FINALS Obesity and Diabetes Flashcards
What are the risk factors of obesity??
1) genes
2) Obesogenic environment
3) Medications (KNOW THESE)
4) Secondary causes:
- Cushing syndrome
- Insulinoma
- Hypothyroidism
- Polycystic ovarian syndrome
- Hypogonadism
- Pregnancy
- Growth hormone deficiency
What are “Obesogenic Medications” that cause obesity???
- Meds for Diabetes: Insulin, Sulfonylurenes, Thiazolidinediones)
- Anti-hypertensive drugs (Alpha & Beta blockers)
- ## Corticosteroids & Estrogen(“4 Anti’s”):
- Antihistamines
- Anticonvulsants
- Antipsychotics
- Antidepressants
What is the Body Mass Index (BMI) for adults?????
- Underweight <18.5
- Normal weight 18.5 - 24.9
- Overweight 25-29.9
- Obesity (Class 1) 30-34.99
- Obesity (Class 2) 35-39.9
What is the waist circumference for men and women to classify if they have CENTRAL OBESITY???
(Central Obesity is the apple shape body = abdominal fat = NOT GOOD!)
* Measure with arms straight down, measure at elbow joint!—————————-
- MEN: >40 INCHES
- WOMEN: >35 INCHES
THIS IS CONSIDERED CENTRAL OBESITY!!!!!!!!!
- Which cells REQUIRE insulin for glucose uptake?
- Which cells that DON’T require insulin?
Cells that REQUIRE:
1. Muscle
2. Fat
3. Portions of the LIVER
———————
Cells that DON’T Require :
1. Brain
2. RBCs
3. Cornea
4. Intestine
5. Kidneys
6. Portions of the liver
What are 3 main things insulin does its job??
- FUEL PROVISION (glucose into cells that require insulin: such as muscles, fat, and portions of the liver)
- STORAGE FACILITATION (Insulin stores some of extra glucose in fat cells by converting it into triglycerides and stored in the liver in the form of glycogen!)
- BREAK DOWN INHIBITION (when we get a big load of glucose, insulin tells parts of the body that we don’t need to convert/break more sugar)
What is normal blood glucose???
70-100 mg/dL
What are the actions of Insulin??? (THE GO’S AND STOP’S)
GO:
1. Glucose uptake in MUSCLE and FAT cells
2. GLYCOLYSIS (glucose is broken down in the cells to produce energy)
3. GLYCOGEN SYNTHESIS (storing glucose in the liver in the form of glycogen)
4. PROTEIN SYNTHESIS**
5. UPTAKE OF IONS (SODIUM AND POTASSIUM)*** (SHIFT potassium from serum INTO THE CELLS)
STOP:
1. GLUCONEOGENESIS (taking protein to convert it into glucose)
2. GLUCOGENOLYSIS (breaking down of stored glucose, glycogen)
3. LIPOLYSIS (breaking down of fat)
4. KETOGENESIS (converting fat into ketones)
5. PROTEOLYSIS (breaking down of proteins used for gluconeogenesis to produce glucose)
What is TYPE 1 Diabetes????
(What do these patients depend on??)
- AUTOIMMUNE DISORDER!!!! Meaning that the body attacks itself and destroys its own beta cells! (So, they have LOW insulin or no insulin at all)
- Viral infection can trigger the autoimmune cascade!
- PATIENTS WITH TYPE I DIABETES ARE DEPENDENT ON *EXOGENOUS INSULIN!!!!!!
What is TYPE II Diabetes???
- PROGRESSIVE disorder, characterized by REDUCED ABILITY OF CELLS NOT RESPONDING TO INSULIN (Insulin Resistance), which CAUSES POOR CONTROL OF LIVER GLUCOSE PRODUCTION and DECREASED BETA CELL FUNCTION OVER TIME LEADING TO BETA CELL FAILURE!!!!
What are the Modifiable VS Non-modifiable RISK FACTORS for Diabetes???
MODIFIABLE:
1. BMI greater than 26 kg/m2
2. PHYSICAL INACTIVITY
3. HDL (High-density lipoprotein) cholesterol levels ≤ 35 mg/dL AND/OR triglyceride level ≥ 250 mg/dL
4. METABOLIC SYNDROME!!!!
—————————————-
NON-MODIFIABLE:
1. Being: AFRICAN AMERICAN, LATINO, NATIVE AMERICAN, ASIAN-AMERICAN, & PACIFIC ISLANDER!!!
2. First Degree Relative w/ Diabetes
3. HYPERTENSION
4. *WOMEN WHO DELIVERED BABY WEIGHING ≥ 9lbs OR WHO WHERE DIAGNOSED WITH GESTATION DIABETES!!!
5. Women with Polycystic Ovarian Syndrome!!!!!!!!!!
6. Hgb A1C ≥ 5.7%
7. History of CARDIOVASCULAR DISEASE!!!
What is METABOLIC SYNDROME?? WHAT ARE THE FACTORS???? (What is the KEY feature of this syndrome????)
Factors:
1. INSULIN RESISTANCY!!!!!*** (KEY FEATURE)
2. Visceral obesity (Apple-shaped/ Central obesity)
3. Hypertension! Greater than or equal to 130/85!!!!!!!!!!!!
4. HIGH Triglycerides: ≥150 mg/dL
5. LOW HDL-Cholesterol (healthy cholesterol being too low) ≤ 40 mg/dL in MEN and ≤ 50 mg/dL in WOMEN!
- What happens when there is NOT enough insulin or when the cells aren’t responding to insulin???? (MANIFESTATIONS OF HAVING HIGH BLOOD SUGAR)
- So, patients with diabetes, type I in particular, often present to the health care provider with reports of what 3 things???? WEIGHT LOSS or WEIGHT GAIN???
- CELLULAR DYSFUNCTION = CELLULAR DEHYDRATION!!!!
- OSMOTIC DIURESIS = Volume loss and electrolyte loss (sodium, potassium, chloride are lost)!!
- POLYDIPSIA AND POLYURIA - CELLULAR STARVATION = fat and protein breakdown
- POLYPHAGIA
————————————————– - POLYURIA (excessive urination)
- POLYDIPSIA (excessive thirst)
- POLYDIPSIA (excessive hunger)
WEIGHT LOSS!!!! (bc of that polyuria and polydipsia)
What does HYPERGLYCEMIA do to Blood Vessels? To serum lipids??
- Vessel wall thickening
- Tendency toward vasoconstriction
- Serum lipids not stored appropriately
There are 3 major CLASSIFICATIONS of chronic complications of HYPERGLYCEMIA?????
- LONG TERM complications: Renal failure, cardiovascular disease, neuropathy, wound healing delays, eye changes.
- Things that can kill a diabetic over the course of days-weeks: DKA and HHS!!!
- Things that can kill a diabetic QUICKLY: HYPOGLYCEMIA!!!! Because it can cause comatose and death!!