/17

Question 1

Hyperglycemia Symptoms

Answer 1

Frequent urination (polyuria)
Thirst (polydipsia)
Blurry vision
Fatigue
Hunger
Weight loss

Question 2

Screen and diagnose diabetes

Answer 2

Fasting Blood Glucose-
Normal: <100 mg/dl
Diabetes: >125 mg/dl

HbA1c-
Normal: <5.7%
Diabetes: >6.5%

2 hour oral glucose tolerance test-
Normal: <140 mg/dl
Diabetes: >200 mg/dl

Test should be considered for overweight adults (BMI >25) with risk factors like race, relatives, sedentary lifestyle, dyslipidemia, Hypertension, and acanthosis nigricans

Low risk patient screening: start testing at 45 years old, repeat every 3 years or yearly if prediabetic

Question 3

Mess for type II diabetes

Answer 3

Goal is to lower glucose

Pancreas: sulfonylurea and meglitinides enhance insulin secretion (insulin secretagogues) by inhibiting beta cell K+/ATP channel and binding to SUR1, GLP-1 analogues and DPP4-inhibitors up insulin secretion and lower glucagon secretion

Liver: metformin inhibits gluconeogenesis

Gut: Acarbose (Amy Lin analogue) and Alpha-glucosidase inhibitors reduce glucose absorption

Reduce endogenous glucose production- biguanides and bile acid sequestrants

Muscle: thiazolidinediones address insulin resistance by increasing insulin sensitivity

Kidney: SGLT2 inhibitors block renal glucose reabsorption

A1C % reduction-
0.5%: DPP4 inhibitors
1%: SGLT2 inhibitors
1.5%: TZDs and GLP-1
2%: Metformin and sulfonylurea

Question 4

Pathophysiology of Type II

Answer 4

Peripheral insulin resistance

Progressive beta cell dysfunction: lower mass and function, accompanied by inadequate insulin secretion

Hypersecretion of glucagon: elevates blood sugar due to increased hepatic output, glucagon not suppressed after meals like it should be

Gastric Emptying: potentiates postprandial glucose levels

Impaired incretin effects: contributes to elevated postprandial glucose levels, have less insulin potentiation than normal

Question 5

Incretin Response

Answer 5

Difference between oral glucose load and intravenous glucose infusion

Type II diabetics have lower incretin response

Question 6

Incretin normal physiology

Answer 6

Secreted from L-cells of jejunum and ileum in a biphasic manner

Suppresses glucagon Secretion and stimulates glucose-dependent insulin secretion

Slows gastric emptying, reduces rate of nutrient absorption and slow the rate of glucose apparent in blood

Animal studies show increase beta cell mass and improve function