Exam 2 pre lecture Flashcards
what is polyuria
frequent urination
polydipsia meaning
excessive thirst
what is polyphagia
lack of weight gain and feeling hungry
WHat are the 3 cardinal signs of diabetes
polyuria, polydipsia, polyphagia
What is the mechanism leading to the 3 polys
high BG leads to glucose in urine.
This leads to excessive water loss (polyuria) leading to dehydration and polydipsia.
Inability to utilize glucose as fuel lowers BW and leads to excessive hunger
what is the criteria for diagnosis of diabetes
A1C > or = 6.5% or fasting plasma glucose (FPG) > or = 126
2-H plasma glucose of >200
random plasma glucose >200
Type 1 diabetes is also known as
Insulin dependent diabetes mellitus (IDDM)
What percent of people have type I DM
10%
insulin secretion in Type I DM
no functional insulin secretion due to near complete loss of pancreatic B cells
Type I DM may cause ________
ketoacidosis
Why does T 1 DM lead to ketoacidosis
We use fatty acids for fuel leading to the production of ketoacids
Age onset of T I DM
early
what is T I DM
an autoimmune response that specifically targets pancreatic B cells
FH for T 1 DM
often negative family history
What are the two antibodies that suggest an immune response against pancreatic B cells
ICA- islet cell cytoplasmic antibodies
IAA- Insulin antibodies
how does T 1 DM appear as person ages
Early on, they have 100% BCM (Beta cell mass) and are ICA and IAA negative. presence if ICA and IAA suggest immune response to pancreatic B cell. loss of BCM is gradual and fasting blood glucose (FBG) is normal until 70% of BCM is lost.
what is OGTT, what is it used for?
Oral glucose tolerance test, we give large bolus of glucose and BG is measured. SHows hyperglycemia if BCM does not have enough insulin to bring it down.
What is C-peptide
It indicates the presence of functioning B cell mass. It is a marker for insulin secretion even if they are receiving exogenous insulin
No c-peptide= no BCM left
sensitivity vs selectivity difference
sensitivity- if someone does not have type I DM, but have IA-2 they have a 57% chance of developing it
selectivity- 99% of T 1 DM have antibodies against IA-2
T 2 diabetes % of diabetic population
90
T 2 DM is also known as_________ and can be classified into _______ and ________
non-insulin dependent diabetes mellitus
can be classified into obese and non-obese
percentage of obese T 2 DM pts
80%- obese, 10% non-obese
non obese T 2 DM is often referred to as
MODY (maturity onset diabetes of young)
Why is T2 DM referred to as MODY
age of onset is below 25
age of onset of obese T 2 DM
usually over 35
Which one is positive for FH, T1 or T2
T2
Insulin secretion in T1 vs T2
T1 has no secretion while T2 has low secretion
what aspect of obese T 2 diabetics leads to loss of B cell mass
Obese T 2 diabetics show insulin resistance, this leads to overproduction of insulin stressing B cell. Leads to loss of B cell mass.
What are the 4 consequences of lack of insulin
Hyperglycemia-
glucosuria
hyperlipidemia
uninhibited glucagon secretion-
How does a lack of insulin affect glycogen synthesis
decreases it
how does a lack of insulin affect gluconeogenesis
insulin inhibits gluconeogenesis. A lack causes aa conversion into glucose
how does a lack of insulin lead to hyperlipidemia
causes increased fat mobilization from fat cells.
Also increased fat oxidation (leads to ketoacidosis sue to accumulation of ketone bodies)
relationship between insulin and glucagon
glucagon is opposite of insulin. Insulin inhibits glucagon.
prolonged hyperglycemia complications
Cardiovascular
neuropathy
nephropathy
ocular
increased susceptibility to infections
what are some CV complications hyperglycemia could cause
Micro and macro angiopathy (damage to large and small BV)
what are some neuropathies hyperglycemia could cause
accumulation of glucose in nerves are then reduced by aldose reductase to sugar alcohol. This leads to reduced protection from oxidative damage and H20 accumulation in neurons
What are some nephropathies caused by hyperglycemia
Changes in renal vasculature and to glomerular basement membrane
What are some ocular complications that could be caused by hyperglycemia
Cataracts, retinal microaneurism
Insulin therapy goals in diabetics
keep avg glucose below 150.
fasting-70-110
pre-meal- 80-130
peak food- less than 180
ideal A1c vs A1c for diabetic pt
ideal 6 or below
diabetic 7 or below
Why is A1c a goof measure
It is considered a good average of total glucose levels because it is a sum total of the exposure of erythrocytes to glucose concentration in blood stream
