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PSIO 469 Exam 04 > Lecture 20: Gestational Diabetes > Flashcards

Lecture 20: Gestational Diabetes Flashcards

1
Q

What is Gestational Diabetes Mellitus (GDM)?

2

A
  • Glucose intolerance with onset or first recognition

- Insufficient pancreatic Beta-cell function

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2
Q

If a women who has a history of GDM, she is more likely to have worsen effects when pregnant.
T/F

A

True

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3
Q

Most, but not all women with GDM will develop diabetes ______ of pregnancy

A

outside

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4
Q

GDM is caused by?

3

A
  • Insulin resistance (most common)
  • Auto-immune disease (less common)
  • Monogenic causes (single gene defect, rare)
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5
Q

What are 2 reasons for the rise in GDM?

A
  • Increased screening during pregnancy

- Changes in diagnostic criteria

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6
Q

What explanations because of increased screening?

A
  • More women are being screened

- Undiagnosed diabetes is being diagnosed first in pregnancy

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7
Q

What was the mean GDM percentage in 1991?

What is the mean GDM percentage in 2000?

A
  • 5.1

- 6.9

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8
Q

Blood glucose homeostasis is maintained within the ____ ______.

A

Narrow Range

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9
Q

What is the normal range when fasting?

A

70-100mg/100ml or (3.9-5.5mmol/L)

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10
Q

What happens during Hypoglycermia when it is less than 2.5 mmol/L? (4)

A

Confusion, Drowsiness, Coma, Seizure

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11
Q

What happens during Hypoglycemia when it is less than 2.7 mmol/L? (7)

A

Nervousness, Sweating, Intense Hunger, Trembling, Weakness, Irregular Heart Rate, Difficulty Speaking

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12
Q

What happens during Hyperglycemia when it is greater than 14 mmol/L? (5)

A

Frequent Urination, Sugar in Urine, Frequent Thirst and Hunger, Ketoacidosis, Coma

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13
Q

Insulin is the only hormone capable of:

A

lowering blood glucose

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14
Q

Actions of insulin lowering blood glucose

A
  • Promotes cellular uptake of glucose form the blood
  • Promotes energy storage
  • Promotes utilization for energy production
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15
Q

Which cells in the Islets of Langerhans sense blood glucose levels?

A

Pancreatic Beta Cells

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16
Q

When Blood glucose rises, Pancreatic Beta-cells:

A

Secrete insulin into systemic circulation

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17
Q

Starting with the uptake of glucose by the _____ transporter, the phosphorylation of glucose causes a rise in the ___:___ ratio

A

GLUT2

ATP; ADP

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18
Q

The rise in the ATP:ADP ratio ______ the potassium channel that _________ the membrane, causing the ______ channel to ____ up allowing calcium ions to flow ____.

A 
inactivates
depolarizes
calcium
open
inward
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19
Q

The ensuing rise in levels of _____ leads to the ______ of insulin from storage _______

A

Calcium
exocytosis
granules

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20
Q

Insulin Structure

Insulin is a _____ hormone derived from ____

A

peptide; proinsulin

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21
Q

Insulin Structure

_-_______ is cleaved off during processing and packaged along with _____ in storage granules

A

C-Peptide

Insulin

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22
Q

Insulin Structure

C-peptide is _____ along with insulin from _______ ____-______.

A

released

Pancreatic Beta-Cells

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23
Q

This muscle is the principal site of whole-body glucose disposal

A

Skeletal

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24
Q

Less_____ is transported into _____ tissue than into _____ muscle but ____ is still an important tissue for glucose uptake

A

Glucose, adipose, skeletal, adipose

25
Q

This is the main insulin-responsive glucose transporter

A

GLUT-4

26
Q

GLUT 4 is both expressed in skeletal muscle and adipose

T/F

A

True

27
Q

When insulin levels are low, GLUT-4 is stored in

A

Intracellular Vesicles

28
Q

Insulin-Stimulated Glucose Uptake

_____ is stored in intracellular vesicles.

A

GLUT-4

29
Q

Insulin-stimulated Glucose Uptake
Insulin binds to the _______ domain of its receptor in the _____ membrane, resulting in ______ of _____ portion of the receptor (a _____ kinase)

A 
extracellular
plasma
phosphorylation
intracellular
Tyrosine
30
Q

Insulin-stimulated Glucose Uptake

The activated ____ kinase phosphorylates insulin-receptor _______ such as the ___ molecules

A

Tyrosine
substrates
IRS

31
Q

What are the IRS molecules being referred to ?

A

IRS-1
IRS-2
IRS-3
IRS-4

32
Q

Insulin-stimulated Glucose Uptake
These insulin-receptor substrates form ______ with docking _____ such as ______ at its regulatory ___ by means of ___ domains

A

complexes
proteins; PI-3K
p85
SH2

33
Q

Insulin-stimulated Glucose Uptake

____ is the constitutively bound to the catalytic subunit (____)

A

p85

p110

34
Q

Insulin-stimulated Glucose Uptake

Activated of ____ is a major pathway in the mediation of insulin stimulated glucose transport and metabolism

A

PI-3K

35
Q

PI-3K activates _______-______ kinases that participate in the activation of _____ ______ _ and typical forms of _____ _____ _____

A

phosphoinositide-dependent
protein kinase B
protein kinase C

36
Q

Protein kinase B is aka?

Protein kinase C is aka?

A
  • Akt

- PKC

37
Q

Insulin-stimulated Glucose Uptake
____ stimulates glucose transport by pathways that are independent of _______ kinase and that may involve ________activated kinase

A

Exercise
phosphoinositide-3
5’-AMP

38
Q

When is the Oral Glucose Tolerance Test used on pregnant women?

A

24th-28th week (end of second trimester)

39
Q

What does the Oral Glucose Tolerance Test do?

A
  • measure levels of glucose in the mother’s blood following ingestion of sugary drink (100g dextrose)
  • abnormal levels may indicate gestational diabetes
40
Q

Postpartum blood glucose in GDM group was ____ to pregnant controls (______ insulin action resolves with delivery of baby)

A

similar

inadequate

41
Q

Normal Glucose Regulation during Pregnancy
Normal pregnancy is characterized by _____ decrease in insulin mediated glucose uptake and a ___-____ increase in insulin secretion to maintain _____ in pregnant mothers

A

50%
200-250%
euglycermia (normal blood glucose levels)

42
Q

Progressive insulin resistance begins near mid-pregnancy and progresses through the _____ trimester to levels that are approximate insulin resistance seen in ___-__ ________.

A
  • third

- Type-2 Diabetes

43
Q

Pancreatic Beta-cells normally ______ insulin secretion to compensate for _____ resistance of pregnancy

A

increase

insulin

44
Q

Normal Glucose Regulation during Pregnancy
changes in circulating _____ levels over a course of pregnancy are quite _____ compared with ____ changes in insulin sensitivity.

A

glucose
small
large

45
Q

Insulin Resistance may be due to:

2

A
  • increased maternal adiposity

- Insulin-desensitizing effects of placental hormones

46
Q

What is an example of placental hormones?

A

Human placental lacotgen or human chorionic somatomammotropin

47
Q

Rapid abatement of insulin resistance after delivery suggests:

A

Major contribution from placental hormones

48
Q

Abnormal Glucose Regulation with GDM
Insulin secretion is ____ to compensate for the insulin resistance, leading to _______ that is detected by routine glucose screening in pregnancy

A

inadequate

hyperglycemia

49
Q

Abnormal Glucose Regulation with GDM

Gestational diabetes results from:

A

inability of pancreatic Beta-cells to make enough insulin

50
Q

Increased insulin resistance with GDM

Glucose Infusion Rate (GIR) is ____ in pregnant women than in women with _____

A

higher

GDM

51
Q 
Increased Insulin Resistance with GDM
Lower GIR (\_\_-\_\_%) in women with GDM indicates \_\_\_\_ glucose uptake and \_\_\_\_\_ insulin resistance
A

30-40
less
more

52
Q

Women who had GDM will have less insulin resistance post partum.
T/F

A

False, they will have more

53
Q

What are some risk factors for GDM?

which one is not a modifiable risk factor

A
  • Obesity
  • Physical inactivity
  • Diet in Saturated Fat
  • Smoking
  • Advance Maternal Age
  • Family history of Diabetes (not modifiable)
54
Q

What are some ways obesity increases risk of GDM?

A
  • Increased Circulating levels of leptin
  • increased inflammatory marker TNF-alpha and C-reactive protein
  • Decreased levels of adiponectin
  • Increased fat in liver and muscles
  • Abnormal sub-cellular localization of GLUT4 transporters
55
Q

What are some treatments in GD?

A
  • Low-carb diet
  • Exercise
  • Maintain healthy pregnancy weight
  • Monitor glucose levels
  • If necessary, take daily insulin injections
56
Q

What are some risks to the offspring of GDM mothers?

A
  • Greater birth weight (macrosomia)
  • Obesity
  • Increased of Type 2 diabetes
57
Q

____ is the most important risk factor for development of _________ in youth

A

Obesity

Type 2 diabetes

58
Q

_____ has led to dramatic _____ type 2 diabetes among _____ and _____ over the past 2 decades

A

Obesity
increase
youth; adolescents

PSIO 469 Exam 04 (5 decks)

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