DM Flashcards
What organ controls the body’s fuel supply in response to hormones from the pancreas
liver
What is the only hormone that lowers glucose?
insulin??
Ingested glucose is stored in the liver as _________ and is released as needed in between meals.
glycogen
Liver can also make new glucose as needed and this is called
glucogenisis
Common metabolic disorders are characterized by
-Hyperglycemia resulting from imbalances between insulin secretion and cellular responsiveness to insulin
-Results in an inability to transport glucose into cells
-Body cells are starved, so fat and protein breakdown is increased to be used as cellular energy
Prediabetes
elevated glucose, but does not meet diagnostic criteria
Type I DM
insufficient insulin production – autoimmune destruction of beta cells
-There is a rare idiopathic form with no autoantibodies
Type II DM
insulin resistance and progressive decline in insulin secretion
Gestational DM
develops during pregnancy because of increased weight gain and change in hormones. 50% of time they go on to develop type 2 DM but they initially had some insulin resistance even if they didn’t recognize it
DM is more prevalent among which population?
Native Americans/Alaska Natives, African Americans, Latinx Americans
The highest prevalence of Type I DM is among which population?
White Americans
Type 2 rates are increasing within _______ with obesity epidemic
children
DM is a significant risk factor in
CAD, stroke, leading cause of blindness, chronic kidney disease, lower extremity amputation
Dx of DM
- Fasting (8 hours) glucose > 126 mg/dl
- <100 normal
- 100-125 “impaired fasting glucose”
- Oral glucose tolerance test > 200 mg/dl 2 hours after glucose ingestion - Hemoglobin A1C > 6.5%
-Measures the quantity of a subtype of hemoglobin that is bound to glucose molecules (glycated)
- Hgb contains no glucose when it leaves the bone marrow
- When serum glucose levels are increased, more glucose will bind
Therefore, levels reflect glucose control over the past 3 months (lifespan of a RBC)
- Glucose in the urine reflects increased levels of blood glucose because the renal threshold for reabsorption has been exceeded
- Increased urine ketones also reflect the body’s increased use of non-glucose energy sources
What does Hemoglobin A1C measure?
Measures the quantity of a subtype of hemoglobin that is bound to glucose molecules (glycated)
Hgb contains no glucose when it leaves the bone marrow
When serum glucose levels are increased, more glucose will bind
Therefore, levels reflect glucose control over the past 3 months (lifespan of a RBC)
T1 DM occurs primarily in which population?
younger people, but the rate of beta cell destruction can be variable, so it can be diagnosed later
What is T1 DM characterized by?
AN ABSOLUTE LACK OF INSULIN, elevated blood glucose, and breakdown of fats and proteins
* Prone to the development of ketoacidosis – fatty acids are converted to ketones by the liver
What is the treatment for T1 DM
Insulin
What is Type 2 DM and what is it often associated with?
hyperglycemia with INSULIN DEFICIENCY due to beta cell dysfunction
associated with obesity and has a strong genetic component
What is Type 2 DM caused by?
-Insulin resistance
-Deranged secretion of insulin by the beta cells
-Increased glucose production by the liver
What is insulin resistance?
Decreased ability of insulin to act effectively on target tissues (muscle, liver, fat)
What is insulin resistance caused by?
genetic susceptibility and obesity.
-Initially stimulates an increase insulin secretion as the beta cells attempt to maintain a normal blood glucose level
-Over time increased demand can lead to beta-cell exhaustion and failure
-Results in increased glucose level and increased glucose production by the liver (because the cells aren’t receiving glucose, so the liver thinks it needs to make more)
What is metabolic syndrome and what increases the risk for developing it?
-central obesity
-Increased adipose tissue makes vascular perfusion more challenging and chronic underperfusion/tissue hypoxia leads to macrophage response to cellular damage, thus an increased inflammatory state
In metabolic syndrome, evidence suggests that insulin resistance contributes to more than just hyperglycemia which is
Obesity, elevated triglycerides, low levels of HDL, HTN, systemic inflammation, abnormal function of the vascular endothelium (leading to things like CAD/PAD)
