Diabetes Flashcards
What is the normal range of plasma glucose levels?
70-100 mg/dL
What are the signs and symptoms of ketoacidosis?
abdominal pain, nausea, vomiting, CNS changes from drowsiness to lethargy
Where is glucagon produced?
Alpha cells in the pancreas.
What is the A1C of a person without diabetes?
Approximately 5% of hgb will be glycated
What is type 1 diabetes?
Auto immune distruction of beta cells and thus and inability to produce insulin; tissue and cell response it one of starvation
What is glycogenolysis?
Break down of glycogen into glucose. Primary mechanism to make glucose between meals.
What is glucose toxicity?
Chronic exposure to hyperglycemia impairs beta cells to respond to incretin hormones and glucose
What does hyperglycemia do to cells?
Dehydrating effect as increased osmotic pressure draws water out of cells.
What happens when cells have stored as much glycogen as possible?
Excess glucose is directed to fatty acid synthesis and deposited as fat
What are the diagnostic criteria for diabetes?
FBG > 126; Random BG >200 plus symptoms; A1C >6.5%;
What is the role of incretin hormones?
GLP1 amplifies insulin by sensitizing beta cells; activation of the GLPI receptor suppresses post prandial glucagon secretion, delays gastric emptying, increases satiety.
Describe the role of glucagon
Glucagon is a hormone that stimulates glycogenolysis and gluconeogenesis in the liver and fat breakdown in adipose tissue
What serves as the primary source of energy for most cells in the body?
Glucose
What is the common plasma glucose level at diagnosis for Type 1?
Glucose can commonly be 300-500mg/dL
What is the half life of human insulin?
Half life is about 6m, it is cleared in 10-15 minutes
Brain cells can only use ___ as an energy source
Glucose
What are the characteristics of type 1 diabetes?
Hyperglycemia becomes evident when 80-90% of beta cells are destroyed; body is unable to maintain normal blood glucose concentrations. Hyperglycemia post-prandial.
What is the risk of gestational diabetes?
Hyperglycemia is associated with higher rates of birth defects and miscarriage.
What is the primary acute metabolic complication of T2DM?
Hyperosmolar hyperglycemic state - severe hyperglycemia (+600), plasma or serum hyperosmolality, and dehydration
Where is insulin produced?
In beta cells in pancreas
Describe the role of insulin
Insulin is a hormone that stimulates the uptake of glucose by cells, and suppresses other energy use pathways
Egregious 11 - what is the contribution of alpha cells
Alpha cells become insulin resistant, don’t stop releasing glucagon and so hepatic glucose production continues
Egregious 11 - what is the contribution of beta cells
Beta cell disfunction leads to lower insulin levels
Name the egregious 11
Beta cells, alpha cells, small intestine/stomach, liver, kidney, brain, incretin, adipose tissue, muscle,inflammation, colon
Name 3 organs/systems affected by diabetic neuropathy
constipation, diabetic diarrhea, gastroparesis, gustatory sweating, neurogenic bladder, orthostatic hypotension, ED
Egregious 11 - what is the contribution of the liver
In the liver, insulin resistance means that liver continues to produce glucose
What is the most common precipitating factor for DKA and hyperglycemic hyperosmolar state?
infection
Egregious 11 - what is the contribution of the brain
Insulin resistance means the brain is tricked into thinking its starving, increasing appetite
