Module 9: Diabetes Pathophysiology Flashcards
This is a group of diseases characterized by high blood glucose concentrations resulting from defects in:
- Insulin secretion
- Insulin action
- Or both
diabetes mellitus
Galactose and most fructose are converted to _________.
glucose
If we don’t get glucose from CHO (food), the liver will make new glucose out of non-CHO substrates like lactate or AAs. What process is this called?
Gluconeogenesis
T/F: Glucose is the universal fuel source for every cell of the body.
T
T/F: RBCs can ONLY use glucose for fuel.
T
T/F: RBCs have mitochondria and go through glycolysis.
F (they don’t have mitochondria)
________ is termed a LOW blood glucose.
Hypoglycemia
_________ is termed a HIGH blood glucose.
Hyperglycemia
T/F: Hyperglycemia increases a person’s risk for atherosclerosis and CVD.
T
Hyperglycemia can cause microvascular complications in the vessels of the eyes and kidneys, leading to ____________and the _____________.
retinopathy, nephropathy
Hyperglycemia can cause damage to nerves called ______________.
neuropathy
Those with DM may have amputated toes and/or feet due to ________ damage and poor ______________ to those extremities.
nerve, circulation
The key regulators of blood glucose are the 2 peptide hormones: ______________ and __________.
glucagon, insulin
Insulin is synthesized and secreted by _______________ of the __________.
beta-cells, pancreas
Glucagon is synthesized and secreted by _________________ of the __________.
alpha-cells, pancreas
After eating CHO, blood glucose levels _________ and the pancreatic __________ cells secrete ___________ into the blood.
increase/rise, beta, insulin
Insulin stimulates _______________ uptake by cells. Then blood glucose returns to normal.
glucose
Without insulin, glucose can’t enter the cells leading someone to become _____________.
hyperglycemic
If blood glucose decreases/drops, then the pancreas secretes ____________.
glucagon
Glucagon stimulates the ___________ to break down glycogen and release that glucose into the _________.
liver, blood
______________ stimulates the liver to synthesize glucose from non-CHO (i.e. lactate & AAs).
Glucagon
When blood glucose levels ________________, insulin is secreted from pancreatic _____________ __________. This acts to __________ blood glucose levels.
increase/rise, beta cells, lower/decrease
T/F: The prevalence of diabetes increases with age.
T
T/F: The prevalence of diabetes is more common among those who are underweight.
F (more common in overweight and obese people)
T/F: Obesity is a major risk factor for Type 2 DM.
T
This type of diabetes is a stage of IMPAIRED glucose homeostasis (i.e. impaired fasting glucose, impaired glucose tolerance, etc.) This indicates they’re at a HIGH RISK for developing diabetes.
Prediabetes
This type of diabetes only accounts for about 5 - 10% of cases.
Type 1
Type 1 was previously called Insulin-dependent Diabetes Mellitus (IDDM) or “_____________ onset”.
juvenile
Type 1 diabetes is caused by destruction of the ____________ - secreting __________ cells of the pancreas; usually due to an autoimmune dysfunction.
insulin, beta
In Type 1 diabetes, the ______ cells lose their ability to produce ____________, leading to absolute insulin deficiency.
beta, insulin
T/F: Someone with Type 1 diabetes would required exogenous insulin to live.
T
Type 2 diabetes was previously called Non-insulin Dependent Diabetes Mellitus (NIDDM) and “___________ onset”.
adult
This type of diabetes develops during pregnancy.
Gestational diabetes
In gestational diabetes, the hormones produced during pregnancy cause insulin _____________. SO the amounts of insulin needed are _________ to control blood glucose levels.
resistance, increased
T/F: Gestational diabetes can go away when once the baby is born.
T
T/F: A woman who had gestational diabetes is NOT at risk for developing Type 2 diabetes.
F (they’re at a much greater risk)
IFG stands for impaired _________ _________.
fasting glucose
FPG stands for fasting ____________ glucose.
plasma
IGT stands for impaired glucose ____________.
tolerance
T/F: Brain cells can use ketone bodies, but prefers glucose.
T
What is the FPG of those with prediabetes (above normal)?
> 100 mg/dL and < 126 mg/dL
Those who have Prediabetes have an elevated plasma glucose after ________g glucose load (> 140 and < 200mg/dL).
75
In the initial onset of Type 1 DM, affected persons are usually __________, have abrupt onset of symptoms before the age of _____.
lean, 30
This “phase” is after the dx of Type 1 DM and correction of hyperglycemia and metabolic derangements, when the person may not need much exogenous insulin and can maintain normal blood glucose for up to 1 year.
Honeymoon phase
Type 1 DM may be due to an ____________ disorder. Where the body destroys its own ____-cells in the pancreas as if they’re foreign antigens.
autoimmune, beta
Idiopathic means that the cause is __________.
unknown
-Hyperglycemia
- Excessive thirst (polydipsia)
- Frequent urination (polyuria)/glycosuria
- Significant wt loss
- Electrolyte disturbance
- Ketoacidosis
Are all sx of which type of diabetes?
Type 1
Polydipsia is excessive _________
thirst
Polyuria is frequent __________
urination
Normally when the kidneys filter blood, all the glucose is reabsorbed in the __________ tubules.
renal
____________ is the presence of glucose in the urine.
Glycosuria
In ketoacidosis, the cells resort to burning ________ for fuel instead of glucose. Beta oxidation of FAs are done to an extent that it leads to the formation of ____________ bodies.
fat, ketone
Is Type 1 or Type 2 Diabetes more common?
Type 2
T/F: Type 2 Diabetes has a cure.
F
Type 2 Diabetes is due to a progressive loss of ______ -cell insulin secretion, frequently on the background of ________ resistance.
beta, insulin
T/F: Someone with Type 2 DM would rarely experience ketoacidosis.
T
In Type 2 DM, ATP is NOT required for glucose uptake. But it requires ___________ proteins to enter the cell.
transport
Glut - 4 transporter is a ________ protein that facilitates ___________ uptake from the blood into muscle and fat cells.
transport, glucose
People with Type 2 DM have higher than normal levels of insulin, but their cells are not responding to it. This is called what???
Insulin resistance
Insulin resistance may be due to decreased tissue ______________ or not ____________ to insulin.
sensitivity, responsive
When the pancreas can no longer keep up and produce enough insulin, then blood glucose levels will ________ initially after meals, but also eventually in the ________ state too.
increase, fasted
Type 2 DM begins with ___________ resistance.
insulin
Increased __________ ___________ production (from the liver) causes increased FPG in Type 2 DM.
hepatic glucose
T/F: Someone may go years without signs & sx of Type 2 DM.
T
- Insidious onset
- Often goes undiagnosed for yrs
- Hyperglycemia
- Polydipsia
- Polyuria
- Polyphagia/hyperphagia
- Weight loss (occasionally)
These are the sx of which type of DM?
Type 2
- Family hx of DM
- Older age
- Obesity, particularly intra-abdominal obesity
- Physical inactivity
- Prior hx of gestational DM
- Impaired glucose homeostasis
- Higher risk among certain racial/ethnic groups (African American, Latino, Native American, Asian American, Pacific Islander)
These are the risk factors of which type of diabetes?
Type 2
- Insulin resistance
- Compensatory hyperinsulinemia
- Abdominal obesity
- Dyslipidemia (elevated TG, low HDL)
- HTN
These are characteristics of _____________ syndrome.
metabolic
Metabolic syndrome is a risk factor for _________.
CVD
What are the methods of DM Dx?
- Fasting plasma glucose (FPG)
- Random plasma glucose
- Oral glucose tolerance test (OGTT) 2-hr Plasma Glucose
- Hemoglobin A1C (HbA1c)
How is a FPG blood test performed?
No calories for at least 8 hrs
How is a random plasma glucose blood test performed?
At any time of day
How is an oral glucose tolerance test (OGTT) 2-hr plasma glucose test performed?
pt is fasted and takes a 2 hr blood draw AFTER oral glucose load of 75 g glucose
A Hemoglobin A1C (HbA1c) blood test provides an estimate of __________ blood glucose over the past few ___________. This test measures _____________ __________.
average, months, glycosylated hemoglobin
HbA1c is a measure of how much __________ adheres to hemoglobin of ________ blood cells.
glucose, red
T/F: The higher a person’s blood glucose, the higher their HbA1c.
T
The ADA recommends for people aged ______ years and older to be screened for DM, and repeat every ________ yrs.
35, 3
T/F: High risk persons should be screened for DM at a younger age and more frequently.
T
Recommendation for glycemic control (in nonpregnant adults w/DM) of HbA1c level is _______%.
< 7.0%
Recommendation for glycemic control (in nonpregnant adults w/DM) of PREPRANDIAL CAPILLARY PLASMA GLUCOSE level is __________ mg/dL (4.4 - 7.2 mmol/l).
80 - 130
Recommendation for glycemic control (in nonpregnant adults w/DM) of PEAK POSTPRANDIAL CAPILLARY PLASMA GLUCOSE level is _________ mg/dL (< 10.0 mmol/l).
< 180
