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GIR Test 1 > B5.002 - Diabetes Mellitus Physiology > Flashcards

B5.002 - Diabetes Mellitus Physiology Flashcards

1
Q

what is DM

A

group of metabolic disorders that share a common feature of hyperglycemia

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2
Q

describe T1DM

A

destruction of beta cells - absolute insulin insufficiency
autoimmune
idiopathic
usually occurs at young age

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3
Q

describe T2DM

A

resistance to insulin and relative insulin insufficiency
classically called adult onselt
genetic and lifestyle factors

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4
Q

rank which ethnicities have the highest to lowest risk of DM

A 
hispanic F
non hispanic black F
hispanic M
non hispanic black M
non hispanic white F
non hispanic white M
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5
Q

90% of pts with newly diagnosed diabetes re what

A

overweight or obese

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6
Q

what is the most important stimulator of insulin secretion

A

glucose

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7
Q

what yields the best plasma insulin response, IV or oral insulin

A

oral, indicating alimentary mechanisms in addition to the arterial blood sugar concentration regulate insulin secretion

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8
Q

what are the core defects in T2DM

A

beta cell dysfunction

insulin resistance

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9
Q

more than 80% of pts progressing to T2DM are what

A

insulin resistant

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10
Q

what tissue is the major player in insulin resistance

A

skeletal muscle

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11
Q

describe the 2 major methods of glucose transport into skeletal muscle

A

insulin receptor is stimulated

muscle contraction

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12
Q

describe hepatic insulin resistance

A

NAFLD, ectopic lipids decrease sensitivity to insulin

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13
Q

what defines steatosis

A

> 5% of liver comprised of fat

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14
Q

hyerglycermia is linked to what

A

oxidative stress and CVD

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15
Q

insulin secretion is inversely related to what

A

insulin sensitivity

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16
Q

how are plasma glucose levels regulated

A

by alterations in insulin secretion relative to the underlying level of insulin sensitivity

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17
Q

what are measures of insulin sensitivity

A 
OGTT >200 = DM, >150 = IGT
Mixed meal tolerance test
continuous glucose monitors 
fasting lood glucose (100-125 elevated; >126 = DM)
HOMA >3 insuline resistance
hyerinsulinemic euglycemic clamp
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18
Q

fasting glucose levels

A

<100 normal
100-126 pre diabetic
>126 diabetic

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19
Q

OGTT levels

A

<140 normal
140-200 pre diabetic
>200 diabetic

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20
Q

what are IFG and IGT

A

IFG - impaired fasting glucose

IGT - impaired glucose tolerance

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21
Q

what is HbA1C

A

glucose chemically linked to Hb

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22
Q

excellent, good and bad HbA1C

A

4-6 excellent
7-8 good
9-14 action suggested

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23
Q

what are components leading to beta cell failure

A 
chronic hyperglycemia
glucotoxicity
lipotoxicity
oversecretion of insulin to compensate
high circulating free fatty acids
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24
Q

what are incretins

A

GLP-1, GIP

as much as 50% post prandial insulin release dependent on incretins

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25
Q

describe how GLP-1 works

A 
upon ingestion of food GLP-1 is secreted from L cell in the intestine
this stimulates insulin secretion
suppresses glucagon secretion
slows gastric emptying
reduces food intake
increases B cell mass and maintains B cell function 
improves insulin sensitiviy
enhances glucose disposal
26
Q

describe GLP-1 levels in T2DM

A

they are lower either due to decreased production or increased production of DPP-4

27
Q

cellular mediators of insulin secretion

A 
gut peptides (GLP-1, GIP)
glucose
28
Q

biguanides MOA

A

activates AMP kinase

decreases hepatic glucose production

29
Q

advantages of biguanides

A

extensive experience
no hypoglycemia
weight neutral
low cost

30
Q

disadvantages of biguanides

A

GI
Lactic acidosis
B12 deficiency

31
Q

SU/Meglitinides MOA

A

closes KATP channels

increases insulin secretion

32
Q

advantages of SU/Meglitinides

A

extensive experience
decreased microvascular risk
low cost

33
Q

disadvantages of SU/meglitinides

A

hypoglycemia
weight gain
low durability

34
Q

TZDs MAO

A

PPAR gamma activator

increased insulin sensitivity

35
Q

advantages of TZDs

A

no hypoglycemia
durability
decreased TGs
increased HDL

36
Q

disadvantages of TZDs

A

weight gain
edema/CHF
bone fractures
high cost

37
Q

a-GIs MOA

A

inhibits alpha glucosidase

slows carbohydrate absorption

38
Q

advantages of a-GIs

A

no hypoglycemia
nonsystemic
decreased post prandial glucose

39
Q

disadvantages of a-GIs

A

GI
dosing frequency
modest decrease in a1c

40
Q

DPP-4 inhibitors MOA

A

inhibits DPP-4

increases GLP-1, GIP

41
Q

advantages of DPP-4i

A

no hypoglycemia

well tolerated

42
Q

disadvantages of DPP-4i

A

modest dec in a1c
urticaria
high cost

43
Q

GLP-1 receptor agonist MOA

A

activates GLP-1 R
increases insulin decreaes glucagon
decreased gastric emptying
increased satiety

44
Q

advantages of GLP-1 RA

A

weight loss

no hypoglycemia

45
Q

disadvantages of GLP-1RA

A

GI
medullary ca
injectable
high cost

46
Q

amylin mimetics MOA

A

activates amylin receptor
decreasesd glucagon
decreased gastric emptying
increased satiety

47
Q

advantages of amylin mimetics

A

weight loss

decreased PPG

48
Q

disadvantages of amylin mimetics

A 
GI 
modest dec in a1c
injectable 
hypo w insulin
dosing frequency
high cost
49
Q

bile acid sequestrants MOA

A

bind bile acid

dec. hepatic glucose production

50
Q

advantages of bile acid sequestrants

A

no hypoglycemia
nonsystemic
dec post prandial glucose
dec CVD events

51
Q

disadvantages of bile acid sequestrants

A

GI
modest dec in a1c
dosing prequency
high cost

52
Q

dopamine 2 agonist MOA

A

activates DA receptor
modulates hypothalamic control of metabolism
increased insulin sensitivity

53
Q

advantages fo dopamine 2 agonists

A

no hypoglycemia

54
Q

disadvantages of dopamine 2 agonists

A 
modest dec in a1c
dizziness/syncope
nausea
fatigue
high cost
55
Q

do treatments stay constant over time?

A

no all get worse

56
Q

what is the downside to using HbA1C as the measure of interest for treatment

A

it doesnt capture short term changes in glycemic control and dose not distinguish pre and post prandial conditions

57
Q

what is the primary cause of T2D

A

inactivity

58
Q

what volume of activity is needed to offset T2D?

A

> 3500 steps/day

59
Q

how does chronic exercise and weight loss affect DM

A

evidence of improved beta cell fxn

60
Q

rank types of physical activity in order of best to worst at lowering a1c

A

aerobic
resistance
combined

GIR Test 1 (15 decks)

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