Diabetes (Rahhal) Flashcards
What hormones do each of the following cells produce? Beta cells:______ Alpha cells:_____ Delta cells:_____
Beta cells: insulin Alpha cells: glucagon Delta cells: somatostatin
How does insulin work in regards to the protein GLUT4?
the pancreas releases insulin where it travels to find its receptor on various tissues. When insulin binds to its receptor, a cascade of events occurs, one of which is the expression of the protein GLUT4. GLUT4 gets inserted into the cell membrane to allow for the passage of Glc into the cell.
What are the 3 anabolic actions of insulin with regard to the following tissues? Adipose tissue:_______ Muscle:___________ Liver:_____________
Adipose tissue: increase glc uptake and lipogenesis, decrease lipolysis Muscle: increase glc uptake, glycogen synthesis and protein synthesis Liver: increase glc synthesis and lipogenesis, decrease gluconeogenesis
type ___ diabetes is a defect first of insulin action and second secretion, whereas type ____ diabetes is purely a defect of insulin secretion.
II; I
type I diabetes is mostlly caused by an autoimmune response in which antibodies are made to various types of cells or antigens in the pancreas - one of the most common antibodies in type I diabetes is against this enzyme
glutamic acid decarboxylase
what is the most common environmental trigger that turns on type II diabetes?
obesity; thought to be due to the excess circulation of free fatty acids and inflammatory cytokines that impair the insulin receptor, causing resistance, and that are toxic to beta cells
what is a hemoglobin A1c, and why is it measured as an average over several months?
it is a percentage that represents that amound of glucose that is attached to red blood cells. should be <5.7%
diabetes leads to complications such as _______ disease, which is the leading cause of end stage renal disease, adult onset blindness, and nontraumatic lower extremity amputations
microvascular
this disease is seen an ~20-30% of patients with DM, which presents initially with microalbuminemia that progresses to heavy albuneuria and proteinuria
diabetic kidney disease (nephropathy)
what is the leading cause of death in diabetics?
cardiovascular disease
Is diabetes good or bad?
BAD (you’re ready for the wards!)
what non-pharmacological approaches are appropriate for a type I diabetic? Type II?
Type 1: control carb intake Type 2: lose weight and control carbs
these diabetes managment drugs inhibit the enzymes that break down complex sugars, which then slows the absorption of glucose
alpha glucosidase inhibitors
this alpha glucosidase inhibitor decreases the absorption of glucose, does not affect insulin secretion so do not cause hypoglycemia, and main side effect includes flatulence and diarrhrea
acarbose
what are the 3 types of insulin “secretagogues”?
sulfonylureas/meglitinides, GLP-1 agonists, DPP-IV inhibitors
this class of drugs binds to their own receptors on the ATP-sensitive K+ channels in the pancreatic islet cells which starts a chain reaction that ultimately leads to the influx of calcium into the cell, and glucose-independent secretion of insulin
sulfonylureas (ie, glipizide, glimepiride, glyburide) and meglitinides
where is endogenous GLP-1 made, and how do GLP-1 agonists work?
GLP-1 is made endogenously in the L-cells of the small intestine. GLP-1 agonists work by binding the GLP-1 receptor on the islet cells to enhance the production of insulin. It is glucose-dependent, so the main benefit is they do not cause hypoglycemia. They do not work unless glucose is already present.
how do DPP-IV inhibitors work?
they help GLP-1 last longer by preventing its breakdown by the DPP-IV enzyme.
*same side effects as GLP-1 agonists - may cause pancreatitis in some individuals with a history and do NOT cause hypoglycemia because they are glucose-dependent drugs.
class of drugs that prevents the reabsorption of glucose, increasing its excretion in the proximal tubule of the kidneys
SGLT-2 inhibitors (ie, canagliflozin)
