Diabetes Flashcards
Diabetes Mellitus
Pancreatic hormones
-Islet of Langerhans
–4 types of cells
-A(alpha), B (beta), D(delta), and F/G cells
- a cells produce ________
-B cells produce _____ and _____ (amyloid)
-Delta cells produce _________
-F and G cells: ______ and ______ peptides
- _____ & ____
- -primarily role in regulation of glucose metabolism
- _______
- -increases hepatic glucose output and blood glucose concentration
glucagon insulin, amylin somatostatin gastrin, pancreatic peptides glucagon, insulin glucagon
Insulin
- 51amino acids linked by 2_____ bridges
- resting pancreatic beta cells store _____ in secratory vesicles
- promotes the uptake, utilization and storage of glucose
- thereby lowers ________ concentration
- exists as _____ insulin, which is converted to _____ and ______
disulfide insulin plasma glucose pre-pro insulin, C-peptide
Insulin secretion
- released at a low _______
- released at a ______ rate (stimulated) in response to a variety of stimuli
- -GLUCOSE, ______, AND ______ (parasympathetic) stimulation
- high blood _____ is the main trigger, but other hormones and autonomic mediators are involved
- -digestive hormones
- drugs can stimulate release
- -_______, ______, _____ agonists
basal rate higher amino acids, vagal glucose sulfonylureas, meglitinides, B2
Insulin secretion
Mechanism
-Glucose is taken up by _ cells (via glucose transporter _____)
-Glucose undergoes ______ with production of high energy ATP
-this process is ________
-intracellular ___ levels increase
–ATP dependent __ channels close, leadung to membrane _________
-influx of __ causes ______ of insulin
b, GLUT2 glycolysis phosphorylation ATP K+ depolarization Ca2+, exocytosis
Insulin
-binds to insulin receptors located on the plasma membrane of target cells - _____, cells, ______ muscle, and ______ tissue
-receptor stimulation activates ________
-leads to _______ of target proteins
-phosphorylated proteins after synthesiso f enzymes involved in gluconeogenesis, glycolysis and other metabolic processes
-insulin is the classic _____ hormone (energy storing)
-in muscle: insulin increases _____ uptake
in adipose tissue- increased uptake of _____
-in all tissue: increased glucose movement ____ cells
hepatic, skeletal, adipose tyrosine kinase phosphorylation anabolic amino acid fatty acids INTO
HbA1c
- elevated blood glucose causes non enzymatic ______ of proteins
- hemoglobin gets _______ on its ____ residue (A1c)
- higher levels of HbA1c are found in people with persistantly elevated blood ____
- concentration of HbA1c is established since the half life of glycosylated cells is the same as ____
- The International Diabetes Federation and American College of Endocrinology reccomend values below __% while Ameriican Diabetes Association reccommends that the HbA1c be below ___%for most patients
glycosylation glycosylated valine sugar RBCs 6.5 7
Diabetes Mellitus
Type 1 (insulin dependent diabetes mellitus)
-5-10% of diabetes in the US
-_______
-severe/absolute deficiency of production
–mainly in _______
-destruction of pancreatic beta cells
–no circulating ______
–______ like response of the body
–_______ and ______ occur
–constant delivery of glucose to the ____
–muscle breakdown and amino acids fuel gluconeogenesis
-adipose tissue: _____ which form _______ which c ause serum ______ depletion
–__________ results
autoimmune juveniles insulin starvation glycogenolysis, gluconeogenesis blood ketones acetocetates bicarbonate metabolic acidosis
Diabetes Mellitus Type 1 diabetes -clinical features -tired, unwell -\_\_\_\_ loss: inability to thrive -polyuria, polydipsia, prone to \_\_\_\_\_\_\_ -extreme: \_\_\_\_\_\_\_\_ respirations/ \_\_\_\_\_\_\_\_ emesis
management: insulin
- ______ insulin , at the time of diagnosis to maintain acceptable levels of glycosylated ______ and avoid ________
weight ketoacidosis kussmaul coffee ground exogenous hemoglobin ketoacidosis
Type 1 Diabetes Mellitus
- management: insulin (injected)
- IV or IM or SC (long term)
- -human insulin (Humulin) recombinant DNA
- is less ________ ,shorter duration of action than animal preparations
- start with lower doses to avoid _______, adjust dose upwards
- optimum control, regular insulin should be administered 20 to 30 mins ____ meals
- continuous subcutaneous insulin infusion, provides better. ____ but more expensive
- insulin occurs in the ______ complexed with _____
immunogenic hypoglycemia before control pancreas zinc
Insulin Preparations Injected: -rapid acting: insulin \_\_\_\_\_; insulin \_\_\_\_\_\_ (ultra-short) -short-acting: \_\_\_\_\_\_ -intermediate-acting: \_\_ (isophane) \_\_\_\_ (insulin Zn) -long-acting - \_\_\_\_\_; insulin \_\_\_\_\_\_\_ -pre mixed combinations -50% NPH/ 50% regular -70% NPH/ 30% regular SC absorption - abdominal wall, arm, buttock, thigh -inhaled: Exubera beef/pork insulin are no longer produced
lispro aspart regular NPH Lente Ultralente Glarginine
Insulin - adverse effects
Hypoglycemia
Very common, more frequent in patients on tight diabetic control
–missed _____, unusual amounts of exercise
–hypoglycemic unawareness
-mild hypoglycemia: _____, _____ tachycardia, ______, sensation of weakness
severe hypoglycemia:
-_______; altered ______; disorientation progression to seizures and coma
-unconcious patient - 1 mg of _____ im/sc followed by intake of _________
-glucagon not effective in _______ patients or _________ hypoglycemia - IV of 5-% dextrose
meals sweating, tremors hunger confusion behavior glucagon malnourished alchohol induced
Insulin adverse effecs -
-localized fat ______ at injection site
-________-
-result of frequent reutilization of the same injection site
allergic reactions:
-____ with human insultin
-uticaria, angioedema rashes, local erythema
-immune-mediated insulin resistance
-production of anti-insulin antibodies, rare with uman insulin
hypertrophy
lipodystrophy
RARE
Type 2 Diabetes
- non-insulin dependent diabetes mellitus
- late adult onset; 90% of diabetes
- overall insulin production is decreased by up to __%
- sufficient insulin to prevent ________
- tissue insensitivity or tissue resistance
- _____ is a major factor
- ______ predisposition 95% concordance in identical twins
50%
ketoacidosis
obesity
genetic
Diabetes Mellitus
Type 2 Diabetes
-deficiency in ___ cell response to glucose
-tissue _____ and impaired _ cell response
-initial management by ___ and ___
-pharmalogical management indicated when ____ reduction fails to correct hyperglycemia
B insensitivity B diet, exercise weight
Antidiabetic Drugs Oral:Secretagogues Sulfonylureas: Tolbutamide, Glyburide Biguanides: Metformin Meglitinides: Repaglinide; Nateglinide Alpha glucosidase Inhibitors: Acarbose; Miglitol Glitazones: Rosiglitazone; Troglitazone Dipeptidyl peptidase 4 inhibitors: Sitagliptin; Saxagliptin
Injected
Incretin mimetics: Exenatide; Liraglutide
Amylinomimetics: Pramlinitide
idk
