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Pharmacotherapy 3 > Diabetes Pathophysiology > Flashcards

Diabetes Pathophysiology Flashcards

1
Q

Type 1

A
  • Autoimmune destruction of pancreatic beta cells
  • Impairment of insulin secretion (absolute deficiency of insulin)
  • Children, young adults
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2
Q

Type 2

A
  • Obesity is a major contributing factor
  • Impairment of insulin secretion and defects in insulin action (relative insulin deficiency)
  • Adults, increasing in children
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3
Q

Complications of Diabetes

A 
Retinopathy
Neuropathy
Amputation
Nephropathy
Cardiovascular complications
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4
Q

Absorptive State

A
  • Ingested glucose supplies immediate energy needs of the body and builds body energy stores
  • Glucose is taken up by liver, pancreas, muscle, adipose tissue
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5
Q

Glucose from diet gets stored as

A

Glycogen

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6
Q

Free fatty acids from fat in diet get stored as

A

Triglycerides

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7
Q

Amino acids get stored as

A

Protein

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8
Q

Insulin stimulates what in the liver

A

Glycogen synthesis

Fatty acid synthesis

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9
Q

Insulin inhibits what in the liver

A

Glycogenolysis
Gluconeogenesis
Ketogenesis

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10
Q

Insulin stimulates what in fat

A

Glucose uptake

Triglyceride synthesis and storage

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11
Q

Insulin inhibits what in fat

A

Lipolysis

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12
Q

Insulin stimulates what in muscle

A

Glucose uptake
Glycogen synthesis
Amino acid uptake
Protein synthesis

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13
Q

Insulin inhibits what in muscle

A

Protein breakdown

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14
Q

Glucagon

A

Glucose provider

released in response to low plasma glucose concentrations

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15
Q

Glucagon increases

A 
Glycogenolysis
Gluconeogenesis
Plasma glucose concentration
Fat breakdown
Protein breakdown
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16
Q

What goes wrong in diabetes

A

Increased blood glucose levels are a result of

  • insufficient insulin secretion
  • Resistance to the action of insulin
  • Inadequate suppression of post-meal glucagon
    - Body still releases glucagon instead of inhibiting glucagon
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17
Q

Symptoms of Type 2 Diabetes

A 
Polyuria
Polydipsia
Unexplained weight loss
Fatigue
Recurrent infections
18
Q

FPG Diabetes

A

> /= 126 mg/dL

19
Q

FPG prediabetes

A

100-125 mg/dL

20
Q

FPG normal

A

less than 100 mg/dL

21
Q

Tolerance Test diabetes

A

> /= 200 mg/dL

22
Q

Tolerance Test prediabetes

A

140-199 mg/dL

23
Q

Tolerance Test normal

A

less than 140 mg/dL

24
Q

A1c diabetes

A

> /= 6.5%

25
Q

A1c prediabetes

A

5.7-6.4%

26
Q

A1c normal

A

less than 5.7%

27
Q

Categories of Increased Risk for Diabetes (prediabetes)

A
  1. Elevated glucose that does not meet the classification for diabetes, but is still too high to be considered normal.
  2. Impaired Fasting Glucose (100-125)
  3. Impaired Glucose Tolerance (140-199)
  4. A1c 5.7-6.4%
  • These categories confer an increased risk of progressing to diabetes and CVD in the future (30-50% will convert)
28
Q

Type 1 diabetes

A

Absolute deficiency of insulin secretion
5-10% of all diabetes cases
Develops around 10-14 years, typically childhood/early adulthood
Immune mediated is most common form
-Autoimmune destruction of pancreatic beta cells

29
Q

Symptoms of Type 1 diabetes

A 
Polyuria
Polydipsia
Weight loss
Polyphagia
Fatigue
Ketoacidosis
30
Q

Risk Factors for T2D-Modifiable

A 
Overweight/obesity
Physical inactivity 
IFG/IGT
HTN >140/90
HDL = 35 mg/dL
Triglycerides >/= 250 mg/dL
31
Q

Risk factors for T2D-Nonmodifiable

A 
Family history
Race/ethnicity
History of gestational diabetes
Delivery of a baby > 9 lbs
Poycycstic ovary syndrome
32
Q

Mechanisms of insulin resistance

Pre-receptor defects

A

Abnormal insulin molecule (mutations)

Anti-insulin antibodies

33
Q

Mechanisms of insulin resistance

Receptor defects

A

Decreased number of receptors

Reduction in receptor’s binding affinity to insulin

34
Q

Mechanisms of insulin resistance

Post-binding defects

A

Defective insulin signal transduction

Defects in GLUT4 translocation

35
Q

Consequences of insulin resistance in muscle

A

Impaired glucose uptake and glycogen synthesis

36
Q

Consequences of insulin resistance in fat

A

Impaired glucose uptake
Increased lipolysis
Increased flux of free fatty acids to liver (dyslipidemia)

37
Q

Consequences of insulin resistance in liver

A

Increased glucose output
Alterations in lipoprotein metabolism
-Increased VLDL and triglycerides
-Leads to increased hepatic glucose production

38
Q

Compensatory hyperinsulinemia

A

Pancreas secretes more insulin in an effort to overcome insulin resistance and maintain glucose homeostasis (helps for a short time)

39
Q

Post-prandial hyperglycemia

A

Loss of first phase insulin secretion
Diminished glucose uptake in peripheral tissues
Failure to suppress glucagon after a meal

40
Q

Fasting Hyperglycemia

A

Increased hepatic glucose production

Hepatic glucose output exceeds glucose uptake

41
Q

Amylin

A

Hormone co secreted with insulin from the pancreatic beta cells
Involved in glucose regulation
Slows rate of gastric emptying
Suppresses postprandial release of glucagon
Improves satiety signals

Pharmacotherapy 3 (4 decks)

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