INP final - DIABETES Flashcards
Flashcards for the second half of the INP course. This set will cover DIABETES
What is the major function of insulin?
- powerful anabolic “builder” hormone
- helps control blood glucose levels by signaling the cells (liver, muscle, fat, etc) to take in glucose from the blood
- helps cells to take in glucose to be used for energy and if body has sufficient energy, insulin signals the liver to take up glucose and store it as glycogen
Insulin increases (which processes)?
- glycogen synthesis
- protein synthesis
- lipogenesis
- glucose uptake
Insulin decreases (which processes)?
- glycogenolysis
- gluconeogenesis
- ketogenesis
- proteolysis
- lipolysis
What is diabetes?
- multifactorial disease that is caused by many factors such as physical inactivity, diet, endocrine disruptors that influence metabolism, viruses (leading to T1D) and the microbiome
- abnormal glucose elevations due to absence of insulin (T1) or resistance to insulin (T2)
How is diabetes diagnosed in adults?
- HbA1c >6.5%
- fasting plasma glucose of 126 mg/dL
- 2h post-prandial glucose of 200 mg/dL on OGTT or randomly
What is the difference between type 1 and type 2 diabetes?
TYPE 1 - INSULIN DEPENDENT beta cell destruction, GADA +, C-peptide < 0.3 nmol/L -> GADA are glutamic acid decarboxylase antibodies and they are the MOST important factor for prediction of insulin therapy and is the most common used predictive marker for diabetes low levels of C-peptide is associated with a low level of insulin production
TYPE 2 - NON-INSULIN DEPENDENT insulin resistance + defective insulin secretion (relatively impaired beta-cell function; delayed or inadequate insulin secretion)
- LADA GADA +, C-peptide >0.3 nmol/L
How is Alzheimer’s disease related to diabetes?
- impairments of cerebral glucose utilization and energy metabolism and impaired insulin signaling
- chronic insulin resistance plus deficiency confined to the brain is the pathogenic mechanism seen in AD neurodegeneration
- both oligomers of beta-amyloid (which are elevated in the AD brain) are pro-inflammatory cytokines (which are elevated in the aged or AD brain) can be used to mimic the trophic factor/insulin resistance observed in AD
What is insulin sensitivity?
the ability of cells to respond to insulin by it binding to the receptors on the cells
What is insulin resistance?
- low insulin sensitivity and is characterized by the inability of the receptors on the cells to respond to insulin despite its presence
- may be a cellular antioxidant defense mechanism. It involves cells not being as responsive to the hormone insulin —> high levels of insulin as well as high blood sugar
What is the time course of changes in glucose and insulin that leads to T2D?
- pancreas can no longer adjust to the continuous increases in glucose – overtime the beta cells of the pancreas fail
- then pancreas produces less and less insulin which means that the level drops significantly
What impacts insulin sensitivity?
- Genetic determinants (Gene-environment interaction)
- Demographics (Age, sex, race, ethnicity)
- Weight status
- Physical activity
- Impairments in brain glucose utilization and insulin signaling cause neurodegeneration & cognitive impairment (type 3 diabetes)
What are the complications of diabetes?
- CVD: damage to microvasculature; peripheral vascular disease
- Hypertension: stiffening of arteries
- Neuropathy: nerve damage, reduced sensation in feet
- Immune deficiency: increased risk of infections
- Premature aging: cognitive impairments
Who should be screened for diabetes?
People with:
- Family history of diabetes mellitus
- History of Gestational Diabetes
- Women delivering a baby larger than 9 pounds
- Women with polycystic ovary syndrome
- High risk ethnicities
- Sedentary lifestyle
- CVD
- Metabolic syndrome features
- middle age
What types of evaluations should be performed on diabetic px?
- medical history
- physical examination
- lab blood work
- imaging
What lifestyle changes are recommended for patients with diabetes?
- increase sleep (sleep is restorative)
- decrease stress
- increase physical activity
- healthy diet and glucose monitoring
