Diabetic Complications

Question 1

Major Hormones of energy metabolism:

• ______ - hypoglycemic hormone of the absorptive state
• ______ - hyperglycemic hormone of the post-absorptive state (assisted by _____, _____, _____)

Answer 1

• insulin

- glucagon (EPI, Cortisol, GH)

Question 2

Diabetes Mellitus:

• loss of _____ = severe metabolic derangement of ___, ___ and ___
• Excess glucose –> ________ = ______ = ______
• excess lipids = _______ = ______ = _____ + ______
• excess protein degradation = _______ = _______ + ______

Answer 2

• insulin (glucose , AAs, and lipids)
• hyperglycemia = polyuria/polydipsia = dehydration
• hyperlipidemia = ketogenesis = ketonuria + metabolic acidosis
• aminoacidemia = excess gluconeogenesis + negative protein balance

Question 3

what is unique about cortisol?

Answer 3

only hormone to stimulate glycogen formation and gluconeogenesis

Question 4

States of Diabetes:

• type I (IDDM) - onset occurs _______, cause —>____, ____ prevents DKA
• Type II (NIDDM) - onset _____, _____ prevents DKA, absence of _____

Answer 4

• usually in children, cause –>autoimmunity to beta cells, exogenous insulin prevents DKA
• usually in adults, endogenous insulin, absence of automimmune B cell destruction

Question 5

HORMONAL PATHOPHYSIOLOGY OF IDDM:

• diminished _____ relative to _____
• balance shifts to _____ state
• enhanced delivery of ____ to liver
• enhanced ____ via stress hormones
• infection, M.I., burns, trauma = _____ + ____

Answer 5

• insulin, glucagon
• fasting (catabolic) state
• substrates to liver for glucose/ketone body production
• glucagon
• = hyperglucagon + DKA

Question 6

HORMONAL PATHOPHYSIOLOGY OF NIDDM:

• most common - due to age and obesity
• Two defects: _____/_____ = ________, leads to failure to _____
• obesity-induced hyperinsulinemia:
• failure of _____ to counteract insulin resistance
• ____ blockade of islet glucose metabolism/insulin secretion (“__________”)

Answer 6

-insulin resistance/hyperinsulinemia = hyperglycemia, leads to failure to secrete insulin
-beta-cells
-FFA (free fatty acid) - beta cells must metabolize glucose in order to secrete insulin (FFAs impede this)
“LIPOTOXICITY HYPOTHESIS”

Question 7

Acute Decompensation: IDDM

• acute illness in IDDM is _______
• precipitated by _____, _____, ______
• ______/_____ increase glucagon/potentiate effects
• _____ and _____ exacerbate stress hormones and hyperglucagonemia
• results in profound _____/______
• prolonged ______, decreased ____ = decreased glucose excretion, electrolyte derangement, metabolic acidosis

Answer 7

• DKA
• illness, stress, insulin omission
• stress/catecholamines
• osmotic diuresis and hypovolemia
• hyperglycemia/hyperketonemia
• hypovolemia, decreased GFR

Question 8

Acute Decompensation: NIDDM

• acute illness in NIDDM = __________
• develops due to imbalance between _____ and _____
• hyperosmolar coma results when _____ + _____ < ____
• common in ________ - leads to stress hormone-hyperglycemia = inadequate fluids
• declining ECF reduces ______ + increases ______ = CNS impairment + ______

Answer 8

• Nonketotic Hyperosmolar Coma
• hepatic glucose production and renal excretion
• glucose excretion + utilization < glucose production
• older adults with significant illness

-glucose excretion + increases glucose production = CNS impairment + coma

Question 9

why is exercise so important in the management of diabetes?

Answer 9

exercises induces glucose uptake in skeletal muscle without the need for insulin