Diabetes

Question 1

What is the normal range of plasma glucose levels?

Answer 1

70-100 mg/dL

Question 2

What are the signs and symptoms of ketoacidosis?

Answer 2

abdominal pain, nausea, vomiting, CNS changes from drowsiness to lethargy

Question 3

Where is glucagon produced?

Answer 3

Alpha cells in the pancreas.

Question 4

What is the A1C of a person without diabetes?

Answer 4

Approximately 5% of hgb will be glycated

Question 5

What is type 1 diabetes?

Answer 5

Auto immune distruction of beta cells and thus and inability to produce insulin; tissue and cell response it one of starvation

Question 6

What is glycogenolysis?

Answer 6

Break down of glycogen into glucose. Primary mechanism to make glucose between meals.

Question 7

What is glucose toxicity?

Answer 7

Chronic exposure to hyperglycemia impairs beta cells to respond to incretin hormones and glucose

Question 8

What does hyperglycemia do to cells?

Answer 8

Dehydrating effect as increased osmotic pressure draws water out of cells.

Question 9

What happens when cells have stored as much glycogen as possible?

Answer 9

Excess glucose is directed to fatty acid synthesis and deposited as fat

Question 10

What are the diagnostic criteria for diabetes?

Answer 10

FBG > 126; Random BG >200 plus symptoms; A1C >6.5%;

Question 11

What is the role of incretin hormones?

Answer 11

GLP1 amplifies insulin by sensitizing beta cells; activation of the GLPI receptor suppresses post prandial glucagon secretion, delays gastric emptying, increases satiety.

Question 12

Describe the role of glucagon

Answer 12

Glucagon is a hormone that stimulates glycogenolysis and gluconeogenesis in the liver and fat breakdown in adipose tissue

Question 13

What serves as the primary source of energy for most cells in the body?

Answer 13

Glucose

Question 14

What is the common plasma glucose level at diagnosis for Type 1?

Answer 14

Glucose can commonly be 300-500mg/dL

Question 15

What is the half life of human insulin?

Answer 15

Half life is about 6m, it is cleared in 10-15 minutes

Question 16

Brain cells can only use ___ as an energy source

Answer 16

Glucose

Question 17

What are the characteristics of type 1 diabetes?

Answer 17

Hyperglycemia becomes evident when 80-90% of beta cells are destroyed; body is unable to maintain normal blood glucose concentrations. Hyperglycemia post-prandial.

Question 18

What is the risk of gestational diabetes?

Answer 18

Hyperglycemia is associated with higher rates of birth defects and miscarriage.

Question 19

What is the primary acute metabolic complication of T2DM?

Answer 19

Hyperosmolar hyperglycemic state - severe hyperglycemia (+600), plasma or serum hyperosmolality, and dehydration

Question 20

Where is insulin produced?

Answer 20

In beta cells in pancreas

Question 21

Describe the role of insulin

Answer 21

Insulin is a hormone that stimulates the uptake of glucose by cells, and suppresses other energy use pathways

Question 22

Egregious 11 - what is the contribution of alpha cells

Answer 22

Alpha cells become insulin resistant, don’t stop releasing glucagon and so hepatic glucose production continues

Question 23

Egregious 11 - what is the contribution of beta cells

Answer 23

Beta cell disfunction leads to lower insulin levels

Question 24

Name the egregious 11

Answer 24

Beta cells, alpha cells, small intestine/stomach, liver, kidney, brain, incretin, adipose tissue, muscle,inflammation, colon

Question 25

Name 3 organs/systems affected by diabetic neuropathy

Answer 25

constipation, diabetic diarrhea, gastroparesis, gustatory sweating, neurogenic bladder, orthostatic hypotension, ED

Question 26

Egregious 11 - what is the contribution of the liver

Answer 26

In the liver, insulin resistance means that liver continues to produce glucose

Question 27

What is the most common precipitating factor for DKA and hyperglycemic hyperosmolar state?

Answer 27

infection

Question 28

Egregious 11 - what is the contribution of the brain

Answer 28

Insulin resistance means the brain is tricked into thinking its starving, increasing appetite