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Medical Perspectives 411 > DM > Flashcards

DM Flashcards

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USMLE® Step 1 flashcards
1
Q

DM literal meaning

A

blood sugar in urine, the urine tastes sweet, thats why MD use to drink to diagnose

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2
Q

DM is what kind of disease resulting from a ?

A

DM is a metabolic disease resulting from a defect in insulin secretion, action, or both, and is chronic, systemic disorder characterized by hypoglycemia and disruption of carbs, fat, and protein metabolism

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3
Q

What is responsible for DM ?

A

The chronic state of hypoglycemia is responsible for dysfunction and impairment in tissues and organs

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4
Q

Type I DM is called

A

insulin dependent/ juvenile

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5
Q

Type I DM is an

A

autoimmune response at the islet cells of the pancreas associated with an absolute deficiency of insulin production and secretion, typically before 14, peak onset 11

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6
Q

A patient with Type I DM requires

A

exogenous insulin to maintain life

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7
Q

Type II DM previously known as (On test)

A

Non-insulin dependent DM (NIDDM) or adult onset DM

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8
Q

Type II DM derived from a

A

combo of cellular resistance to insulin and an inadequate adjustment via secretion to the desensitized receptors, which are the alpha subunits on tyrosine kinase

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9
Q

Autoimmune component of Type II DM

A

happens in middle to late adulthood
does not impact affect of pancreatic beta cells
immune cells attack body cuz they see the cells as foreign invaders/ bad shit

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10
Q

Individuals have endogenous insulin production, yet

A

ineffective insulin action at the cellular level, so exogenous insulin is not effective in type II DM

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11
Q

Type II DM is associated with what

A

obesity, inactivity/ prolonged sedentary nature, smokers, age, gene susceptibility

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12
Q

Beta cells are unable to do what in type II DM

A

unable to increase production of insulin to compensate for the cell receptor hyposensitivity

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13
Q

When the body cannot use glucose the way that it should is considerd what?

A

preDB

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14
Q

When less glucose moves into the celll, plasma glucose levels rise =

A

preDB

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15
Q

Decreased insulin sensivity is

A

PreDB

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16
Q

The cells stop responding to the action of insulin (insulin resistance)

A

PreDB

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17
Q

Blood glucose levels are above normal but do not yet meet the criteria for diabetes diagnosis

A

preDB

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18
Q

100 mg/dl to 125 mg/dl plasma glucose levels

A

preDB

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19
Q

DB severe complications of: due to oxidative stress/ systemic inflammation include diseases and SX

A 
Heart disease 
stroke
Kidney disease
blindness
loss of limbs
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20
Q

WHAT IS THE MOST COMMON ENDOCRINE DISEASE?

A

DM

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21
Q

insulin is an antagonist to the hormone

A

cortisol

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22
Q

cortisol causes

A

hypoglycemia and stress to sys, and makes cells desitivied to insulin receptor, resitin

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23
Q

Since 1970 DM rates have increased due to

A

prolonged life expectancy

increased incidence of obesity

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24
Q

diabetes insipidus caused by

A

trauma to hypothalamus

lack of ADH production

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25
Q

Watching 2 or more hours of TV daily is a RF for

A

DM

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26
Q

Skipping breakfeast is a RF for

A

DM cuz coritsol is released to conserve glucose

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27
Q

Insulin is secreted by

A

beta cells (Tyrosine kinase) of pancreas

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28
Q

Insulin helps to

A

transport glucose into cells for fuel or for storage (glycogen/adipose)

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29
Q

insulin stimulates what mTOR stimulates

A

protein synthesis

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30
Q

insulin stimulates not carbs but

A

FFA storage

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31
Q

When glucose levels after meal,

A

beta cells increase secretion of insulin into the blood stream, thus, lowering plasma glucose levels

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32
Q

Blood glucose levels drop as the cells take up glucose, this does what?

A

reestablishes plasma homeostasis

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33
Q

Deposit large amounts of glucose in the liver as per glycogen storage, but unable if

A

insulin resistant or insensitive, which increases glucose secretion due to lack of phosphorylation of glucose to glucogen

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34
Q

Kidneys excrete excess

A

glucose in an attempt to balance blood sugar levels, making sweet urine yum

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35
Q

Kidney action of DM is due to

A

excessive water loss to osmotic diuretic force generated from glucose excretion, forces water out increasing urination

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36
Q

Increased fat mobilization occurs causing

A

excessive ketone formation creating decreased pH, increasing acidity

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37
Q

By-products of fat metabolism in combo with glucose excretion by the kidneys increase the

A

osmotic pressure and rapid dehydration can happen in conjuncton with elctrolyte imbalance

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38
Q

Muscle and most other body tissues are most blank to glucose

A

impermeable

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39
Q

What is used to increase permeability to glucose?

A

insulin increases cell membrane permability to glucose more than 10 fold/times

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40
Q

Liver is moderately

only organ to do this

A

permeable to glucose, both in and out, when insulin is or isn’t present

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41
Q

Glucose can leave Liver

A

easily unless it has been phosphorylated, not converted to glycogen via glycogen synthase

42
Q

Insulin promotes the activity of the

A

glucokinase enzyme, which phosporylates glucose and enzymes that promote glycogen synthesis (vital for later portion of exercise)

43
Q

Insulin promotes protein what

A

storage in muscle cells as amino acids

44
Q

Insulin promoting protein storage cuases promotion and enhances

A

protein synthesis, stimulates AA uptake across the plasma membrane

45
Q

Protein and insulun increases

A

DNA/RNA transcriptional mechanism and inhbits protein catabolism, break down AA causing muscle wasting in DM due to protein synthesis lacking

46
Q

Lipid and insulin stimulates the synthesis and storage of

A

TGs, which inhibits the enzyme that break down stored llipids, (HSL) Hormone sensitive lipase

47
Q

DM has plasma lipid levels rise by approx

A

500%

48
Q

DM results in

A

atherosclerosis

49
Q

DM can cause

A

cardiovascular complications, and impaired protein use occurs for fuel

50
Q

DM 3 three complication vascular/ neurology

A

Large blood vessels (atheroscelorss)
small blood vessels (retina damage)
nerves (neuropathies)

51
Q

DM and mitochondria

A

excess superoxide production in the mitochondria

52
Q

DM causes lack of the body to

A

heal or regenerate results in increased susceptibility to infection, or lack of ability to heal from infection (weak immune sys)

53
Q

DM can result in

A

sensory, motor, and/or autonomic neurppathy

54
Q

DM and ecg with autonomic neuopathy

A

ECG not accurate secondary to autonomic neuropathy

55
Q

Sensory example with DM

A

Poor temp regulation/ BP regulation with exercise

56
Q

There frequent what in DM

A

frequent ulceration

57
Q

healthy A1C desire less than

A

5

58
Q

Hemoglobin A1C indicates the average

A

hemoglobin exposure to glucose over a prolonged time period for approx. 30-60 days

59
Q

insulin molecule is comprised of

A

large polypeptide of 51 amino acids

60
Q

insulin facilitates

A

the entrance of glucose into peripheral tissues

61
Q

Alpha cells of pancreas yield

A

glucagon

62
Q

Beta cells of pancreas produce

A

insulin

63
Q

Delta cells of pancreas produce

A

somatostatin

64
Q

somatostatin regulates

A

GI absorption and motility

65
Q

F cells of pancreas produce

A

pancreatic polypeptide

66
Q

GLUT proteins are

A

glucose transporters from the intracellular storage sites to the cell membrane of skel muscle and other peripheral tissues

67
Q

GLUT proteins synthesized and stored in the

A

Golgi system of the cell

68
Q

GLUT-4:

A

glucose transporter in muscle and fat cells

69
Q

GLUT4 promote

A

facilatated diffusion for glucose transport across the plasma membrane

70
Q

Insulin binds to a specific insulin receptor (a paired receptor)

A

Tyrosine kinase

71
Q

Alpha subunit =

A

receptor site

72
Q

Beta:

A

enzyme that reuslts in autophosporylation through a tyrosine kinase mechanism that initiates a series of biochemical cellular reactions

73
Q

Insulin Receptor Substrates (IRSs) get

A

phosphorylated by tyrosine

74
Q

IRSs initate changes in

A

various metabolic pathways that result in increase glucose uptake

75
Q

IRSs initiate the translocation of

A

glucose transporters from intracellular storage sites to the cell membrane

76
Q

IRSs and GLUT proteins promote

A

facilated diffusion via glut4

77
Q

As plasma glucose [ ] rise, what happens

A

beta cells increase synthesis/ release of insulin

78
Q

increased plasma glucose causes insulin to take it into cells, which reduces

A

blood glucose [ ] to normal

79
Q

increased plasma glucose causes insulin to take it into cells, controlled by other factors:

A

cortisol, thyroxine (T4), lipid, and AA [ ]

80
Q

Insulin release inhibits what

A

glucagon synthesis/release from the alpha cells

81
Q

Reduced insulin release is correlated w/

A

increased glucagon

82
Q

Factors afecting insulin release

A

Elevated blood glucose
rising AA and Fatty acid levels
ACh through parasympathetic pathways
Somatostatin and sympathetic nervous system pathways

83
Q

Rising AA and fatty acid levels increases

A

insulin secretion

84
Q

ACh through parasympathetic pathways increases

A

insulin secretion

85
Q

Somatostatin and sympathetic nervous system pathways

A

decreases insulin release allowing increase in blood glucose levels

86
Q

Hyperglycemia

A

lack of insulin mediated tissue glucose uptake

87
Q

Microangiopathy and why?

A

abnormalities in small diameter blood vessels because of thickening of the basement membrane causing occulsions causing ischemia to tissues

88
Q

hyperglycemia and microangiopathy damage by DM

A

Retina
kidneys
poor wound healing

89
Q

Microangiopathy disease

A

large vessel thickening resulting in atherosclerosis, diseases include HTN, MI, CVA, and these conditions also demonstrate insulin resistance even when not combined with DM

90
Q

adverse effects of exogenous insulin for type I DM

A

hypoglycemia

91
Q

Immunosuppressants for type I DM

A

has an autoimmune origin, drugs that suppress the immune sys are becoming more common

92
Q

sulfonylureas act directly on

A

pancreatic beta cells

93
Q

sulfonylureas stimulate the release of

A

endogenous insulin

94
Q

sulfonylureas released directly into the

A

hepatic portal vein travelling to the liver, which inhbits hepatic glucose production

95
Q

sulfonylureas effect, increased insulin prodcution also aids in

A

glucose entry into muscle tissue

96
Q

sulfonylureas most succesful for individuals with early

A

type II DM and still have good beta cell function

97
Q

biguanides act directly on the

A

liver to decrease hepatic glucose production, also increase sensitvity of peripheral tissues to insulin

98
Q

Alpha-glucosidase inhibitors inhbit

A

sugar breakdown in the intestines and also delays glucose absorption from the intestines

99
Q

Thiazolidinediones similar mech to

A

biguanides

100
Q

Dietary management non-pharm intervention for DM

A

total caloric intake and percentage of those being carbs

101
Q

Weight loss non-pharm intervention for DM reduce the amount of

A

tissue that requires insulin, therby reducing the need for exogenous drugs

Medical Perspectives 411 (9 decks)

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