DM Lecture 54

Question 1

Microalbuminuria results due to what?

Answer 1

Advanced Glycation end products of protein (AGE)

Question 2

Sickling crisis results in jaundice. What is a characteristic lab finding in this person? (IMCQ)

Answer 2

Increased serum unconjugated (indirect) bilirubin

-Prehepatic

Question 3

A person has renal colic due to the passage of stones in his urine. What is a clinical scenario? (IMCQ)

Answer 3

• Cystinuria (defect in cysteine reabsorption

- Cysteine stones

Question 4

If you don’t intake essential amino acids, you can get a negative nitrogen balance (IMCQ)

Answer 4

PVT TIM HALL

• Phenylalanine
• Valine
• Threonine
• Tryptophan
• Isoleucine
• Methionine
• Histidine
• Alanine
• Leucine
• Lysine

Question 5

What clinical disorder is an example of Secondary diabetes?

Answer 5

Hemochromatosis

Question 6

Type I diabetes

Answer 6

• Autoimmune destruction of B cells

- Marked reduction in insulin secretion (insulin is low or absent)

Question 7

Type II diabetes

Answer 7

• Metabolic syndrome/Syndrome X

- Insulin resistance and Beta cell dysfunction/fatigue

Question 8

Polyuria, Polyphagia, and Polydipsia are typically seen with what clinical finding?

Answer 8

Type I diabetes

Question 9

Explain why there is weight loss in type 1 diabetes?

Answer 9

Accelerated lipolysis and muscle proteolysis (negative nitrogen balance due to increased tissue protein catabolism)

Question 10

Hyperglycemia in both type I and II diabetes is due to what 2 clinical findings?

Answer 10

1. Gluconeogenesis is activated because of low insulin

2. Decrease in number of GLUT-4 receptors bc of low insulin

Question 11

What two pathways are inhibited during diabetes I or II? And why?

Answer 11

Glycolysis and Glycogenesis due to low insulin levels

Question 12

What is a dietary recommendation for people with Type I or II diabetes?

Answer 12

Avoid Carbohydrate rich diets because you cannot break it down as Glycolysis and Glycogen synthesis are inactive. You already might have high Glucose because of gluconeogenesis

Question 13

What may you recommend to diabetic patients?

Answer 13

Exercise - causes uptake of Glucose by muscle in the absence of insulin (via AMPK pathway)

Question 14

Osmotic dieresis/dehydration

Answer 14

Can occur with patients with diabetes if you have an increasingly high amount of polyuria.

Question 15

What are the acute complications of Type I and II diabetes?

Answer 15

Type I
-Ketoacidosis
Type II
-Hyperosmolar hyperglycemic state

Question 16

What are the chronic complications of Type I and II diabetes?

Answer 16

Type I and II

• Microvascular
• Macrovascular

Question 17

Diabetic Ketoacidosis

Answer 17

• Deep sighing respiration (Kussmaul breathing) –> washout of CO2
• Fruity odor/high acetone in breath due to increase in ketone bodies (spontaneous reaction)
• Increased anion gap (high 3-hydroxybutyrate- anion)
• Increased ammonium and phosphate excretion

Question 18

Acetone

Answer 18

has to be lost in the urine or breath, it’s an end product of Ketone bodies synthesis

-Spontanenous, non-enzymatic reaction

Question 19

What may cause drowsiness in diabetics?

Answer 19

water leaving the ECF

Question 20

What are 3 cardinal clinical features of diabetic ketoacidosis?

Answer 20

1. Hyperglycemia
2. Ketosis
3. Metabolic acidosis

Question 21

What happens to insulin levels during an illness?

Answer 21

insulin requirements increase during an episode of illness due to insulin resistance due to stress

Question 22

Where do gluconeogenesis, ketogenesis, and lipolysis take place?

Answer 22

liver, liver, and adipose tissue

Question 23

What happens to Potassium during diabetes?

Answer 23

Hyperkalemia, but when you inject insulin Potassium goes back into the ICF and you can get Hypokalemia.

Question 24

Hyperosmolar Hyperglycemic (Type II)

Answer 24

• Confused and lethargic
• occurs during superseding stress or infection/illness
• High plasma glucose and osmolarity (name)

Question 25

What are the 3 clinical feautures of Hyperosmolar hyperglycemic state?

Answer 25

1. Hyperglycemia
2. dehydration (glucose is excreted in the urine and pulls water with it)
3. hyperosmolarity

Question 26

How do you tell diabetic ketoacidosis apart from hyperosmolar hyperglycemic?

Answer 26

Ketone bodies levels are normal in the latter, which they are high in Diabetic ketoacidosis.

Question 27

Why don’t you have ketoacidosis in Type II?

Answer 27

You have some insulin

Question 28

HbA1c levels in diabetes indicate what?

Answer 28

The higher the levels, the more chronic the complications of Type I and II diabetes

Question 29

Microvascular Chronic complication occur where?

Answer 29

Eyes, retina, neurons, kidney

-entry of glucose into these tissues does not require insulin

Question 30

Macrovascular Chronic complications occur where?

Answer 30

Atherosclerosis changes

Question 31

What 4 things contribute to Microvascular complication?

-non-enzymatically bind to glucose

Answer 31

1) Sorbitol formation
2) AGE
3) Hexosamine pathway
4) DAG and Protein Kinase C

Question 32

Advanced glycation end products (AGE) and clinical findings

Answer 32

• Glycation of proteins results in cross-linking of glycated proteins and altered function
• Diabetic retinopathy and microalbuminuria
• painless foot ulcers

Question 33

DAG pathway

Answer 33

-Hyperglycemia increases DAG and PKC activation

Question 34

Hexisamine pathway

Answer 34

• Hyperglycemia forms Fructose 6-P and Hexosamine –> can make amino sugars
• Damages basement membrane

Question 35

Hypertriglyceridemia

Answer 35

-decreased action of LPL

Question 36

High 3 hydroxybutyrate

Answer 36

-HSL activity

Question 37

High LDL

Answer 37

-macrovascular complications

Question 38

Higher HbA1c levels indicate:

Answer 38

higher complications

Question 39

Microalbuminemia

Answer 39

early indicator for renal nephropathy