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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
Q

Gestational diabetes Classification

A

diabetes that is first diagnosed in the 2nd or 3rd trimester that is not clearly preexisting type 1 or 2 diabetes

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26
Q

Possible causes of diabetes?

A

genetic defects
Disease of the exocrine pancreas
Drug induced Hyperglycemia

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27
Q

Type 1 Diabetes cycle

A
  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

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28
Q

Stages of Type 1 diabetes?

A

Stages 1 - Stage 3

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29
Q

Stage 1 of Type 1

A

Autoimmune
Normoglycemic
Presymptomatic

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30
Q

Stage 2 of Type 1

A

Autoimmune
Dysglycemic
Presymptomatic

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31
Q

Stage 3 of Type 1

A

Autoimmune
Hyperglycemic
Symptomatic

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32
Q

Type 1 Diabetes Rate of Progression depends on….

A

Age at first detection of autoantibody
# of autoantibodies
Autoantibody specificity
Autoantibody titers

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33
Q

Insulin resistance

A

Inability of peripheral tissues to respond properly to insulin.

Get insulin resistance at muscle, liver, adipocytes

34
Q

“Core Defects” of Type 2 diabetes?

A

Insulin Resistance and B-cell failure

35
Q

(T2DM Defects) Impaired Insulin Secretion

A

B-cells of pancreas cant make enough insulin

36
Q

(T2DM Defects) Inefficient glucose uptake in muscle

A

“Lock and Key” Insulin needed to “open” cell to let glucose in

37
Q

(T2DM Defects) Insulin resistance in liver

A

Leads to overproduction of glucose

Especially overnight when sleeping

38
Q

(T2DM Defects) Insulin resistance at fat cell

A

Fat cell becomes resistant and starts to breakdown triglycerides, leads to release of free fatty acids

39
Q

(T2DM Defects) Alpha cell of pancreas

A

supposed to turn off glucagon production.

This is signaling is “Off”

40
Q

(T2DM Defects) Decreased Incretin effect

A

resistance to incretin hormones

contributes to impaired insulin and excessive glucagon secretion

41
Q

(T2DM Defects) Increased Glucose Reabsorption

A

Kidney reabsorbs a bunch more glucose cause have so much. Leads to glucose staying in the blood stream.

42
Q

(T2DM Defects) Neurotransmitter dysfunction

A

Related to appetite suppression, contributes to feeling of fullness.

System isn’t working.

43
Q

How many total defects with (T2DM Defects)

A

8

“Ominous Octet’

44
Q

% Loss of beta cell function at diagnosis?

A

~ 50%

45
Q

Type 1 Summary

A

Defect in pancreatic B-cell function

Absolute insulin deficiency

46
Q

Type 2 Summary

A

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
Q

Type 1 Risk factors

A

Genetics

Environmental (Poorly defined)

48
Q

Type 2 Risk factors

A 
Obesity (weight circumference in asians)
Physical inactivity
Hypertension
Abnormalities in Cholesterol
HTN
FMH
Women w/ GDM
AA,Latino, Asian, Native, Pacific Islanders 
CVD
49
Q

Acanthosis Nigricans

A

Skin issue that shows insulin resistance

50
Q

% of pop that is Type 1 Diabetes?

A

5-10%

51
Q

% of pop that is Type 2 Diabetes?

A

up to 90%

52
Q

Difference vs Type 1 and Type 2 onset?

A

1 is abrupt

2 is usually gradual

53
Q

Symptoms common with Type 1 Diabetes?

A

3 P’s

Poluria, polydipsia, polyphagia

unexplained weight loss

54
Q

Symptoms common with Type 2 Diabetes?

A

Fatigue, poor wound healing, polyuria, polydipsia, nocturia

55
Q

Risk factors for Gestational Diabetes?

A

Overweight/Obese
Older age >30
FMH of Type 2

56
Q

Pathophysiology Gestational Diabetes

A

insulin resistance

Diminished insulin secretory response

57
Q

Riks to mother and baby from Gestational Diabetes

A 
Macrosmia
Shoulder dystocia
Preeclampsia
Cesarean delivery
Stillbirth
58
Q

Clinical Manifestations of Hyperglycemia

A

Fungal and microorganism growth
Osmotic diuresis
Depletion of carb stores/ poor use of food products

59
Q

Things that decrease glucose

A

insulin
Excess DM meds
increased exercise
Alcohol

60
Q

Things that increase glucose

A 
Counter-regulatory hormones
Insufficient DM Meds
Other meds (Gluccocorticoids, Clozapine, Olanzipine)***
Excess Food
Illness
Stress
61
Q

Drugs that increase glucose that are clinically relevant?

A

Gluccocorticoids
Clozapine
Olanzipine

62
Q

Autoantibodies you would check for in Type 1 diabetes?

A 
Islet cell (ICA)***
Glutamic Acid decarboxylase (GAD65)***
Insulin autoantibodies (IAA)
Tyrosine phosphates (IA-2 and IA-2B)
Zinc Transporter 8 (ZnT8)

*** = Most common

63
Q

Screening for Type 2 Diabetes

A

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
Q

If Type 2 diabetes screening results are normal then….

A

can repeat every 3 years

65
Q

If Type 2 diabetes screening results indicate pre-diabetes then….

A

repeat yearly

66
Q

Tests used for both screening and diagnosing of diabetes?

A

Fasting plasma glucose (FPG)
Casual plasma glucose
2h plasma glucose during oral glucose tolerance test (OGTT)
Hemoglobin A1C

67
Q

When is OGTT often used?

A

In pregnant women

68
Q

Limitations of A1C test

A

conditions that alter red blood cell turnover

Sickle Cell
Pregnancy
etc.

69
Q

A1C levels

A

Prediabetes: 5.7-6.4%
Diabetes: >6.5%

70
Q

FPG levels

A

Prediabetes: 100-125 mg/dL
Impaired fasting glucose

Diabetes: >126 mg/dL

71
Q

OGTT levels

A

Prediabetes: 140-199 mg/dL
Impaired glucose tolerance

Diabetes: >200mg/dL

72
Q

Random glucose levels

A

> 200mg plus classic symptoms of hyperglycemia or hyperglycemic crisis

73
Q

Goals for Type 1 and Type 2 Diabetes?

A

A1C < 7%
preprandial glucose 80-130 mg/dL
Peak postprandial glucose <180

74
Q

Pediatrics Type 1 Diabetes goals?

A

A1C: <7.5%
Preprandial glucose: 90-130mg/dL
Bedtime/overnight: 90-150 mg/dL

75
Q

Is A1C accurate in pregnant women?

A

not as accurate, would use OGTT to assess

76
Q

Target range of glucose for hospitalized patients?

A

target range 140-180 mg/dL

77
Q

Wen adjusting A1C goal, don’t want to greater than….

A

8.5%

78
Q

Older adult goals: Healthy

A

A1C: <7-7.5%
Preprandial glucose: 80-130mg/dL
Betime glucose: 80-180mg/dL

79
Q

Older adult goals: Complex/Intermediate

A

A1C: <8%
Preprandial glucose: 90-150 mg/dL
Bedtime glucose: 100-180mg/dL

80
Q

Older adult goals: Very Complex/poor health

A

A1C: <8.5%
Preprandial glucose: 100-180 mg/dL
Bedtime glucose: 110-220 mg/dL

81
Q

Rational between Health statuses?

A

Life expectancy

CDM 1 Exam 2 (16 decks)

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