Diabetes and obesity

Question 1

1) What are the actions of insulin?

2) What effects does glucagon have on blood glucose levels?

3) What effects does epinephrine have on blood glucose levels?

4) What effects does growth hormone have on blood glucose levels?

Answer 1

1) Increased glucose uptake in cells + storage of glucose as glycogen in liver, Decreased fat and glycogen breakdown, Decreased gluconeogenesis, Increased protein synthesis

2) Maintains levels between meals (Increased hepatic breakdown of glycogen + gluconeogenesis)

3) Maintain blood glucose during stress (Gluconeogenesis + Decreased insulin production)

4) Increased cellular protein synthesis, Increased fatty acid release. Increased insulin -> Decreased GH, Increased glucose -> Increased GH

Question 2

1) The definition of T1D and risk factors

2) Pathophysiology of T1D

3) Clinical manifestations of T1D if not treated and their relation to the pathophysiology

4) Treatment and why

Answer 2

1) Destruction of pancreatic beta-cells (most are immune mediated) Risk factors Genetic predisposition.

2) Absolut lack of insulin, elevation in blood glucose, breakdown of body fat + proteins

3) Polyuria - excessive urination Increased glucose in plasma -> Filtration exceeds amount that can be reabsorbed -> Increased glucose in urine + osmosis draws water to the glucose. Polydipsia - excessive thirst Intracellular dehydration due to high glucose in plasma. Polyphagia - excessive hunger Cellular starvation + depletion of cellular stores

4) Insulin replacement therapy. Needed to reverse catabolic state, control blood glucose levels and prevent ketoacidosis

Question 3

Describe ketoacidosis

Answer 3

Lack of insulin -> Increase of fatty acids from adipose tissue -> ketone production in liver. Ketone bodies are acids -> acidosis

Question 4

1) What is included in the metabolic syndrome?

2) What can it lead to?

Answer 4

1) Insulin resistance, central obesity, Decreased HDL levels, hypertension, systemic inflammation

2) Atherosclerosis, coronary artery disease, peripheral artery disease, T2D

Question 5

1) What can cause hypoglycemia in patients treated with insulin?

2) Manifestations and onset

Answer 5

1) Error in insulin dose, not eating, increased exercise, alcohol

2) Rapid onset. Manifestations divided into 2. Altered brain function Headache, Decreased ability to problem solve, coma, seizures. Activation of autonomic nervous system Hunger, anxiety, sweating

Question 6

1) Risk factors of T2D

2) The 3 metabolic abnormalities of T2D

3) How would weight loss impact insulin resistance + blood glucose levels in T2D?

4) Clinical manifestations of T2D including when/how it is first detected

5) Differences between T1D and T2D in regards to insulin deficiency

Answer 6

1) Adults, overweight/obese, strong genetic component (impairment of beta cell function), inactivity

2) Insulin resistance, Deranged secretion of insulin by beta cells (first: increased, later: exhaustion + failure), Increased glucose production in the liver

3) Obesity Increased resistance to actions of insulin + Decreased suppression of glucose production by liver = Hyperglycemia + Hyperinsulinemia. Weight-loss Decreased insulin resistance + Decreased glucose in blood

4) Develops slowly. Discovered through routine check. Signs from hyperglycemia: Blurred vision, fatigue, skin infections

5) T1D Absolute insulin deficiency T2D Relative insulin deficiency