Glucose and fat metab + T1D

Question 1

RLS in FA synthesis

Answer 1

conversion of acetyl coa to malonyl coa by ACC

Question 2

What are the primary fuel source for m during fasting (not starving)?

Answer 2

FFAs

but also:
aa from muscle
glycogen from muscle indirectly

Question 3

Liver metabolism switches fro glycogenolysis and gluconeogenesis in the fasting state to what in the starvation state?

Answer 3

FA oxidation in adipose tissue –> glycerol –> slower gluconeogenesis

Ketone body formation
- hallmark of starvation

Question 4

Hallmark of starvation

Answer 4

ketone bodies due to ketoacidosis from hepatic ketogenesis

-

Question 5

What gives you a fruity breath?

Answer 5

Acetone, which is not metabolized.
- it is one of the ketones

Common sx of DKA

Question 6

Microvascular disease

Answer 6

Dysfxn of organs (kidney, eyes, nerves) produced by hyperglycemia/diabetes.

Question 7

Diabetic Fasting glucose

Answer 7

> 126 mg/dl

Question 8

diabetic 2hr plasma glucose (GTTT)

Answer 8

> 200 mg/dl

Question 9

diabetic HBA1c

Answer 9

> 6.5%

represents average blood sugar over 3 months

Question 10

Impaired fasting glucose

Answer 10

100-125 mg/dl

Question 11

Impaired glucose tolerant (IGT) after 2 hours

Answer 11

140-199 mg/dl

Question 12

Impaired HBA1c

Answer 12

5.7-6.4%

Question 13

You will expect to see low C-peptide in which diabetes?

Answer 13

T1D - evidence of insulin deficiency

Question 14

DKA is usually seen in which diabetes?

Answer 14

T1D - more reliant on FAs+Ketones

T2D - more gradual

Question 15

How does pancreatic diabetes result?

Answer 15

surgical removal of pancreas or injury to pancreas

• affected individuals lack glucagon and insulin
• may have pancreatic malabsorption, diarrhea, steatorrhea, fat soluble vit def.
• UNDERWEIGHT

Question 16

GSD that does not result in liver enlargement

Answer 16

GSD 0

- glycogen synthase def

Question 17

Islet cells Antibodies in T1D

Answer 17

1. ZnT8
2. GAD65
3. IA2
4. Antibody to insulin

> 2 = will get T1D and hyperglycemia

Question 18

When you have overt diabetes, what test should you run?

Answer 18

C-petide

in progressive loss, glucose is still nl

Question 19

2 loci associated with T1D

Answer 19

MHC + HLA

Question 20

HLA genetic risk for T1d

Answer 20

50% genetic risk for T1D is thanx to HLA genes

They bind peptides w/in the cell and present these proteins to cells w/in the immune system (Tcells)
- self recognition promoted

Question 21

Highest risk HLA genotype

Answer 21

DR3/4

• 2.4% of population
• risk of having T1D by age 20

Question 22

Protective HLA genotypes

Answer 22

DQA1 0102
DQB1 0602

(DQB1 0302 is bad - 7x more likely to get diabetes)
- 6 pack is good

Question 23

Accelerator hypothesis

Answer 23

increase in childhood obesity –> beta cell stress –> expose beta cell antigens

Question 24

essential cofactors for PDH

Answer 24

Vit B 1,2,3,5
Lipoic acid

(one of those is niacin)