Diabetes Flashcards

1
Q

What are the 5 actions of insulin?

A

Glucose:
1. Dec HGO
2. Inc muscle uptake

Protein:
3. Dec preoteolysis

Fat:
4. Dec lipolysis
5. Dec ketogenesis

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2
Q

What are GLUT-4 proteins?

A

Glucose transporter protein
- high in myocytes and adipocytes
- highly insulin-responsive —> GLUT-4 vesicles fuse
with plasma membrane
- inc glucose intake x7

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3
Q

How does insulin act on myocytes? (4)

A
  1. Inc glucose uptake

Dec gluconeogenesis:
2. Dec amino acid production (protein breakdown)
3. Dec uptake of oxygen
4. Inc protein synthesis (dec amino acids)

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4
Q

Which hormones act on myocytes during hypoglycaemia? (2)

A
  1. Glucagon —> dec glucose uptake
  2. GH —> dec glucose uptake
    —> inc protein breakdown to amino acids
  3. IGF-1 —> inc protein breakdown to amino acids
    - inc gluconeogenesis
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5
Q

How does insulin act on hepatocytes? (4)

A

Dec HPO:
1. Dec gluconeogenesis
2. Inc protein synthesis (dec amino acids)
3. Dec ketogenesis
4. Inc glycogenesis

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6
Q

Which hormones act on hepatocytes during hypoglycaemia? (2)

A
  1. Glucagon —> inc gluconeogenesis
    —> inc protein breakdown to amino acids
    —> inc ketogenesis
    —> inc glycogenolysis
  2. Cortisol —> inc gluconeogenesis
    - inc HPO
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7
Q

How does insulin act on adipocytes? (4)

A

Inc lipid stores:
1. Inc LPL (lipoprotein lipase) —> more triglyceride
breakdown in capillaries —> inc lipid intake
2. Inc triglyceride formation in cells
3. Inc glucose uptake
4. Dec triglyceride breakdown in cells —> dec lipid exit

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8
Q

Which hormones act on adipocytes during hypoglycaemia? (2)

A
  1. GH —> inc triglyceride breakdown in cells
  2. Cortisol —> inc triglyceride breakdown
    - inc glycerol and NEFA out for gluconeogenesis +
    ketogenesis
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9
Q

Where is insulin secreted to and why?

A

Hepatic portal system
- act on liver very quickly

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10
Q

Where is insulin injected in diabetics and why?

A

Adipose tissue —> slow absorption —> gradual rise in blood glucose

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11
Q

Which organ is glucose essential for and why?

A

Brain
- main energy source (+ partially ketone bodies)
- fatty acids can’t cross blood brain barrier

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12
Q

How does diabetes affect ketone body production?

A

Dec insulin response —> dec glucose uptake —> inc ketone body production for brain
- see high sugar + high ketones in blood (unusual)

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13
Q

What are the main differences between the fasted vs fed state?

A

Fasted:
- blood —> low insulin : glucagon
—> [glucose] 3.0-5.5 mmol/L
—> [NEFA] inc
—> [amino acid] inc (prolongued fasting)
- myocytes —> inc proteinolysis
—> uses lipids (β-ox)
- hepatocytes - inc HPO
—> inc gluconeogenesis
—> inc glycogenolysis
—> inc ketogenesis
- adipocytes —> inc lipolysis

Fed:
- blood —> high insulin : glucagon
- 1st and 2nd phase insulin release
- myocytes —> dec proteinolysis
—> inc protein synthesis
- hepatocytes - dec HPO
—> dec gluconeogenesis
—> inc glycogenesis
- adipocytes —> inc lipogenesis

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14
Q

How is diabetes diagnosed? (7)

A

2 positive tests/ 1 positive tests + symptoms

  1. Fasting glucose >6.9 mmol/L
  2. Random glucose >11.1 mmol/L
  3. Oral glucose tolerance test
    • take fasting glucose
    • give 75g glucose load
    • take blood glucose after 2 hours
  4. HbA1c >48 mmol/mol

T1DM:
5. Antibodies —> GAD
—> IA2
6. C-peptide
7. Blood ketones

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15
Q

What is T1DM?

A

Autoimmune condition —> insulin deficiency

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16
Q

What is diabetic ketoacidosis?

A
17
Q

What are the 4 symptoms of T1DM?

A
  1. Weight loss
  2. Hyperglycaemia
  3. Glycosuria —> polyuria
    —> nocturia
    —> polydipsia
    —> polydipsia
  4. Ketones in blood and urine —> diabetic
    ketoacidosis
18
Q

How is T1DM treated and what is the main associated complication?

A

Exogenous insulin (basal-bolus regime)
+ self-monitoring of glucose levels, diet
- too much insulin —> hypoglycaemia
- too little insulin —> hyperglycaemia

19
Q

How does the body prevent hypoglycaemia?

A

Counterregulatory response:
- inc glucagon, cortisol, GH, catecholamines
- recurrent hypoglycaemia —> lose counterregulatory
response —> impaired awareness of hypoglycaemia

20
Q

What are the symptoms of hypoglycaemia?

A

Autonomic:
1. Sweating
2. Pallor —> pale
3. Palpitations
4. Shaking

Neuroglycopenic:
5. Slurred speech
6. Poor vision
7. Confusion
8. Seizures
9. Loss of consciousness

Severe hypoglycaemia = need 3rd party assistance
- 1mg glucagon 1M injection

21
Q

What is T2DM?

A

Prolongued hyperglycaemia —> insulin resistance
- still enough for ketogenesis and proteolysis

22
Q

What are the symptoms of T2DM?

A
  1. Hyperglycaemia
  2. Overweight —> inc waist circumference
  3. Dyslipidaemia (high cholesterol)
  4. Complications —> eyes (leading cause of blindness)
    —> renal
    —> foot
    —> brain (stroke)
    —> heart + vessels
    —> nerves
  5. May develop insulin deficiency
23
Q

Which pathways are affected by insulin resistance?

A

Inc insulin secretion (try to counteract resistance)
1. MAPK —> inc growth and proliferation
- when in blood vessels —> hypertension
2. PI3K-Akt —> inc metabolic actions

24
Q

What are the 6 risk factors of T2DM?

A
  1. Age
  2. High BMI
  3. Ethnicity
  4. PCOS
  5. Family history
  6. Inactivity
25
Q

How is T2DM managed?

A

Diet —> dec calories
—> dec fat
—> dec refined carbs
—> inc complex carbs
—> dec Na
—> inc fibre
Meds

26
Q

Which 4 complications must be monitored for in diabetes?

A
  1. Retinopathy
  2. Neuropathy
  3. Nephropathy
  4. Cardiovascular