Diabetes Flashcards
Glucagon
Inhibited by insulin
Hypoglycemia states
Stimulates: Gluconeogenesis Glycogenolysis Lipolysis Insulin secretion
Insulin
Allows glucose to move out of blood into sk.m. and adipose tissue
Pre-proinsulin -> proinsulin -> insulin and c-peptide
Hyperglycemia triggers release
Anabolic effects:
Increased glycogen synthesis
Increased TG synthesis
Increased protein synthesis
Binds insulin receptor on cells – tyrosine kinase -> GLUT 4 transports on membrane
C-peptide
Differentiate T1DM and T2DM cause of hypoglycemia
No c-peptide: exogenous insulin
Insulinoma – high c-peptide
Insulin release mechanism
Glucose enters beta cell via GLUT2
Metabolized to ATP
Elevated ATP closes K+ channel -> depolarizes cell
Voltage gated Ca2+ channels open, calcium influx -> release of insulin
GLUT1
No insulin required
Brain and RBCs
GLUT2
Insulin independent
Beta cells, liver, sm. intestine
Renal cells
GLUT4
Insulin response
Adipose tissue, sk.m.
Cotton wool spots
DM, HTN, AIDS
Draw out insulin formulations
Page 664
Meal time- short acting:
Aspart
Glulisine
Lispro
Regular insulin peaks 3 hrs, done by 9 hrs
NPH – peaks 6 hrs, mostly done by 12 hours
Long acting – 24 hours
Glargine
Detemir
PPAR gamma
Peroxisome proliferator activated receptor gamma
Regulates fatty acid storage and glucose metabolism
Target for –glitazone diabetic drugs