exam 2: glucagon Flashcards
what is 29 amino acid peptide, secreted from pancreatic ____ cells
glucagon
alpha cells
glucagon is the hormone of
starvation
secretion of glucagon is controlled by ______ levels (inverse relationship)
blood glucose
the primary target tissue for glucagon is ______ to increase blood glucose.
does this by
1
2
3
liver
1.stimulating glycogenolysis and inhibiting glycogen synthesis (bc inverse relationship)
2. increasing gluconeogenesis (new glucose)
3. increases blood FA and ketoacid levels to provide more substrates for gluconeogenesis
metabolic disorder characterized by HYPERGLYCEMIA due to insufficient insulin or cellular resistance to insulin (or both)
diabetes mellitus MI
DM is hyperglycemia due to two things:
insufficient insulin or cellular resistance to insulin
with this, it takes longer to reduce blood glucose levels and glucose levels dont reach the control level
DM
percent of type 1 and 2
type 1 10%
type 2 90%
3 classic symptoms of DM called the 3 P’s
polyuria (pee)
polydypsia (thirst)
polyphagia (hunger)
type 1 or 2?
-weight loss even though you are eating more=
-tingling, pain or numbness in the hands or feet=
weight loss= type 1
numb= type 2
what functions like a buffer for blood glucose
liver
people with severe liver disease have a difficultly maintaining a
narrow plasma glucose range
glucagon secretion is stimulated by:
1
2
3
hypoglycemia
epinephrine (B2)
vagus nerve
remaining symptoms of diabetes mellitus
extreme fatigue
blurry vision
cuts/bruises that are slow to heal
hypoinsulinemia
type 1
hyperinsulinemia
type 2
25% of patients with type 1 DM initially present in diabetic __________ (bc of high glucagon levels) (hyperglycemia >250mg/dl
ketoacidosis
diagnosis of DM glucose levels that show symptoms of HYPERGLYCEMIA: (casual plasma glucose)
what is normal:
casual plasma glucose > or equal to 200 miligrams/dl
100 and below normal (like 70-100)
A1c is the measurement of long term blood glucose levels (last 2-3 months)
A1C of DM patient:
normal patient:
> =6.5%
(normal patient <5.6%)
Diabetes Mellitus Type 1 is autoimmune destruction of
pancreatic beta cells
what are the risk factors for Diabetes Mellitus Type I
- genetic predisposition-increased susceptibility
- environmental triggers (viral infection)
- less than 40, non-obese younger patients
what is the fasting plasma glucose level for DM:
normal:
126
normal: 100
DM 2 hour post-prandial glucose:
normal:
DM: 200
normal: 140
insulin dependent diabetes:
DM type 1
when does beta destruction occur slowly
in DM type 1
when does hyperglycemia occur in DM type1:
when 80-90% of cells are destroyed
what is DM type 1 triggered by
stressor (illness)
hyperglycemia in DM type 1 lead to:
-3 p’s: polyuria, polydipsia, polyphagia
-glucosuria (glucose in urine)
-weight loss
-malaise and fatigue
-hyperkalemia (due to lack of insulin which normally activates Na/K pump)
due to increased lipolysis to fatty acids to produce ketoacids
-most common in type 1
diabetic ketoacidosis (DKA)
response to cellular starvation brought on by relative insulin deficiency and couterregulatory or catabolic hormone excess:
diabetic ketoacidosis (DKA)
hormone excess:
would be glucagon, catecholamines, cortisone and growth hormone
causes of DKA
-reduced daily insulin injections
-infection
-surgery
-cushing’s
-substance abuse
-steroids
-all have in common that stimulate catechcholamones, cortisone, glucagon, or GH
what are the pathophysiology of DKA:
- osmotic diuresis and dehydration (hyperglycemia)
- metabolic acidosis (increase H+=coma)
- fluid and electrolyte imbalances (from osmotic diuresis)
signs and symptoms of DKA
-fruity breath (acetone)
-nausea/abdominal pain
-dehydration
-tachycardia
-lethargy
-coma
-3 p’s
-kussmaul respirations (deep/ blow off CO2 to reverse acidosis)
pH and category of individual that will be in coma
pH less than 7.0
DKA/acidosis depresses neuronal function since it blocks inward current of
so that decreases nerve and muscle excitability
Na and Ca
fasting hyperglycemia despite availability of insulin=insulin resistance
DM type 2
insulin dependent:
insulin resistance:
dependent: type 1
resistance: type 2
risk factors for DM type 2
-history of diabetes in parents or siblings!!
-obesity
-physical inactivity
-race
-women
-hypertension and high cholesterol
T2DM
early in disease: DMT2 ________ due to insulin resistance
later: ______ dysfunction with impaired insulin secretion-pancreatic exhaustion
hyperinsulinemia
beta cell dysfunction
we dont really know, but think T2DM caused by:
down regulation of insulin receptors in target tissues and insulin resistance
insulin resistance is part of a cascade of disorders that are called:
5 of them:
1
2. insulin resistance
3
4
5
metabolic syndrome
- obesity, especially abdominal deposition
- insulin resistance
- fasting hyperglycemia
- lipid abnormalities (HIGH TG and LOW HDL (cholesterol)
- hypertension
those with metabolic syndrom have increased risk for CVD (Cardiovascular disease) and insulin resistance is a contributing factor for devloping
type 2 DM
chronic complications of DM
retinopathy
nephropathy
neuropathy
vascular disease
myopathies
oral manifestations of DM
-burning mouth
-xerostomia
-diminished salivary flow
-periodontal disease
-delayed healing
periodontal disease makes diabetic complications worse and someone who has it has:
-poor glycemic control
-increased cardiovascular complications
therefore, someone who has periodontal disease and DM, taking care of periodontal infection may improve
glycemic control
