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Biochemistry Unit 5 > diabetes mellitus and nutrition > Flashcards

diabetes mellitus and nutrition Flashcards

1
Q

diabetes is the _th leading cause ofdeath in the US

A

7th

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2
Q

Distinguish between the following and their cause

  1. T1DM
  2. T2DM
  3. gestational diabetes
  4. impaired glucose tolerance
  5. others
A
  1. T1DM
    1. 5-10% of cases
    2. insulin-dependent
    3. cause
      1. autoimmune destruction of pancreatic cells
      2. can occur at any age
  2. T2DM
    1. 90-95% of DM cases
    2. non-insulin dependent/ insulin resistant
    3. prevelant in elder and larger
    4. treated with diet and exercise
  3. gestational diabetes
    1. occurs during pregnanacy
    2. temporary form of DM
    3. follow a careful diet
      1. blood glucose, blood pressure and urinary protein
  4. impaired glucose tolerance
    1. DM that appears with combination of other factors
      1. hypercholesterolemia
      2. obesity
      3. hypertension
    2. risk of becoming T2DM
  5. drug/toxin
    1. genetic defect
    2. pancreatic conditions or disease
    3. endocrinopatthies
      1. imbalance with other hormones in the body
    4. second-generation antipsychotics
      1. metabolic adverse effects are glucose dysregulation
        1. increased risk of diabetes
    5. corticosteroids
      1. decrease glucose utilization
      2. increase hepatic gluconeogenesis
        1. overall increase blood glucose
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3
Q

What are the screening tools for diabetes?

A
  1. signs
    1. polydipsia
    2. polyuria
    3. polyphagia(hunger)
    4. unusual weight loss (TYPE 1)
    5. unusual weight gain (TYPE 2)
  2. lab
    1. glycosuria
    2. hyperglycemia
    3. abnormal glucose tolerance test
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4
Q

Which type of DM is ketoacidosis seen in?

A

Usually in type 1.

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5
Q

what are normal glucose blood levels?

A

70-110

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6
Q

what are the sources of blood glucose?

A

dietary intake

glycogen from liver

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7
Q

what are the uses of blood glucose in the muscle?

A
  1. synthesis of glycogen
  2. synthesis of triglycerides
    1. VLDL
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8
Q

diagram the glucose metabolism

A
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9
Q

What are the stimulatory and inhibitory actions of insulin?

A
  1. stimulatory
    1. lipogeneisis
    2. glucose transit into cell
      1. muscle and adipose
  2. inhibitory
    1. lipogenisis
    2. proteolysis
  3. also
    1. promotes the dietary uptake of amino acids
    2. influences burning of glucose for energy (glycolysis)
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10
Q

what does the liver use insulin for?

A
  1. NOT GLUCOSE UPTAKE
  2. needed for activity
    1. Glycolysis for acetyl CoA synthesis
    2. glycogen synthesis
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11
Q

What are the functions of glucagon?

A
  1. break down stoerd glycogen
  2. gluconeogenesis from non-carbohydrate stores
  3. glycogenolysis

raises blood glucose during rest

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12
Q

why is the degradation of fat necessary during gluconeogenesis?

A

gluconeogenesis is expensive and fats contain alot of energy.

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13
Q

explain the metabolism in uncontrolled DM

A
  1. condition
    1. insulin insufficieny
  2. macrnutrients
    1. glucose
      1. w/o insulin cells are starved for glucose
      2. causing
        1. release of glucagon
          1. gluconeogenesis
          2. ​lipolysis
        2. more glucose in the bloodstream
    2. fat
      1. w/o insulin LPL synthesis decreases
        1. insulin stimulates the synthesis of LPL,
        2. result in
          1. uptake of fatty acids
          2. accumulation of
            1. _​chylomicrons_
            2. VLDLs
      2. triglyceride breakdown INCREASES
        1. intermediate fats are broken down into ketones, and accumulate in the blood stream.
          1. leads to ketoacidosis (T1DM)
    3. protein
      1. w/o insulin proteins are broken down to secure energy
        1. loss of protein leads to weight loss, muscle waisting, urinary nitrogen loss
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14
Q

how is heart disease related to diabetes?

A

insulin is necesarry for the synthesis of LPL.

With the decrease in insulin circulation, the patient experiences an accumulation of chylomicrons** and **VLDL

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15
Q

describe the clinical feature of dylipidemia

A

elevated triglycerides

decreased HDL cholesterol

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16
Q

what is hypertension considered?

A

a comorbid condition, two conditions at once.

17
Q

long term complications of diabetes lead two -emia’s and damage to what organ?

A
  1. hyperglycemia
  2. hyperlipidemia

these both cause microvascular and macrovascular trauma. Acut pancreatitis is the result from damage to acinar cells and microvasculature. this condition is compounded by the release of pancreatic enzymes in the enviornment. with a decrease in pH, due to CO increase, the trypsinogen is converted to active form trypsin and causes more damage.

18
Q

what is the general management of diabetes

A
  1. early detection
  2. prevention of complications
  3. glucose tolerance test
  4. goals
    1. mantaining optimal nutrition
    2. avoiding symptoms
    3. preventing comlications
  5. self care skills
    1. basic elements
    2. healthy diet
    3. physical activity
      1. generates GLUT4 channlels in muscle w/o insulin
    4. adequate dosage and timely intake of hypoglycemic agents (only T2DM)
    5. titrate insulin dosage
19
Q

describe the order of macronutrients in order for diabetic persons

A
  1. carbohydrates
  2. proteins
  3. fats

paying attention to the glycemic index of foods

20
Q

wat is FITT?

A

frequency, intensity, time and type

21
Q

what can stop the efficiency of insulin?

A
  1. stress
    1. increase of corisol
  2. epinephrine
    1. antagonist to insulin
22
Q

differentiate between the diseases associated with

  1. hyperglycemia
  2. lyperlipidemia
A
  1. hyperglycemia
    1. sugar is taken up and turned into sorbitol
      1. swelling of cells
      2. retinopathy
      3. nephropathy
      4. neuropathy
  2. hyperlipidemia
    1. increasing lipids in blood
      1. heart disease
        1. dylipidemia
        2. hypertension
    2. based on what is in the blood stream
      1. VLDL may lead to clogging in macro and microvasculature
      2. hyperlipidemia pancreatis
23
Q

What does the liver do with excess lipid?

A

repackage them and send them out as VLDL

24
Q

what role does isulin play other than glucose absorption?

A

fat and protein mettabolism

25
Q

What has a strong genetic link to disease?

A

T2DM

26
Q

Jerrys blood glucose is above fasting levels but not high enough for diabetes, what is his disease?

A

impaired glucose tolerance

  1. risk factor for T2DM
  2. presence underlying conditions
    1. hypercholesterolemia
    2. obesity
    3. hypertension
27
Q

metabolism of what two macronutrientts is related to diabetes?

A

metabolism of carbohydrates and fat

it actually involves all three, but C and F have the largest contributions

28
Q

what are the specia lobjective during pregnacny for diabetes?

A
  1. tetam of speialists
  2. carful monitoring
  3. incresed physiological demands
  4. normal pregnancy must resist diabetets manifestation
29
Q

what is the medical nutrtion advice for pre-diabetics vs diabetics?

A

IGT

  1. promote healthy food choices
  2. increase PA
  3. loose weight

diabetics

  1. mainttain blood glucose
  2. monitor lipid profile
    1. avoid high TG
  3. monitor blood pressure
  4. slow chronic complications
  5. maintain the pleasure of eating
30
Q

what should total energy balance for diabetics be for weight loss?

A

avoid negative energy balance for weight loss

fresh fruits have lower glycemic index than dried fruits.

more carbs and proteins, than fats

31
Q

how can illness affect a diabetic

A

raising the stress levels may counter insulin affects. should increase protein and monitor glucose levels closely

Biochemistry Unit 5 (7 decks)

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