Diabetes Flashcards
What is diabetes mellitus?
the inability of the body to regulate blood glucose through insulin
What type of diabetes is described by the following?
autoimmune; loss of insulin producing beta cells
genetically linked
juvenile onset
type I diabetes - insulin-dependent diabetes mellitus
What type of diabetes is described by the following?
insensitivity to insulin
lifestyle and genetics
adult onset, though becoming more prevalent in juveniles
type II diabetes - non-insulin-dependent diabetes mellitus
What type of diabetes is described by the following?
develops during pregnancy
fetus-induced changes in metabolist
gestational diabetes
which cells in the pancreas release insulin and which release glucagon?
- beta cells release insulin
- alpha cells release glucagon
what does the pancreas release in response to high blood glucose levels? what about low blood glucose levels?
- high blood glucose levels
- pancreas releases insulin
- stimulus: glucose is absorbed after a meal
- low blood glucose levels
- panreas releases glucagon
- stimulus: cells use or store glucose between meals
T or F:
type I and II diabetes have different causes, but the symptoms of uncontrolled disease are similar
true
describe the symptoms of type I diabetes
- polyuria and thirst: ++
- weakness or fatigue: ++
- polyphagia and weight loss: ++
- blurred vision: +
- peripheral neuropathy: +
- nocturnal enuresis: ++
- Other signs include sweet smelling breath, sweet smelling urine, and impaired wound healing
describe the symptoms of type II diabetes
- polyuria and thirst: +
- weakness or fatigue: +
- polyphagia and weight loss: -
- blurred vision: ++
- peripheral neuropathy: ++
- nocturnal enuresis: -
- Other signs include sweet smelling breath, sweet smelling urine, and impaired wound healing
in type I diabetes, the onset is typically ___
juvenile
type I diabetes is a lack of ___ production
insulin
type I diabetes is a ___ disease that destroys ___ cells
- genetic, autoimmune
- beta
in type I diabetes, circulating ___ is absent
insulin
in type I diabetes, ___ is elevated at onset
plasma glucagon
in type I diabetes, pancreatic beta cells fail to respond to ___ stimuli
insulinogenic
in type I diabetes, insulin target tissues (liver, muscle, fat) fail to properly absorb ___
nutrients
in type I diabetes, ___, ___, and ___ are released into and dysregulated within the blood stream
glucose, fats, and amino acids
in type I diabetes, improper fatty acid metabolism increases ___ production and release
ketone
in type I diabetes, lack of insulin leads to what?
a dysregulated metabolic state of extreme fasting and starvation
autoimmune targeting of ___ drives type I diabetes
beta cells
delta cells in the pancreas release ___
somatostatin
___% of type I diabetes cases are immune-mediated, and ___% of cases are idiopathic
- 95%
- 5%
is the cause of type I diabetes known?
no, but there is a strong genetic predisposition and environmental triggers
in insulin-dependent diabetes, a ___ cell recognizes peptides from a beta cell-specific protein and kills the ___
- effector T cell
- beta cell
- …so the pancreas can still produce stomatostatin (delta cells) and glucagon (alpha cells), but can no longer produce insulin (no beta cells)
describe loss of insulin signaling in type I diabetes
describe systemic mimicry of prolonged fasting in type I diabetes
uncontrolled type I diabetes leads to ___
ketoacidosis
describe how insulin deficiency can lead to coma and tachycardia?
what type of therapy is required by type I diabetes?
insulin replacement therapy
what are the three coordinated interventions used in insulin replacement therapy for type I diabetes?
- insulin administration
- glucose monitoring
- diet
describe insulin administration as a method of insulin replacement therapy for type I diabetes
- discovered by frederick banting and charles best in 1921
- required for survival
- mimic normal insulin response to food
- scaled use depending on blood sugar and diet
describe glucose monitoring as an insulin replacement therapy for type I diabetes
- glucometer or continuous interstitial fluid monitoring
- allows correction for hyperglycemia and hypoglycemia
describe diet as an insulin replacement therapy for type I diabetes
- low CHO diet (35% or lower)
- insulin administration is primarily scaled on CHO consumption
- glycemic index affects blood sugar and insulin administration
what is the goal of insulin administration?
maintain fasting blood glucose between 80 and 140 mg/dl
what are 2 approaches of insulin administration?
- injections
- pump
describe insulin injections
- several injections per day
- different insulin types per basal and bolus use
- basal insulin maintains low-level systemic insulin
- bolus insulin given when food is consumed
- highly variable per individual, scaled to CHO consumption
describe pumps as a form of insulin administration
- single insulin type
- continuous (basal) administration
- basal insulin when food is consumed
- scaled to consumption and activity
- improved control over injections
describe type II diabetes
- insulin insensitivity
- progressive increase in fasting glucose due to reduced insulin sensitivity followed by a degeneration of insulin production
describe the progression of type II diabetes
type II diabetes is a ___ disorder, and is the most ___ form of diabetes
- heterogenous
- prominent
type II diabetes is closely tied to ___
obesity and visceral adiposity
lifestyle factors play a prominent role in the development of which type of diabetes?
type II
does type II diabetes have a strong genetic link?
yes
there is a high incidence of type ___ diabetes in developed countries
II
what are the 3 possible mechanisms of insensitivity in type II diabetes?
- adipokine signaling
- ectopic lipid storage and free fatty acids
- inflammatory signaling
___ may drive type II diabetes insulin insensitivity
adipose signaling
describe how adipose signaling can drive type II diabetes insulin insensitivity
what 3 things can manage type II diabetes?
- lifestyle changes
- oral hypoglycemics
- insulin
describe lifestyle changes as a type II diabetes management approach
- reduced CHO and simple sugar consumption
- prevent glucose swings
- increase physical activity
- maintain healthy body weight
describe how oral hypoglycemics can be used to manage type II diabetes
- increase insulin secretion
- increase insulin sensitivity
- decrease CHO absorption
how is insulin used as a management approach for type II diabetes?
required when beta cell mass degenerates
at what stages of type II diabetes can the 3 management approaches be effective?
name 5 common type II drugs used to treat hyperglycemia
- sulfonylureas
- metformin
- peroxisome proliferator-activated receptor agonists
- alpha-glucosidase inhibitors
- drug combinations
describe how sulfonylureas can treat hyperglycemia
- increase beta cell insulin secretion (secretagogues)
- glipizide, glyburide, and glimepiride
describe how metformin can treat hyperglycemia
- uncouples oxidative phosphorylation, reducing liver gluconeogenesis and lipogenesis
- AMPK signaling pathway
describe how peroxisome proliferator-activated receptor agonists can treat hyperglycemia
- increase glucose transporter expression
- thiazolidinediones
describe how alpha-glucosidase inhibitors can treat hyperglycemia
- prevent CHO absoprtion
- acarbose, miglitol
what are the 5 primary methods used to detect diabetes?
- urinalysis
- glucose monitoring
- HBA1c
- glucose tolerance test
- c-peptide test
what is hypoglycemia?
low blood sugar
how is hypoglycemia treated?
- immediate sugar
- glucagon
- test blood sugar
- repeatedly test
- call 911 if necessary
what is hyperglycemia?
high blood sugar
how is hyperglycemia treated?
- insulin
- oral hypoglycemic
- activity
- diet
what are some long-term diabetic complications?
- cardiovascular disorders
- heart disease, stroke, peripheral vascular disease
- blindness
- glaucoma, retinopathy
- kidney disease
- neurologic complications
- peripheral and autonomic neuropathy, erectile dysfunction
- impaired wound healing and amputation
