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BSNC 2000 > Metabolism & Diabetes > Flashcards

Metabolism & Diabetes Flashcards

1
Q

Normal blood glucose levels

A

4-7 mmol/L

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2
Q

Glycogen

A

long-term storage of glucose

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3
Q

Where is glycogen produced

A

skeletal muscle

liver

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4
Q

Glycogenolysis

A

breakdown of glycogen to glucose in the liver

maintain blood glucose livers between meals (fasting state)

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5
Q

Glycogenesis

A

conversion of glucose –> glycogen

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6
Q

Gluconeogenesis

A

glucose synthesis from non-carbohydrate sources (fatty acids & amino acids)

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7
Q

Glycolysis

A

breakdown of glucose –> ATP production

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8
Q

Hypoglycemia definition

A

abnormally low blood glucose levels

<4.0 mmol/L

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9
Q

Hyperglycemia definition

A

abnormally high blood glucose levels

>10.0 mmol/L

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10
Q

Hypoglycemia symptoms

A 
early:
tremors
mood changes (irritability, anxiety)
nausea
hunger
cool, clammy skin 
weakness, fatigue
dizziness, vision changes
tachycardia
late:
decreased LOC
confusion, inattention
seizures 
behavior changes, lack of coordination
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11
Q

Hyperglycemia symptoms

A 
hunger
thirst
dehydration
fatigue 
kussmaul respirations 
reduced weight
poor wound healing 
polyuria
blurred vision 
fatigue (high blood glucose, low cellular glucose)
paresthesia
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12
Q

Polyphagia

A

increased hunger

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13
Q

Polydipsia

A

increased thirst

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14
Q

Blood glucose tests

A 
glycated hemoglobin (HgbA1C)
random blood glucose test
oral glucose tolerance test 
fasting glucose test (>8 hours)
capillary blood glucose monitoring (self-monitoring)
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15
Q

Glycated hemoglobin

A

glucose adheres to hemoglobin molecules

used to measure average blood glucose levels over a 3 month period

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16
Q

Lifespan of RBC’s

A

120 days

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17
Q

Insulin

A 
hormone produced by pancreatic B cells
increases glycolysis
increases glycogenesis
increases lipogenesis
increases protein synthesis
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18
Q

Glucagon

A 
hormone produced by pancreatic alpha cells 
increases glycogenolysis 
increase gluconeogenesis 
increase lipolysis 
increase ketogenesis
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19
Q

Counterregulatory hormones

A

sympathetic catecholamines - epinephrine, norepinephrine
cortisol
glucagon
growth hormone

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20
Q

Diabetes definition

A

metabolic disorder resulting in body’s inability to blood glucose levels. can be caused by insulin deficiency or resistance

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21
Q

Type 1 Diabetes

A 
10% of cases 
early onset
absolute insulin deficiency
usually requires insulin therapy
results from autoimmune destruction of pancreatic b cells
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22
Q

Type 2 Diabetes

A

90% of cases
adult onset
relative insulin deficiency + insulin resistance
can be managed with lifestyle changes, pharmacologic treatment
eventually may require insulin therapy

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23
Q

Insulin resistance

A

cells are unable to respond to insulin leading to impaired glucose regulation
can be caused by decreased # of insulin receptors or glucose transporters

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24
Q

Causes of Hypoglycemia

A 
poor nutrition
medication (too much insulin)
insulin antagonist deficiency 
increased exercise 
stress (mental, physical, illness)
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25
Q

Ketogenesis

A

free fatty acids are converted into ketones by the liver

distributed in the bloodstream to be used as an alternate energy source by body cells

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26
Q

Diabetes complications

A

endothelial injury –> atherosclerosis
nephropathy
peripheral neuropathy
perfusion issues –> decreased wound healing
development of chronic conditions (stroke, hypertension, hyperlipidemia)
retinopathy

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27
Q

Diabetes & Vascular changes

A

glucose is inflammatory –> damage endothelium & basement membrane
cause stiffening/thickening of blood vessels –> reduced compliance

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28
Q

Diabetic Ketoacidosis

A 
hyperglycemic state >13.8 mmol/L
more common with type-1 diabetes
low serum bicarbonate
low arterial pH
urine/serum ketones
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29
Q

Types of diabetes

A

Type 1
Type 2
Gestational
Other

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30
Q

Ethnic groups at risk of T2DM

A

Indigenous
African
Hispanic/Latino
Asian

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31
Q

Modifiable Risk Factors

A 
Diet (high fat, high calorie)
Weight
Exercise 
Chronic conditions (HTN, malabsorption, vitamin D deficiency)
Chronic stress 
Medication
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32
Q

Non-modifiable risk factors

A

Age

Family history/genetics

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33
Q

Acanthosis nigricans

A

velvety darkening of skin

commonly found in neck, axilla, groin folds

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34
Q

Diagnostic tests

A 
blood glucose tests
antibody testing
lipid analysis
renal function
CRP protein
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35
Q

15/15 Rule

A

used to treat hypoglycemia
15 grabs of quick-acting carbohydrate every 15 min
severe hypoglycemia = 30 g carb

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36
Q

Types of Insulin

A

short-acting
intermediate
long-term
rapid-acting

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37
Q

Macronutrients

A

large organic molecules
carbohydrates
proteins
fats

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38
Q

Micronutrients

A

vitamins & minerals

act as enzyme co-factors

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39
Q

Major Minerals

A 
Calcium
Phosphorous
Magnesium
Sodium
Potassium
Chloride
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40
Q

Older Adult Malnutrition RF

A 
impaired chewing (dentures, muscle weakness)
decreased saliva production, dysphagia
decreased sense of taste/appetite
elongated esophagus
impaired swallowing d/t muscular atrophy
decreased metabolic function of liver, pancreas, gallbladder
chronic conditions 
medications
socioeconomic status
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41
Q

Underweight BMI

A

<18.5

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42
Q

Overweight BMI

A

25-29.9

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43
Q

Obesity Class I BMI

A

30-34.9

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44
Q

Obesity Class II BMI

A

35-39.9

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45
Q

Obesity Class IV BMI

A

> 40

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46
Q

Protein deficiency

A

impaired tissue repair

decreased liver proteins (clotting factors, inflammatory proteins, plasma proteins)

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47
Q

Carbohydrate deficiency

A

weight loss due to gluconeogenesis

ketoacidosis

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48
Q

Fat deficiency

A

impaired plasma membranes

decreased steroid hormone synthesis?

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49
Q

Folate

A

important for CNS development

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50
Q

Carotenoids

A

help prevent macular degeneration

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51
Q

Vitamin A

A

important for vision

52
Q

Obesity & Chronic Conditions

A 
T2DM
Coronary heart disease
Hypertension
Stroke
Respiratory problems
Sleep apnea
Fatty liver disease
Gallbladder disorder
Asthma
53
Q

Nutritional Diagnostic Tests

A 
serum albumin & pre-albumin (low albumin = low protein intake)
blood glucose tests
lipid profile (total cholesterol, triglyceride)
54
Q

Islet of langerhans cells

A

beta cells
alpha cells
delta cells
F/PP cells

55
Q

Delta cells

A

release somatostatin

inhibits insulin/glucagon release & slows down gastric motility for adequate absorption

56
Q

F/PP cell

A

produce pancreatic polypeptide

regulates GI secretions, liver glycogen storage, pancreatic release

57
Q

Proinsulin

A

insulin formed in beta cells by cleaving proinsulin –>

insulin & C-peptide

58
Q

Glucose cellular transport

A

glucose cannot cross the plasma membrane (large particle)

requires glucose transporter (protein carrier) to cross the cell membrane

59
Q

Glucose transporters

A 
GLUT-4 = skeletal & adipose tissue
GLUT-2 = beta cells & liver cells
GLUT-1 = loc in brain. does not require insulin activation
60
Q

Sodium glucose cotransporters

A 
SGLT-1 = small intestine 
SGLT-2 = renal tubule
61
Q

Postprandial

A

following a meal

62
Q

Lipase

A

enzyme that breaks down triglycerides –> glycerol + fatty acids

63
Q

Amylin

A

co-secreted with insulin by beta cells

1) decrease postprandial glucagon secretion
2) promoting satiety
3) decreasing gastric emptying (slows glucose absorption)

64
Q

Incretins

A

GI hormones released after a meal

consist of glucagon-like peptide 1 (GLP) and Gastric inhibitory peptide (GIP)

65
Q

Epinephrine function

A

maintain blood glucose levels during stress
increase metabolism
increase glycogenolysis in liver & skeletal muscle
decrease insulin release
increase lipolysis of adipose tissue

66
Q

Growth Hormone function

A

increase protein synthesis
increase lipolysis
decrease cellular uptake of glucose

67
Q

T2DM Impaired Beta Function

A

1) reduced b cell mass
2) increased apoptosis, reduced regeneration
3) beta cell exhaustion (d/t hyperinsulinemia)

68
Q

High FFA Complications

A 
pancreatic beta cell dysfunction
decrease glucose uptake 
decreased glycogen storage
decreased hepatic insulin sensitivity 
non-alcoholic fatty liver disease
69
Q

Adiponectin

A

hormone released by adipose tissue
increase tissue sensitivity to insulin
decreased triglyceride content
increased free fatty acid energy use

increase in adipose tissue = decreased adiponectin production

70
Q

Acute Diabetic Complications

A

diabetic ketoacidosis
hyperglycemic hyperosmolar state (HHS)
hypoglycemia

71
Q

Hyperglycemic Hyperosmolar State (HHS)

A 
increased osmolarity of blood 
hyperglycemia >33.3 mmol/L
shift in fluid compartments (ICF --> ECF)
results in pseudohyponatremia (d/t fluid dilution)
dehydration
polyuria
polydipsia 
hunger
hypotension, tachycardia
72
Q

DKA S/S

A 
hyperglycemia > 13.8 mmol/L
polyuria
polydipsia
nausea/vomiting
fatigue
stupor/coma
abdominal pain/tenderness
fruity breath
hypotension, tachycardia 
Kussmaul breathing
73
Q

DKA Treatment

A

increase blood volume
increase tissue perfusion
reduce blood glucose
treat acidosis, F/E imbalances

74
Q

Somogyi Effect

A

insulin-induced hypoglycemia –> increase in counterregulatory hormones
usually occurs overnight –> hyperglycemic in the morning

75
Q

Dawn Phenomenon

A

high fasting blood glucose between 5am-9am w/o preceding hypoglycemia
related to circadian rhythm of glucose tolerance?

76
Q

Eye complications

A

retinopathy
glaucoma
cataracts

77
Q

CNS complications

A 
dizziness/syncope
impaired sensory/motor function (d/t damage to myelin) --> increased risk for injury, foot ulcers 
decreased somatic sensation 
painful diabetic neuropathy 
autonomic neuropathy
78
Q

Vascular complications

A

atherosclerosis
microangiopathy –> cerebral infarction, hemorrhage
hypertension

79
Q

GI complications

A

impaired gastric emptying
diarrhea
constipation

80
Q

GU complications

A

urinary retention
UTI
erectile dysfunction

81
Q

Autonomic neuropathy

A

sympathetic/parasympathetic dysfunction
decreased vasomotor function (controls HR & smooth muscle tone)
decreased cardiac response
inability to empty bladder –> stasis, infection
impaired GI motility
sexual dysfunction

82
Q

Diabetic FPG (mmol/L)

A

> /= to 7.0

83
Q

Diabetic A1C %

A

> /= to 6.5%

84
Q

Prediabetic A1C %

A

6.0-6.4

85
Q

First line treatment for T2DM

A

Metformin
decrease risk of diabetes-rel deaths
does not cause weight gain
excreted unchanged by kidneys

86
Q

Sulfonylureas Pharmacodynamics

A

MOA: bind to K+ channels on pancreatic B-cells
increase insulin production
increase number of insulin receptors
increase insulin receptor sensitivity
increase effect of ADH on renal cells (collecting duct)

87
Q

CVD treatment for Diabetic pts

A

statin
acei/arb
asa

88
Q

White fat

A

long-term storage of adipoctyes

89
Q

Brown fat

A

fat tissue with metabolic properties

generate heat

90
Q

Glucagon-like peptide 1 (GLP-1)

A

released by L cells in distal small intestine

1) stimulate insulin secretion (glucose dependent)
2) inhibit glucagon secretion
3) inhibit gastric emptying
4) promote satiety
5) increase insulin sensitivity

91
Q

Gastric Inhibitory peptide (GIP)

A

aka glucose-dependent insulinotropic polypeptide
released by K cells in jejunum
1) stimulate insulin secretion (glucose dependent)
2) increase postprandial glucagon release

92
Q

Factors stimulating hunger

A

ghrelin

low blood glucose

93
Q

Factors promoting satiety

A 
incretins (GLP-1, GIP)
CCK
insulin
fatty meals 
leptin
94
Q

Somatostatin

A

released by pancreatic delta cells

decrease insulin & glucagon release

95
Q

Obesity phenotype

A

central, abdominal (apple)

peripheral (pear)

96
Q

Basal insulin

A

Background insulin. Used to maintain blood glucose levels in fasting state. Longer-acting

97
Q

Prandial Insulin

A

Shorter-acting. Used to maintain blood glucose levels in a fed state. Prevent spike in blood sugar after meals

98
Q

Types of basal insulin

A

take effect in a few hours. longer half-life.
intermediate-acting
long-acting

99
Q

Types of prandial insulin

A

take effect in under an hour. shorter half-life.
rapid-acting
short-acting

100
Q

Intermediate Insulin PK

A

ex: insulin NPH
onset: 1-2 hours
peak: 5-8 hours
duration: 14-18

101
Q

Long-acting Insulin PK

A

ex: insulin glargine
onset: up to 6 hours
peak: unknown
duration: 30 hours

102
Q

Short-acting Insulin PK

A

ex: insulin regular (IV only), humulin R
onset: 0.5-1 hour
peak: 2-4 hours
duration: 5-8 hours

103
Q

Rapid-acting Insulin PK

A

ex: insulin aspart, lispro
onset: 10-15 min
peak: 60-90 min
duration: 4-5 hours

104
Q

Correctional insulin

A

insulin that is administered on an ad-hoc basis, when fasting blood glucose levels exceed clinical parameters
uses rapid-acting or short-acting insulin
used as an adjunct with basal insulin

105
Q

Insulin:Glucagon ratio

A

hormone levels are determined in relation to one another
decreased insulin = relative increase in glucagon
increased insulin = relative decrease in glucagon

106
Q

Insulin & Alcohol

A

alcohol increases insulin secretion and gluconeogenesis

risk factor for hypoglycemia

107
Q

Basal metabolic rate

A

energy used to maintain body processes at rest (temperature, autonomic function, muscle tone, etc)

108
Q

Energy expenditure

A

basal metabolism 60%
physical activity 25%
non-exercise activity 7% (ADLs)
food digestion 8%

109
Q

Antidiabetic drug classes

A 
sulfonylureas
biguanides
dpp-4 inhibitors
thiazolidiediones 
sglt-2 inhibitors 
human amyliln
incretin mimetic 
meglitinide 
GLP-1 agonist
110
Q

Sulfonylureas MOA & TE

A

MOA: bind to K+ channels on pancreatic B cells causing depolarization –> insulin release.
increase # of insulin receptors on cell membrane. increase effect of ADH –> dilute blood glucoses by increasing water retention.

increase insulin production
decrease insulin resistance
inhibit glucose absorption from the GI tract and glycogenolysis

*targets the pancreas

111
Q

Biguanide MOA & TE

A

MOA: acts on the liver to decrease glucose production. increases cellular uptake of glucose. decreases GI absorption of glucose. increases sensitivity to insulin.
lowers blood glucose but does not cause blood
*targets the liver

112
Q

Obesity assessment

A 
BMI (>25 overweight, >30 obese)
waist circumference (measures abdominal obesity)
height, weight measurements 
health history 
cardiometabolic risk 
age
SE status
blood pressure
lab tests (lipid profile, blood glucose, ALT)
113
Q

BMI equation

A

kg/height^2

114
Q

Risky waist circumference

A 
>/= 102 cm in men
>/= 88 cm in women
115
Q

Obesity co-morbidities

A 
obstructive sleep apnea
non-alcoholic fatty liver disease
T2DM
hypertension
cardiovascular disease
osteoarthritis 
GERD 
polycystic ovary syndrome
116
Q

Obesity treatment

A

first line: lifestyle modifications
medications (manage chronic conditions)
bariatric surgery (extreme)

117
Q

5 A’s of obesity

A 
ask for permission to discuss weight
assess risk factors/health status
advise on health risks 
agree on realistic goals 
assist with appropriate resources & healthcare providers
118
Q

Obesity & cardiometabolic risk assessment

A 
blood pressure (both arms)
blood glucose (A1C, fasting blood glucose)
lipid panel (total cholesterol, triglycerides, LDL/HDL)
ALT (nonalcoholic fatty liver disease)
119
Q

Osmotic Diuresis

A

increased excretion in water

120
Q

Drug-drug Insulin interactions

A

beta-blockers: can mask symptoms of hypoglycemia
corticosteroids, thyroid supplements, estrogen: may increase insulin demand
alcohol, ace-is, mao-i’s, oral hypoglycemic agents: decrease need for insulin

121
Q

Drug-drug Metformin interactions

A

acute/chronic alcohol ingestion or iodine contrast media: increase risk of lactic acidosis
digoxin, morphine, CCBs, vancomycin: compete for elimination pathways
furosemide: may increase fx of metformin
nifedipine: increased absorption

122
Q

Cardiovascular benefits of Metformin

A

decrease lipid profile (triglcyerides)
decrease body weight
modulate endothelial function

123
Q

Drug-drug Glyburide interactions

A

diuretics, corticosteroids, oral contraceptives, estrogen, thyroid: may decrease fx
alcohol, androgens, clarithoycin, MAOis, NSAIDS, warfarin: may increase risk of hypoglycemia
beta-blockers: may mask symptoms of hypoglycemia

124
Q

Neuroglycopenia

A

shortage of glucose in the brain. usually caused by hypoglycemia

125
Q

Severe hypoglycemia

A

<2.8 mmol/L

may cause unconsciousness

126
Q

Treatment for severe hypoglycemia

A

IV: administer D50% W
SC: glucagon

127
Q

Diabetes foot care

A 
annual foot exam
daily inspection for wounds, sores, infection
trim toenails ---> file sharp edges 
avoid going barefoot 
well-fitting shoes, change socks daily

BSNC 2000 (9 decks)

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