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CDM 1 Exam 2 > Diabetes: Lecture 1 > Flashcards

Diabetes: Lecture 1 Flashcards

1
Q

What is glucose stored as? and where?

A

Glycogen

Skeletal Muscle and Liver

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2
Q

Hormones that control Blood Glucose?

A

Pancreatic
Counter-regulatory
Gut-Derived

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3
Q

Which cells secrete Glucagon?

A

Alpha Cells

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4
Q

What does Glucagon do?

A

effect breakdown of liver glycogen and increase glucose levels in the blood

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5
Q

Which cells secrete Insulin & Amylin?

A

Beta cells

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6
Q

Where are Alpha and Beta Cells located?

A

Pancreatic Islet of Langerhorn

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7
Q

What does Insulin do?

A

Increase uptake of glucose into cells and facilitate conversion of glucose to glycogen in the liver

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8
Q

What does Amylin do?

A

suppress digestive secretions

Slows gastric emptying

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9
Q

What increases Glucagon release?

A

by increased glucose levels and presence of fatty acids and ketones

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10
Q

What stimulates glucagon release?

A

decreased glucose levels and presence of amino acids

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11
Q

List of counter-regulatory hormones?

A

Glucagon
Epinephrine
Growth Hormone
Cortisol

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12
Q

“Fed State” process

A

Increased glucose stimulates B cells to release insulin

Insulin stimulates glucose uptake by cells and glycogenesis in liver

Plasma levels return to normal

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13
Q

“Fasting state” process

A

Decrease glucose stimulates A cells to release glucagon

Glucagon stimulates gluconeogenesis and glycogenolysis in liver and release of glucose to plasma

Plasma glucose levels return to normal

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14
Q

“Lock and Key” Analogy glucose

A

Insulin acts as “Key” so glucose can get into cell “Through door”

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15
Q

What releases GLP-1?

A

L cells of ileum and Colon

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16
Q

What releases GIP?

A

K cells of duodenum

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17
Q

What are glucose dependent hormones?

A

Only secreted in response to oral ingestion of food

GLP-1 and GIP, so levels low when glucose low

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18
Q

What does GIP do?

A

act on B cell

Insulin sensitizer in adipocytes

No effect on glucagon secretion, gastric motility or satiety

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19
Q

What does GLP-1 do?

A

Act on A & B cells?

Suppress glucagon secretion

Slows gastric emptying and increase satiety

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20
Q

GLP-1 and GIP Half life?

A

~10 min

Inactivated by Dipeptidyl Peptidase-4 Enzyme (DPP-4)

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21
Q

Role of Kidney in Glucose Regulation?

A
  1. release of glucose via gluconeogenesis
  2. uptake of glucose from circulation
  3. Kidney reabsorbs glucose

90% by SGLT-2
10% by SGLT-1

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22
Q

Diabetes definition

A

Chronic and progressive metabolic disorder characterized by abnormalities in the ability to metabolize carbohydrate, fat, and protein, leading to a hyperglycemic state

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23
Q

Type 1 Diabetes Classification

A

autoimmune B-cell destruction, usually leading to absolute insulin deficiency

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24
Q

Type 2 Diabetes Classification

A

progressive loss of B-cell insulin secretion frequently on the background of insulin resistance

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25
Gestational diabetes Classification
diabetes that is first diagnosed in the 2nd or 3rd trimester that is not clearly preexisting type 1 or 2 diabetes
26
Possible causes of diabetes?
genetic defects Disease of the exocrine pancreas Drug induced Hyperglycemia
27
Type 1 Diabetes cycle
1. Pancreas doesn't make insulin 2. Decreased insulin in blood vessels 3. Increased glucose due to low insulin 4. Muscle unable to use glucose due to low insulin Glycogen and protein breakdown, causing keto-acidosis
28
Stages of Type 1 diabetes?
Stages 1 - Stage 3
29
Stage 1 of Type 1
Autoimmune Normoglycemic Presymptomatic
30
Stage 2 of Type 1
Autoimmune Dysglycemic Presymptomatic
31
Stage 3 of Type 1
Autoimmune Hyperglycemic Symptomatic
32
Type 1 Diabetes Rate of Progression depends on....
Age at first detection of autoantibody # of autoantibodies Autoantibody specificity Autoantibody titers
33
Insulin resistance
Inability of peripheral tissues to respond properly to insulin. Get insulin resistance at muscle, liver, adipocytes
34
"Core Defects" of Type 2 diabetes?
Insulin Resistance and B-cell failure
35
(T2DM Defects) Impaired Insulin Secretion
B-cells of pancreas cant make enough insulin
36
(T2DM Defects) Inefficient glucose uptake in muscle
"Lock and Key" Insulin needed to "open" cell to let glucose in
37
(T2DM Defects) Insulin resistance in liver
Leads to overproduction of glucose Especially overnight when sleeping
38
(T2DM Defects) Insulin resistance at fat cell
Fat cell becomes resistant and starts to breakdown triglycerides, leads to release of free fatty acids
39
(T2DM Defects) Alpha cell of pancreas
supposed to turn off glucagon production. This is signaling is "Off"
40
(T2DM Defects) Decreased Incretin effect
resistance to incretin hormones contributes to impaired insulin and excessive glucagon secretion
41
(T2DM Defects) Increased Glucose Reabsorption
Kidney reabsorbs a bunch more glucose cause have so much. Leads to glucose staying in the blood stream.
42
(T2DM Defects) Neurotransmitter dysfunction
Related to appetite suppression, contributes to feeling of fullness. System isn't working.
43
How many total defects with (T2DM Defects)
8 "Ominous Octet'
44
% Loss of beta cell function at diagnosis?
~ 50%
45
Type 1 Summary
Defect in pancreatic B-cell function Absolute insulin deficiency
46
Type 2 Summary
Insulin resistance involving muscle, liver and adipocytes Defects in insulin secretion GLP-1 deficiency and resistance Excess glucagon secretion Reabsorption of glucose by the kidney Defects in signaling to the brain
47
Type 1 Risk factors
Genetics Environmental (Poorly defined)
48
Type 2 Risk factors
``` Obesity (weight circumference in asians) Physical inactivity Hypertension Abnormalities in Cholesterol HTN FMH Women w/ GDM AA,Latino, Asian, Native, Pacific Islanders CVD ```
49
Acanthosis Nigricans
Skin issue that shows insulin resistance
50
% of pop that is Type 1 Diabetes?
5-10%
51
% of pop that is Type 2 Diabetes?
up to 90%
52
Difference vs Type 1 and Type 2 onset?
1 is abrupt | 2 is usually gradual
53
Symptoms common with Type 1 Diabetes?
3 P's Poluria, polydipsia, polyphagia unexplained weight loss
54
Symptoms common with Type 2 Diabetes?
Fatigue, poor wound healing, polyuria, polydipsia, nocturia
55
Risk factors for Gestational Diabetes?
Overweight/Obese Older age >30 FMH of Type 2
56
Pathophysiology Gestational Diabetes
insulin resistance | Diminished insulin secretory response
57
Riks to mother and baby from Gestational Diabetes
``` Macrosmia Shoulder dystocia Preeclampsia Cesarean delivery Stillbirth ```
58
Clinical Manifestations of Hyperglycemia
Fungal and microorganism growth Osmotic diuresis Depletion of carb stores/ poor use of food products
59
Things that decrease glucose
insulin Excess DM meds increased exercise Alcohol
60
Things that increase glucose
``` Counter-regulatory hormones Insufficient DM Meds Other meds (Gluccocorticoids, Clozapine, Olanzipine)*** Excess Food Illness Stress ```
61
Drugs that increase glucose that are clinically relevant?
Gluccocorticoids Clozapine Olanzipine
62
Autoantibodies you would check for in Type 1 diabetes?
``` Islet cell (ICA)*** Glutamic Acid decarboxylase (GAD65)*** Insulin autoantibodies (IAA) Tyrosine phosphates (IA-2 and IA-2B) Zinc Transporter 8 (ZnT8) ``` *** = Most common
63
Screening for Type 2 Diabetes
Start age 35 all patients Adults any age BMI >25/23 Asians plus 1 or more risk factor ppl with HIV, prediabetes women with GDM Consider fat kids with 1 or more diabetes risk factor
64
If Type 2 diabetes screening results are normal then....
can repeat every 3 years
65
If Type 2 diabetes screening results indicate pre-diabetes then....
repeat yearly
66
Tests used for both screening and diagnosing of diabetes?
Fasting plasma glucose (FPG) Casual plasma glucose 2h plasma glucose during oral glucose tolerance test (OGTT) Hemoglobin A1C
67
When is OGTT often used?
In pregnant women
68
Limitations of A1C test
conditions that alter red blood cell turnover Sickle Cell Pregnancy etc.
69
A1C levels
Prediabetes: 5.7-6.4% Diabetes: >6.5%
70
FPG levels
Prediabetes: 100-125 mg/dL Impaired fasting glucose Diabetes: >126 mg/dL
71
OGTT levels
Prediabetes: 140-199 mg/dL Impaired glucose tolerance Diabetes: >200mg/dL
72
Random glucose levels
>200mg plus classic symptoms of hyperglycemia or hyperglycemic crisis
73
Goals for Type 1 and Type 2 Diabetes?
A1C < 7% preprandial glucose 80-130 mg/dL Peak postprandial glucose <180
74
Pediatrics Type 1 Diabetes goals?
A1C: <7.5% Preprandial glucose: 90-130mg/dL Bedtime/overnight: 90-150 mg/dL
75
Is A1C accurate in pregnant women?
not as accurate, would use OGTT to assess
76
Target range of glucose for hospitalized patients?
target range 140-180 mg/dL
77
Wen adjusting A1C goal, don't want to greater than....
8.5%
78
Older adult goals: Healthy
A1C: <7-7.5% Preprandial glucose: 80-130mg/dL Betime glucose: 80-180mg/dL
79
Older adult goals: Complex/Intermediate
A1C: <8% Preprandial glucose: 90-150 mg/dL Bedtime glucose: 100-180mg/dL
80
Older adult goals: Very Complex/poor health
A1C: <8.5% Preprandial glucose: 100-180 mg/dL Bedtime glucose: 110-220 mg/dL
81
Rational between Health statuses?
Life expectancy

CDM 1 Exam 2 (16 decks)

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