Diabetes physiology review Flashcards
= storage hormone and ‘puts away’ excess sugars into fats and glucogon
Insulin
Proinsulin = C-pep + insulin ; when you see increasing C peptides and insulin levels = _____
Vs someone overinjecting insulin only see elevated insulin levels, not C peptide
endogenous source
Insulin stimulated glucose uptake in skeletal + heart msl, fat tissue
Glut 4:
: B-cell gluose sensor; transports out of intestinal an renal epithelial cells; on B islet cells, liver, sm intestine and kidney
Glut 2
Insulin effects:
tissue uptake and sequestration of glucose, Fas, AAs and decrease in plasma levels
Control of insulin secreation: Gluose**, AA, FA,…
Amplified by :
Inhibited by :
GI hormones
somatostatins
High levels of AA act on the Alpha cells to produce______ in the pancreas
Glucagon
High levels of Glucose, Insulin, SST, Ketones and FFA_____ release of Glucagon by Alpha cells
inhibit
Secreated from gut in response to feeding::: Acute- increases insulin response to glucose
GLP: glucagon like peptides
= islet cell destruction
= insulin resistance
Type I: T1DM= islet cell destruction
Type 2: T2DM = insulin resistance
= principal stimulus for insulin release from pancreatic β-cell.
Glucose
also stimulates release of insulin; acts in other places as well but as more AMPLYFING effect thus not great for drug therapy
à promotes feeling full, slows gastric emptying, inhibits glucagon secreation
**GLP
: chronic metabolic disorder w/ characteristic complications + hyperglycemia
disease of metabolism: usually insulin/glucagon/SST from pancrease--\>
when this system becomes disrupted can lead to it
Diabetes mellitus
. Diagnosis of Diabetes Mellitus
HbA2c > or =____
Fasting plasma glucose \>/= \_\_\_ 2 hr pl glucose \>/=\_\_\_\_ w/ glucose tolerance test
Random glucose >/= ___mg/dL
6.5%
126
200
200
measure of glycosylated hemoglobin at the terminal valine of the beta chain. Glucose is non-enzymatically attached to proteins. w/ higher concentration and the longer the exposure to glucose, more glycosylation occur
HbA1c:
Dx of Pre-diabetes:
Fasting plasma glucose:
2hr pl glucose= ____ after 75 g oral glucose tolerance test
A1c of _____
Fasting plasma glucose: 100-125
2hr pl glucose= 140-199 after 75 g oral glucose tolerance test
A1c of 5.7 -6.4%
Short term complications of diabetes mellitus left untx
elctrolycte abnormal, fatigue, poor wound healing, impaired immune, prolonged hospital stay, increase inpatient morbidity and mortality, diabetic ketoacidosis, hyperosmolar hyperglycemic state, tx related hypoglycemia
retinopathy, nephropathy, neuropathy; damage to small nutrient vessels; see micro hemorrhages causing accumulation of excudates in the retina; lots of vascular leakage into macular area
All long term complication related to Microvascular diabetes mellitus complications
CAD and peripheral vascular disease; blindness, kidney fail, amputation, heart attack, stroke
Macrovascular complications form long term diabetes mellitus
What is the pathogeneis of diabetes mellitus complications
Pathogenesis of DM complications:
accumulation of advanced glycosylation end products, accum sorbitol, disrupt hexosamine path, disruption of protein kinase C path, activation of poly ADP-ribose, increased oxidative stressà all this shit accumulates
: autoimmine B cell destruction with lack of insulin
: insulin resistance with relative insulin deficiency
Type 1
Type 2
What happens in gestational diabetes?
Gestational: insulin resistance with B cell dysfunx; Pregnancy is an insulin resistance state; the placenta secretes hormones which cause insulin resistance in the mother, so that nutrients can be directed to the growing fetus
Type 2 DM Pathophysiology:
insulin resistance and impaired insulin secretion.
Initially, due to genetic predisposition and poor lifestyle, patient develop insulin resistance: how does the pancreas respond to this?
At this time the pancreas increases insulin secretion to maintain good glycemic control in the face of the insulin resistance. Over time, insulin secretion wanes and hyperglycemia and diabetes mellitus develops.
