Diabetes Lecture

Question 1

Euglycemia

Answer 1

Normal BG levels

Question 2

Preprandial

Answer 2

Before meal

Question 3

Postprandial

Answer 3

After meal

Question 4

HbA1c

Answer 4

Hemoglobin A1C

Estimate of average BG over past 3 months

Question 5

Prevalence of type 1 diabetes is highest among which race/ethnicity group?

Answer 5

Non-Hispanic whites

Question 6

T/F diabetes affects almost every organ system

Answer 6

True

Question 7

Diabetes is the ___ leading cause of death in 2017

Answer 7

7th

Question 8

Normal roles of insulin and glucagon
What are insulin and glucagon?
Where are these hormones produced?

Answer 8

Pancreas produces insulin due to stimulus of high BG to lower BG, produces glucagon due to stimulus of low BG to raise BG
The two main hormones

Question 9

Which organ converts glycogen to glucose and vice versa?

Answer 9

Liver

Question 10

Which hormones regulate blood glucose?

Answer 10

Insulin
Amylin
Glucagon
GLP-1

Question 11

What is amylin?

Answer 11

Hormone that slows gastric emptying
Suppresses glucagon secretion
Increases satiety

Question 12

What is GLP-1

Answer 12

Hormone that carries out lactose dependent insulin secretion
Suppresses postprandial (after meal) glucagon secretion
Regulates gastric emptying
May increase beta-cell mass

Question 13

Describe the process from the release of GLP-1

Answer 13

GLP-1 releases from GI tract to stomach to inhibit gastric emptying to lower BG. Also releases to pancreas to lower glucagon secretion and increase insulin release

Question 14

What is DPP4?

Answer 14

Dipeptidyl peptidase 4

Breaks down GLP-1

Question 15

What is SGLT-2?

Answer 15

Sodium glucose like transporter 2
Responsible for reabsorbing glucose from urine to kidneys
Exchanges sodium for glucose

Question 16

Normal fasting plasma glucose in people w/o diabetes?

Answer 16

<100 mg/dl

Question 17

Normal 2 hour postload glucose in ppl w/o diabetes

Answer 17

<140 mg/dl

Question 18

Inside a red blood cell, glucose and hemoglobin can combine to form?
Determining the amount of this product is used to determine what?

Answer 18

Glycohemoglobin

HbA1c

Question 19

Higher percentage of HbA1c means?

Answer 19

More glucose in blood

Question 20

Normal HbA1c in ppl w/o diabetes? (%)

Answer 20

< or equal to 5.5 or 5.7%

Question 21

What guidelines do we use for diabetes?

Answer 21

American Diabetes Association
AACE/ACE Clinical Practice Guidelines
International Guidelines

Question 22

Classification of Diabetes (types)

Answer 22

1. Prediabetes
2. Type 1 diabetes
   - beta-cell destruction (rapid dec of ins. production)
3. Type 2 diabetes
   - progressive insulin secretory defect
4. Gestational Diabetes Mellitus (GDM) (occurs during pregnancy, risk factor for developing type 2 diabetes)
5. Other specific types of diabetes
   - Monogenic diabetes syndromes (MODY)
   - diseases of exocrine pancreas
   - drug/chemical induces diabetes

Question 23

Diagnostic criteria for prediabetes

Answer 23

Fasting plasma glucose 100-125 mg/dL
Or
2-h plasma glucose 140-199 mg/dL
A1C 5.7-6.4%

Question 24

Diabetes risk factors

Answer 24

Age
Gender
Pregnancy (gestational)
Genetics
HBP
Exercise
Body mass

Question 25

Criteria to diagnose diabetes

Answer 25

Fasting plasma glucose > or equal to 126 mg/DL Or 2-h plasma glucose > or equal to 200 mg/dL Or A1C > or equal to 6.5% Or Classic diabetes symptoms + random plasma glucose > or equal to 200 mg/dL

Question 26

Metabolic syndrome

Answer 26

``` Recognized group of characteristics that puts a pt at risk for type 2 diabetes Include: Obesity Hypertension Hyperlipidemia Insulin resistance/ glucose intolerance Proinflammatory state ```

Question 27

``` Type 1 vs type 2: frequency age of onset body mass symptomatic insulin for survival insulin for treatment presence of antibodies ```

Answer 27

f: t1 5-10% t2 90% a: <30, >30 bm: lean, obese s: symptomatic, symptomatic is: yes, no it: yes, usually poa: yes, rare

Question 28

Frequent symptoms of diabetes

Answer 28

``` May be asymptomatic in type 2 diabetes 3 P’s: polyuria, polydispia: great thirst , polyphagia: excessive hunger Ketoacidosis Weakness/fatigue Glycosuria: peeing sugar Dry, itchy skin Visual changes Skin and mucous membrane infections ```

Question 29

Polyuria

Answer 29

Peeing a lot due to high BG

Question 30

Polydipsia

Answer 30

Thirsty all the time

Question 31

Polyphagia

Answer 31

Hungry all the time

Question 32

Ketoacidosis Define? Symptoms? Relationship to insulin?

Answer 32

``` If you can’t break down glucose for energy your body breaks down fatty acids to ketones leading to pH imbalance Fruity odor breath Polydipsia Polyuria Common when insulin is not present ```

Question 33

Hyperglycemia complications

Answer 33

``` Diabetic ketoacidosis (common in type 1) Hyperglycemic hyperosmolar nonketotic syndrome ```

Question 34

Hyperglycemic hyperosmolar nonketotic syndrome | Type 1 or type 2?

Answer 34

``` More common in type 2 Drawing fluid into blood vessels Polyuria Polydipsia UTI ```

Question 35

Two pathways for development of complications?

Answer 35

Advanced glycosylation endproducts (AGE’S) | Sorbitol (polyol) pathway

Question 36

Advanced glycosylation endproducts (AGE’S)

Answer 36

Elevated levels of circulating glucose attaches to proteins or lipids and glycolates them Accumulate over lifetime indicates development of certain disease including diabetes

Question 37

Sorbitol Pathway

Answer 37

Some cells not dependent on insulin for entry of glucose | Glucose enters these cells and is enzymatically converted to sorbitol and fructose

Question 38

Sorbitol pathway complications

Answer 38

Elevated glucose within cell leads to incr formation of sorbitol and fructose increasing water pulled within cell causing cell swelling and cell damage

Question 39

alpha cells refer to what? what does it do? resulting effect?

Answer 39

glucagon act on liver to release glycogen inc blood sugar

Question 40

beta cells refer to what? what does it do?

Answer 40

insulin | dec blood sugar

Question 41

delta cells refer to what? what does it do?

Answer 41

``` somatostatin stops glucagon, insulin and growth hormone secretion slows gastric emptying dec blood sugar released by other cells ```