Diabetes

Question 0

What metabolism pathways does diabetes cause abnormalities in?

Answer 0

Carbohydrate, fat, and protein.

Question 1

What is the definition of diabetes?

Answer 1

Chronic hereditary disorder characterized by an abnormally high level of glucose in the blood and excretion of sugar in the urine. The basic defect is an absolute or relative lack of insulin.

Question 2

When there is no fed signal (insulin), what happens to the lean body mass?

Answer 2

Broken down.

Question 3

Define type 1 diabetes.

Answer 3

Pancreas stops producing insulin, resulting in hyperglycemia

Question 4

Define type 2 diabetes.

Answer 4

Pancreas may not make sufficient insulin. Cells of the body do not use insulin effectively (insulin resistance). Insulin levels may look normal or high. Cells don’t receive enough glucose,resulting in hyperglycemia.

Question 5

Is any other cell uptake affected by insulin resistance or lack of insulin?

Answer 5

Muscle uptake of amino acid (especially branch chain) also inhibited.

Question 6

What are some common causes of normal weight type 2 diabetes?

Answer 6

Hereditary, virus, alcoholism, low birth weight.

Question 7

Out of the ketosis resistant type 2’s what proportion use what treatments?

Answer 7

25 % diet, 50% oral hyperglycemic agents, 25% insulin.

Question 8

What causes the pancreatic beta cells to release insulin?

Answer 8

Gut hormones prime them, but blood glucose causes the release.

Question 9

What aspect of a mixed meal can slow insulin uptake?

Answer 9

Free fatty acids

Question 10

What is the diagnostic criteria for diabetes? (3 possible).

Answer 10

Symptoms of diabetes + random plasma glucose >200 mg/dL.
Fasting (8 hr) plasma glucose >126 mg/dL.
2 hr post prandial >200 mg/dL. (75 g glucose)

Question 11

What is the conversion from mg/dL to mmol/L?

Answer 11

Divide by 18.

Question 12

What three tests are used to guide glycemic control in the Canadian guidelines?

Answer 12

HbA1C, fasting glucose, and 2 hr post prandial.

Question 13

What is the lifespan of HbA1C? What is the ideal?

Answer 13

120 days. 0.04-0.06 or <100%

Question 14

What is the difference between ideal and optimal glycemic targets?

Answer 14

Ideal is for the non-diabetic patients. Optimal targets are for post diagnosis, little higher range because don’t want to be too aggressive with treatment and risk hypoglycemic reactions.

Question 15

How to target lipid levels change with a diabetes diagnoses and other risk factors?

Answer 15

Targets become more aggressive, so tolerate less lipid elevation the more comorbidities a patient has.

Question 16

Self monitoring glucose levels are important for what types of diabetics?

Answer 16

Type 1, those taking OHA or insulin to prevent hypoglycemia.

Question 17

In the obese insulin resistant person, is there more or less insulin secreted than a normal adult?

Answer 17

Way more!

Question 18

In the type 2 lean diabetic is more or less insulin secreted than a normal adult?

Answer 18

Less, pancreas is getting exhausted and can’t maintain demand for glucose. Still have elevated concentrations, because release a large amount at a time and insulin is broken down at a fixed rate .

Question 19

Why might VLDL be elevated during glucose ingestion when there is insulin resistance?

Answer 19

More FFA delivered to the liver with glucose, insulin impacts flow of nutrients through liver which leads to greater output of VLDL, glycated LPL means that it stays in circulation longer.

Question 20

What are the initial observations and physical symptoms of diabetes?

Answer 20

Polydipsia, polyuria, polyphagia, weight loss or obesity

Question 21

What are some general factors that all contribute to insulin resistance?

Answer 21

Excessive food intake leading to hyperglycaemia and hyperinsulinemia, obesity, inadequate exercise, genetic predisposition.

Question 22

How might compensatory hyperinsulinemia directly contribute to obesity?

Answer 22

Constant “fed” stimulation, increases storage of glucose as fat cells.

Question 23

What are some common risk factors for type 2 diabetes?

Answer 23

Age, obesity, ethnicity, prediabetes, family history, history of gestational diabetes, sedentary lifestyle, child of a woman with poorly controlled diabetes during pregnancy, low birth weight babies, PCOS.

Question 24

What is insulin resistance at a receptor level?

Answer 24

Down regulation of receptor activity to protect against rising insulin levels.

Question 25

How can up regulation be accomplished to counter the effect of insulin resistance?

Answer 25

Drugs , exercise ( walk after eating ), losing weight (central adiposity drives high blood glucose)

Question 26

How does insulin resistance impact on a cellular level?

Answer 26

Proportional to the level of fasting ( rather than post prandial) hyperglycaemia. Causes second messenger defects.

Question 27

How does insulin resistance impact on a hepatic level?

Answer 27

Inappropriately high level of glucose production when fasted and low level of uptake when fed. Liver can uptake glucose independent of insulin, but insulin still enters liver and affects the trafficking of gluconeogenesis.

Question 28

How does insulin resistance impact on a muscle level?

Answer 28

Attributed to receptor defects. Any manipulation that lowers insulin secretion will increase receptor concentration and decrease insulin resistance .

Question 29

What drives hyperglycaemia?

Answer 29

High gluconeogensis, low cellular glucose uptake, high dietary intake

Question 30

What does hyperglycaemia drive?

Answer 30

Impairs beta cell function, basal hyperinsulinemia, decreased glucose transport.

Question 31

What are the “ABCs” of diabetes for heart health?

Answer 31

A1C test
Blood pressure
Cholesterol

Question 32

What is the mechanism for hyperlipidemia in type 1 diabetes?

Answer 32

High TG due to defective removal of chylomicrons and VLDL from impaired LPL activity (including glycation impairment),

Question 33

What is the mechanism for hyperlipidemia in type 2 diabetes?

Answer 33

High TG due to elevated de novo synthesis from glucose. Low HDL may be due to obesity.