Diabetes Case Study

Question 1

Diabetes mellitus is a metabolic disease characterized by _____ and ____.

Answer 1

hyperglycemia and dyslipidemia

Question 2

What is the difference between type one and type two diabetes?

Answer 2

type 1: cant produce insulin, usually autoimmune
type 2: insulin resistance, obesity

Question 3

which type of diabetic assisted with ketoacidosis?

Answer 3

type 1 (body thinks its starving so using ketoacids for fuel)

Question 4

What fuels are mobilized in someone with untreated type 1 Diabetes mellitus?

Answer 4

glucose, FA, ketone bodies, amino acids

Question 5

If insulin is absent or ineffective, what will happen to glucagon levels in the blood?

Answer 5

uncontrolled glucagon levels

Question 6

Glucagon Promotes Fuel Mobilization by

Answer 6

• Increasing glycogenolysis
  (liver)
• Increasing gluconeogenesis
  (liver).
• Increasing lipolysis in
  adipose in concert with low
  insulin

Question 6

Impaired glucose uptake with
diabetes means what for blood glucose absorption?

Answer 6

takes longer for blood glucose to decrease after meal

Question 7

what is glucagon’s effect on muscle?

Answer 7

no effect

Question 7

what effect does epinephrine have on fuel metabolism?

Answer 7

• Increase lipolysis (adipose)
• Increase gluconeogenesis
  and glycogenolysis (liver).
• Increase glycogenolysis
  (muscle)
• Increase glycolysis (muscle)
• Stimulate glucagon release.
• Inhibit insulin release.

Question 8

The energy needed to make new glucose in the liver is
provided primarily by oxidation of which fuel?

Answer 8

fatty acids

Question 9

Glucocorticoids: Released in
response to what?

Answer 9

stress and acute hypoglycemia

Question 10

Blood levels of which fuels will be elevated in response to
elevated glucocorticoids?

Answer 10

glucose, FA, amino acids

Question 10

How does glucocorticoids promote fuel metabolism?

Answer 10

• Increase lipolysis (adipose)
• Increase gluconeogenesis and
  glycogen synthesis (liver).
• Stimulate proteolysis and
  release of amino acids
  (muscle).
• Decrease glucose uptake
  (muscle)

Question 11

Uncontrolled DM1 has what effect on glucose:
*________ glycogenolysis and gluconeogenesis
* *_______ glucose uptake (GLUT4, glycolysis)

Answer 11

Increased
decreased

Question 12

Uncontrolled DM1 has what effect on lipid catabolism:
*____ Lipid Catabolism
* *____ breakdown of triglycerides in adipocytes due to
increased activity of hormone sensitive lipase (HSL).
* *_____ in β-oxidation (FFAs, Malonyl CoA, CPT1)
* *____ Ketone Bodies (increased liver Acetyl-CoA)

Answer 12

increased

Question 12

Uncontrolled DM1 has what effect on lipoproteins like VLDL and chylomicrons?

Answer 12

INCREASES

Question 13

Insulin promotes ______ synthesis. In its absence, _____
breakdown predominates

Answer 13

protein, protein

Question 14

when theres low blood glucose and insulin glut 4 transporters are where?

Answer 14

inside the cell (so cell is taking up less glucose)

Question 14

In type I diabetes, _______ results from increased hepatic gluconeogenesis and decreased glucose uptake from periperal tissues

Answer 14

Hyperglycemia

Question 14

in type 1 diabetes, Chylomicrons and VLDL accumulate due to decreased activity of _______

Answer 14

lipoprotein lipase

Question 15

during type one diabetes, Increased fatty acids in the blood result from Increased activity of
__________

Answer 15

Hormone Sensitive Lipase

Question 16

during type one diabeties, Ketosis results from massive mobilization of fatty acids from adipose followed by ________

Answer 16

hepatic ketogenesis

Question 16

Liver mitochondria synthesize ketone bodies when ________ builds up.

Answer 16

Acetyl CoA

Question 17

Liver mitochondria synthesize ________ when Acetyl CoA
builds up

Answer 17

ketone bodies

Question 18

Ketone Body Synthesis _______ with Prolonged Fasting or Impaired Insulin

Answer 18

Increases

Question 18

Mitochondria in non-hepatic tissues convert _______ back into acetyl CoA which is oxidized to CO2 in the CAC

Answer 18

ketone bodies

Question 18

Ketone Body Synthesis Increases with Prolonged Fasting or Impaired Insulin, which has what effect on release of fatty acids, ketone body synthesis and fatty acid oxidation

Answer 18

increases everything

Question 19

why does DM1 cause increased VLDL and chylomicrons?

Answer 19

increased return of fatty acids due to increased actions of hormone sensitive lipase

Question 20

Blood levels of which fuel are elevated in Type 1DM compared to prolonged fasting?

Answer 20

DM1: high blood sugar
prolong starve: low blood sugar

Question 20

insulin has what effect on hormone sensitive lipase?

Answer 20

potently inhibits it

Question 21

What situation could lead to hypoglycemia in a patient with Type1DM?

Answer 21

fasting while still taking insulin

Question 22

What is the best way to test blood glucose in a individual with DM2 insulin resistance?

Answer 22

HbA1c level (reflects average blood glucose over 3 months)

Question 23

what are AGEs

Answer 23

glycation of proteins, impair protein function.
* long-term complications associated with tissue damage, e.g. nerve, kidney, elevated lipoproteins, *oral tissues

Question 24

The polyol pathway increases ____

Answer 24

ROS

Question 25

Depletion of what can lead to accumulation of ROS?

Answer 25

NADPH

Question 26

what are the most common oral problems associated with poorly controlled DM?

Answer 26

-salivary gland dysfunction
-dental caries
-oral infection
-taste impairment
-poor oral wound healing
-periodontal disease