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LCRS > Endocrinology 5 - Diabetes Mellitus > Flashcards

Endocrinology 5 - Diabetes Mellitus Flashcards

1
Q

How does glucose move into muscle and adipose tissue?

A

Via the GLUT-4 protein. Insulin recruits + stimulates transporters from the cytoplasm to move to the membrane.

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2
Q

What is the structure of the GLUT-4 protein?

A

Has a hydrophobic outer embedded to the membrane and a hydrophilic core, which allows glucose into the cell.

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3
Q

What are the effects of insulin on the liver?

A
  1. Increased protein synthesis.
  2. Decreased protolysis.
  3. Inhibits gluconeogenesis.
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4
Q

What are the effects of insulin on adipocytes?

A
  1. Breaks down triglycerides in the blood to glycerides and non-esterified fatty acids so they can enter the adipocytes (lipoprotein lipase stimulated by insulin).
  2. Promotes formation of triglyceride and fat using glucose.
  3. Inhibits lipolysis.
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5
Q

What is a simple indicator of someone’s risk of ischaemic heart disease?

A

Their waist circumference - omental fat.

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6
Q

How is glycerol used by the liver?

A
  1. Make triglycerides (enters lipoprotein particles).

2. Gluconeogenesis (2 glycerols = glucose).

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7
Q

What fuel can the brain use and what cannot it use?

A

Can use glucose and ketone bodies. Cannot use fatty acids.

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8
Q

What is the effect of insulin on ketone bodies?

A

Insulin inhibits the conversion of fatty acyl CoA to ketone bodies. (glucagon does opposite)

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9
Q

What increases gluconeogenesis in the liver?

A
  1. Cortisol.
  2. Somatotrophin.
  3. Catecholamines.
  4. Glucagon.
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10
Q

What promotes the conversion of fatty acyl CoA to ketone bodies?

A

Glucagon.

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11
Q

What are ketone bodies?

A

Three water-soluble molecules produced by the liver from fatty acids during periods of low food intake:

  1. Acetone.
  2. Acetoacetic acid.
  3. Beta-hydroxybutyric acid.
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12
Q

What is the effect of insulin on glycogenolysis?

A

Insulin promotes the storage of glucose as glycogen (Glucose => Glucose-6-phosphate => glycogen).

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13
Q

What promotes glycogenolysis?

A
  1. Glucagon.

2. Catecholamines.

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14
Q

What is the effect of insulin on glucose uptake by muscle cells?

A
  1. Promotes uptake of glucose via GLUT-4.

2. Glucose is then stored as glycogen but mainly used as fuel source.

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15
Q

What inhibits uptake of glucose via GLUT-4 in muscle cells?

A

Stress hormones.

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16
Q

In a fasted state, what is your insulin:glucagon ratio and what does this result in?

A
  1. Low insulin to glucose ratio.
  2. Increase in protolysis, lipolysis, gluconeogenesis + glyconeolysis (HGO).
  3. Ketogenesis after prolonged time (for brain).
    Decrease in AA concentration after a prolonged time.
17
Q

In a fed state, what is your insulin:glucagon ratio and what does this result in?

A
  1. High insulin to glucagon ratio.
  2. Increase in protogenesis, lipogenesis and glycogen.
  3. Decrease in protolysis, glucogenesis (stop HGO).
18
Q

What happens during insulin induced hypoglycaemia?

A
  1. Increase in insulin, glucagon, catecholamines, cortisol and somatotrophin.
  2. Decrease in HGO and lipolysis.
19
Q

What happens during T2DM?

A
  1. Increase in LDL cholesterol, triglyceride and circulating NEFA (non essential fatty acids).
  2. Decrease in lipoprotein lipase activity, VLDL clearance and HDL cholesterol.
20
Q

How do you distinguish between T1DM and T2DM?

A

T2DM has enough insulin to suppress ketone production and to stop protolysis. Therefore if glucose + ketone are high and losing weight = T1DM.

21
Q

What are the 2 pathways affected by insulin?

A
  1. Mitogenic pathway (MAPK).

2. Metabolic pathway (PI3K-Akt).

22
Q

Which pathway has insulin resistance?

A

The metabolic pathway.

23
Q

What types of tissue does insulin resistance reside in? (3)

A
  1. Liver tissue.
  2. Muscle tissue.
  3. Adipose tissue
24
Q

What is compensatory hyperinsulinaemia?

A

Someone with insulin resistance making more insulin to maintain normal blood glucose (T2DM).

25
Q

How does high insulin harm a person?

A

Has an increased effect on the mitogenic pathway (MAPK).

26
Q

How can the diet be controlled to manage T2DM?

A
  1. Reduce fat, refined carbohydrates and sodium.
  2. Increase complex carbohydrates and soluble fibre.
  3. Control total calorie intake.
27
Q

What are the features of someone with insulin resistance? (9)

A
  1. Hypertension.
  2. High triglyceride.
  3. Low HDL.
  4. High LDL.
  5. Fasting blood glucose > 6.0mmol/l.
  6. Adipocytokines.
  7. Inflammatory state.
  8. Energy expenditure affected.
  9. High Omental fat.
28
Q

What is HGO (Hepatic Glucose Output)?

A

The glucose produced from gluconeogenesis and glycogenolysis in the liver that enters the circulation.

29
Q

What are the effects of insulin on muscle cells?

A
  1. Stops proteolysis.
  2. Increases re-synthesis of proteins.
  3. Increase glucose uptake through GLUT-4.
30
Q

Can fat re-enter the glucose pathway?

A

No

31
Q

What is an indication that someone is Insulin deficient?

A

High glucose + High ketone bodies.

32
Q

After a 10 hour fast, what percentage of our HGO is supported by gluconeogenesis?

A

25%

33
Q

What is type 1 Diabetes Mellitus? And what are its consequences?

A

Absolute insulin deficiency.

  1. Proteolysis and weight loss.
  2. Hyperglycaemia.
  3. Glycosuria and osmotic symptoms (polyuria and polydipsia).
  4. Ketonuria.
34
Q

What would you give to someone suffering from an insulin induced hypoglycemic shock?

A

Intramuscular glucagon.

35
Q

What is a major cause for heart disease in people with diabetes?

A

Dyslipidaemia (Increase in LDL)

36
Q

What does the control of insulin concentration in blood mainly depend on?

A

Blood glucose concentration.

37
Q

What is type 2 diabetes mellitus? And what are some of the signs of it? (6)

A

Insulin resistance.

  1. 60-80% obese.
  2. Dyslipidaemia.
  3. Hyperglycaemia.
  4. T2DM presents with complications whereas T1DM hardly presents with complications.
  5. Fewer osmotic symptoms.
  6. Later insulin deficiency (exhaustion of beta cells).

LCRS (22 decks)

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