Diabetes Flashcards by Brea Glickman

What is Diabetes Mellitus

a group of metabolic diseases - inability to produce sufficient amounts of insulin or to use it properly, or both

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What is the result of diabetes mellitus

hyperglycemia

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What is hyperglycemia

high blood glucose - BG levels poorly managed, diabetic ketoacidosis, hyperosmolar nonketotic syndrome

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What is hypoglycemia?

low blood glucose - too much insulin, too little carb, missed meals, excessive or poorly planned exercise

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What is hypersmmolar syndrome

your body tries to rid itself of of the excess blood sugar by passing it into your urine

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What are the key factors in the development of the complication

impaired glucose clearance from the circulation and an increase in the production of glucose by hepatocytes and portal adipocytes

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What are microvascular diseases

retinopathy, nephropathy

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What are macrovascular diseases?

cardiovascular, cerebrovascular

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What are neuropathies

Autonomic and peripheral - when nerve endings are exposed to high blood glucose over time, those nerve endings lose function

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What is ketoacidosis

muscle cells are not able to get enough glucose in because of insulin resistance, switch to fatty acid metabolism which produces ketone bodies

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Diabetes afflicts ______ people in the US. Approximately ______ are undiagnosed and ____ with pre diabetes.

~34 million; 25%; ~88 million

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What are some reasons for the epidemic?

increasing overweight and obesity, increasing sedentary lifestyle, aging of population

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What are some risk factors for diabetes

age >/= 45 years, BMI >/= 25 kg/m^2 or central adiposity (defined by waist circumference), habitual physical inactivity, having a first degree relative with DM, african american latino native american asian american or pacific islander race/ethnicity

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What are the categories of diabetes

Type 1: beta cell destruction leading to insulin deficiency
Type 2: ranges from insulin resistance to insulin deficiency
Gestational

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what is type 1 diabetes

A. immune mediate (autoimmune disease) - T lymphocytes attack beta-cells labeled with antigens
B. Idiopathic

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What is type 2 diabetes

could include insulin secretion defect, insulin resistance, or both; strong genetic influence

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What is gestational diabetes

glucose intolerance on with pregnancy; fetal hormonal secretions may impact insulin-receptor binding in the mother; increase mother BG -> increase Fetal BG -> increase fetal fat deposits

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What is glucose tolerance

assessment of physiological response to a normal glucose load

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what does glucose tolerance consist of

Normal response by the pancreas
- secretion of insulin
- stop secreting glucagon
Normal response of muscle and adipose tissue to insulin
- insulin stimulated glucose uptake

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describe the molecular pathway responsible for insulin function

Insulin activates insulin receptor (IR)
IR associates with IRS proteins
IRS proteins activate PI3 kinase
PI3 kinase activates AKT
AKT facilitates:
- glycogen synthesis
- glucose intake
- protein synthesis
- cell growth, proliferation
AKT prevents:
- gluconeogenesis

What is fasting plasma glucose

measures glucose levels in a person who has been fasting for at least 8 hours

What is fasting plasma glucose

measures glucose levels in a person who has been fasting for at least 8 hours

What is the 75 g oral glucose tolerance test

requires fasting before drinking a glucose solution. Following a 2 hour waiting period, blood is drawn

What is the hemoglobin A1C test

does not require fasting, and measures the blood level of glycosylated hemoglobin over the past 2 to 3 months

What is insulin resistance

normal amounts of insulin are inadequate to produce normal insulin response in adipose, muscle, and liver tissue; contributes to elevated BG levels

Results of lack of insulin response in muscle and liver

reduced glucose uptake in skeletal muscle inability to inhibit glycogenolysis and GNG in liver

What is the primary cause of Type 2 Diabetes? 1. inactivity 2. hypercaloric diet 3. genetic predisposition 4. inflammation 5. smoking 6. air pollution

4. inflammation

What are adipocytes

major cells in fat tissues: - storage of lipids, carbohydrates - secretion of inflammatory mediators

What are hepatocytes

(70-80% of the liver mass): - protein synthesis and storage - carbohydrate metabolism - synthesis of cholesterol, bile salts, and phospholipids - detoxification, modification and excretion of exogenous and endogenous substances - secretion of inflammatory mediators

What is another reason for insulin resistance other than inflammation?

hyperglycemia and hyperlipidemia - causes stress to ER and mitochondria, induces Reactive Oxygen Species (ROS) --> ER stress and ROS further activates MAP kinases such as JNK (inhibits insulin signaling

What can cause endothelial dysfunction?

high serum glucose levels induce reactive oxygen species

Inflammatory complications of diabetes: Kidney Failure

caused by excessive expression of inflammatory mediators and exposure to ROS. Will damage the endothelium

Inflammatory complications of diabetes: eye complications

retinopathy (loss of blood supply)

Inflammatory complications of diabetes: diabetic wound

reduced ability in wound repair because reduced levels and activities of progenitor cells and blood supply

What are signs and symptom's of diabetes

polydipsia (excessive thirst) polyuria (frequent urination) polyphagia (increase appetite) infections and cuts that are slow to heal blurry vision fatigue

_____% of those with T2DM do not know it

25%

What does a physical exam focus on?

potential diabetes complications: - elevated resting HR - loss of sensation - loss of reflexes (esp. lower extremities) - foot sores or ulcers with poor healing - excessive bruising - retinal vascular abnormalities

Cardiovascular exercise testing is indicated for those with one or more of _______

- age > 40 yr diabetics with or without CVD risk factors - age >30 yr diabetics and type 1 or type 2 diabetes for >10 yr, hypertension, dyslipidemia, retinopathy, nephropathy

What should be tested 1-2 times a year in diabetic adults >45 yrs?

HbA1C testing, dilated eye exam, foot exam, blood pressure, blood lipid assessment, renal functioning testing

What is medical nutrition therapy

may ultimately focus on large weight loss from a complete meal replacement diet or bariatric surgery

Oral glucose lowering medication types

sulfonylureas (first and second gen) Biguanides (metformin) Dipeptidylpeptidase-4 inhibitors Alpha-glucosidase inhibitors Insulin

What is sulfonylureas (first and second gen)

increases insulin production by the beta cells in the pancreas

What is Biguanides (metformin)

decreases hepatic production of glucose

What is Dipeptidylpeptidase-4 inhibitors

prolong and enhance the activity of the insulin by limiting its breakdown

What is Alpha-glucosidase inhibitors

reduce the rate of digestion of carbs in the proximal small intestine, primarily lowering postprandial glucose concentrations as they inhibit intestinal alpha-glucosidase enzymes

What is insulin

the last line of treatment and is reserved for those patients who fail to respond adequately to a combo of orals and injectable antidiabetic agents

Why do we give T2DM patients insulin if they still produce it?

insulin has many pathways of action to cause glucose uptake into cell

Which diabetic medication could be contraindicated for exercise? 1. insulin 2. sulfonylurea 3. biguanides 4. glucosidase inhibitors

1. insulin exercise and insulin together can significantly decrease blood glucose causing diabetic coma. Have to wait 1 hour after insulin injection before exercise

How does exercise increase glucose uptake for diabetics?

exercise induces an increase in glut4 transporter translocation from separate storage sites glucose uptake is increased in active muscle fibers, but not in inactive muscle