Endocrine 1 Flashcards
What are the 3 big categories of insulin resistance? What are some examples?
a. making bad insulin
b. circulating insulin competition (receptors Abs, insulin Abs, inhibitors)
c. target tissue defects (receptor defect, post-receptor defect)
Tell me the following about DM1 and DM2:
a. age of onset
b. weight
c. HLA link
d. concordance
e. Islet Abs
f. C-peptide level
g. ketoacidosis
a. 30
b. low, high
c. yes, no
d. 50%, 100%
e. yes, no
f. low, normal
g. yes, no
Is insulin resistance due to a decrease in the number of receptors?
No.
Is insulin resistance due to a decrease in the number of receptors?
No.
What are two reasons for insulin resistance?
a. IR tyrosine kinase is impaired.
b. GLUT4 translocation/activation is impaired.
What are the three big signs of metabolic disease?
a. HTN
b. obesity
c. hyperlipidemia
What are the levels of hyperlipidemia in metabolic disease for HDL and triglycerides?
HDL 150
What are the differences between DKA and HHNC for the following:
a. serum glucose
b. pH
c. HCO3
d. osmolarity
a. >250, >600
b. 7.3
c. 20
d. variable, >=330
What are some causes of HHNC?
a. new DM2 dx
b. missed meds
c. infection
d. unknown
What are the Dx criteria for DM2?
a. A1c > 6.5%
b. fasting glucose >= 126
c. random glucose > 200 with symptoms
* all should be rechecked*
What are the Dx criteria for DM2?
a. A1c > 6.5%
b. fasting glucose >= 126
c. random glucose > 200 with symptoms
* all should be rechecked*
How can you treat retinopathy?
anti-VEGFs like ranibizumab.
What are the 4 acute complications to DM2?
a. hyperglycemia
b. DKA
c. HHNC
d. infection
What are the 3 microvascular complications of DM2?
a. retinopathy
b. neuropathy
c. nephropathy
what are the 3 macrovascular complications of DM2?
a. CVD
b. CAD
c. peripheral vascular disease
what are the 3 macrovascular complications of DM2?
a. CVD
b. CAD
c. peripheral vascular disease
What releases glucagon?
alpha cells in the islets of langerhans.
Where are ketones produced? What is the effect of insulin on this process?
Produced in the liver.
Insulin decreases ketone production.
Where are ketones produced? What is the effect of insulin on this process?
Produced in the liver.
Insulin decreases ketone production.
Insulin causes decreases in what 5 substrate concentrations?
a. glucose
b. ketones
c. K+
d. FAs
e. triglycerides
Glucagon causes an increase in what 2 substrate concentrations?
a. glucose
b. ketones
What do catecholamines do to serum FFA levels?
increase… the release FFAs into circulation.
What 4 things do glucocorticoids do?
a. mobilize FFAs
b. GLUCONEOGENIC
c. increase ketone synthesis
d. decrease in peripheral glucose use
What 5 things do growth hormones do?
a. mobilize FFAs
b. favor ketogenesis
c. increase hepatic glucose output
d. reduce peripheral glucose use
e. promote protein synthesis
Where is GLUT4 found? Is it insulin responsive?
Found in skeletal muscle, heart, and adipose cells. It is insulin sensitive.
Where is GLUT4 found? Is it insulin responsive?
Found in skeletal muscle, heart, and adipose cells. It is insulin sensitive.
Where is GLUT1 highly concentrated?
brain(!) and endothelial cells.
Where is GLUT2 found, and what is it’s major function?
Found in kidneys, liver, pancreatic beta-cells. It senses glucose levels in islets.
What is special about GLUT5?
It has a high affinity for fructose.
Where is GLUT3 found?
neurons and placenta.
Where is GLUT3 found?
neurons and placenta.
What are the two ways somebody can develop DM1? Gives examples?
a. Genes: HLA-linked
b. Environmental Insult: viral infection and/or damage to beta-cells.
What is reduced in DKA, and what is increased?
Reduced: circulating insulin and its effects
Increased: glucagon, catecholamines, cortisol, growth hormone
Can you hold the insulin of DM1 pts ever?
No. Never. Never. Never.
What are the 5 I’s that precipitate DKA?
a. Infection
b. Insulin (missed)
c. Infarction
d. Ishcemia
e. Intoxication
