Midterm 2 pt. 2 Flashcards
if pancreatic beta cells have decreased sensitivity to incretins,
decreased insulin secretion
if pancreatic alpha cells remain sensitive to GIP,
increased glucagon secretion
in type II DM, there are
altered levels of GLP-1 and GIP and response at tissues
in type II DM, the liver
still takes up glucose in high capacity (because it has GLUT2, insulin independent)
in the type II DM, insulin is a _________________
relative deficiency (not enough to compensate for high levels of blood glucoss
synonym for pre-diabetes is
impaired glucose tolerance
for pre-diabetics, progression of type II DM
is NOT inevitable (can be delayed w/ body wt loss)
healthy fasting blood glucose number/range
below 100 mg/dL
diabetes fasting blood glucose number/range
126 mg/dL
healthy A1C number/range
<5.5%
diabetic A1C number/range
> 6.5%
healthy result from 2 hr oral glucose
below 140 mg/dL
diabetes result from 2 hr oral glucose
200 mg/dL
type II DM is associated
with obesity, but can also occur in lean people
type 1 DM etiology
autoimmune destruction of beta cells
three signs and symptoms of uncontrolled DM
polyuria
polydipsia
polyphagia
polyuria is characterized by
presence of glucose in urine
polydipsia is characterized by
increased thirst
polyphagia is characterized by
hunger
signs and symptoms of type I DM
wt loss, nausea/vomiting, diabetic ketoacidosis
decreased intracellular glucose results
polyphagia
when the threshold of renal glucose is exceeded
polyuria, leads to polydipsia
how is fat metabolism affected by insulin deficiency for type I DM
decreased TG synthesis, increased lipolysis
in type I diabetes, we use _______________ as an energy source
fatty acids, increased risk of ketoacidosis
what is the GLUT4 pathway?
PI3K - AKT
long term consequences of insulin deficiency and hyperglycemia
macrovascular and microvascular
macrovascular complications include
CVD, atherosclerosis, HTN
microvascular complications include
nephropathy, retinopathy, neuropathy
nephropathy refers to
the end stage renal disease
retinopathy refers to
blindness
neuropathy refers to
peripheral neuropathy/foot problems
HbA1C reflects
average blood glucose over the past 3 mo
diabetes control and complications trial
study of type 1 DM, intensive treatment vs conventional treatment, intensive treatment lowered blood glycemia more, better glucose control = fewer complications
10 yrs after the diabetes control and complications trial,
there were still decreases in CVD risk
A1C treatment goal
below 7%, but should be individualized
ABCs and of DM management
A (average blood glucose/HbA1C)
B (blood pressure)
C (cholesterol)
diabetes prevention program
compared lifestyle with metformin, lifestyle decreased much more
nutritional requirements of people with DM are
similar to those of a general healthy population
no insulin or hypoglycemic meds leads to
CHO is spread throughout the day
how does diabetes affect protein metabolism
increased blood amino acids + muscle wasting
what pathway is responsible for bringing GLUT4 to membrane?
PI3K-AKT
what are long-term complications of hyperglycemia?
macrovascular (CVD, atherosclerosis, HTN) and microvascular (retino-, neuro-, nephropathy)
advanced glycosylation end products
accumulation of intermediate products of glycolysis
glycated hemoglobin is an example of
hemoglobin is an example of
an advanced glycosylation end product
risk of diabetes concentrations increases with
average blood glucose concentrations
primary prevention goal in diabetes prevention is to
prevent diabetes
secondary prevention in diabetes prevention is to
prevent complications from diabetes
tertiary prevention in diabetes prevention is to
prevent death from diabetes
for diabetes, is MNT clinically and cost effective?
yes
the american diabetes assocation
does not have an “ADA” diet, no 1 diet for diabetics
basic CHO counting is
adding up total CHO regardless of source
advanced CHO counting
matches insulin to CHO
advanced CHO counting uses
insulin to CHO ratio (ICR) and corrective factor (CF)
advanced CHO counting is useful for
patients with an insulin pump or who take multiple shots a day
taking oral hypoglycemic meds leads to
daily CHO is spread throughout the day, monitor blood sugar closely because some meds cause hypoglycemia
when on a fixed/daily dose of insulin,
need consistent timing and CHO content of meals
kcal for normal wt
30 kcal/kg body wt
kcal for overwt/obese
20-24 kcal/kg body wt
CHO kcal
40-50%
protein kcal
15-20%
fat kcal
30-40%
limit CHO at breakfast to
30-45 g
what eating pattern has robust evidence for type 1 DM?
none, low-carb has preliminary evidence of benefit
what eating pattern has robust evidence for type 2 DM?
low-carb and mediterranean have highest evidence
mediterranean diet vs. low fat in type 2 DM development
mediterranean has lower risk
what has the most overall evidence for improving glycemia?
low carb
glycemic index refers to the
quantity and rate which different CHO foods influence blood glucose response
in individuals with pre-DM, 7-10% wt loss
is shown to prevent/delay type 2 DM
in individuals with type 2 DM, 5% wt loss
achieves clinical benefits
