O'Shea

Question 1

Diagnostic criteria for DM

Answer 1

• Fasting plasma glucose > 126 mg/Dl after an overnight 8 hour fast

OR

• Plasma glucose > 200g/dl 2 hour after a 75g oral glucose load

OR

• Hemoglobin A1c level > 6.5%

OR

• Random Plasma glucose > 200mg/dl with classic symtpoms of DM (increased thirst, or urination) or a hyperglycemic crisis

Question 2

INSULIN

Answer 2

• INCREASES
  
  • glucose uptake in muscle and adipose tissue
  • amino acid uptake and protein synthesis
  • fatty acid synthesis and esterification
  • glycogen synthesisi
  • glycolysis
• DECREASES
  
  • blood glucose levels
  • gluconeogensis
  • lipolysis
  • proteolysis

Question 3

INsulin regulation

Answer 3

• Stimulators:
  
  • increased blood glucose, amino acids, fatty acids
  • Incretin hormones
  • Acetylcholine
• Repressors
  
  • LEPTIN
  • sympahtetic nervous system

Question 4

Glucagon actions

Answer 4

• Increases
  
  • breakdown of glycogen
  • lipolysis (activates hormone-sensitive lipase)
  • gluconeogesis
  • ketogenesis
• Decrease
  
  • syntheisis of glycolytic enzymes
  • rate of glycolysis
  • glycogen synthesis

Question 5

Glucagon regulation

Answer 5

• Stimulators
  
  • low blood gluocse
  • increased circulating amino acids
  • sympathetic nervous sytem
• Repressors
  
  • hyperglycemia
  • increased circulating fatty acids
  • somatostatin

Question 6

Cortisol

Answer 6

• Produced by adrenal cortexi in response to stress, trauma, and hypoglycemia
• Works synergistically with glucagon to activate key gluconeogenesis enzymes
• indirectly maintains glucose production from protein and facilitates fat metabolism

Question 7

Fed vs fasting state******

Answer 7

• FED STATE
  
  • INSULINE SECRETION INCREASES
  • absorbed nutrients are utilized and stored
  • breakdown of stored nutrients suppressed
• FASTED STATE
  
  • Glucose levels fall
  • stored energy sources are mobilized
  • INSULIN SECRETION FALLS, GLUCAGON ACTIVITY RISES

Question 8

Glycemic index (GI)***

Answer 8

• A measure of how quickly a food causes our blood sugar to rise: ranks food on a scale of 0-100
  
  • foods high on GI are quickly digested or absorbed (processed carbs = table sugar, white bread, cheetos)
  • foods low on GI are more slowly digested and absorbed; often contain fiber, protein or fat and cause slower rise in Blood sugar
    *

Question 9

Glycemic LOAD***

Answer 9

• glycemic load is the glycemic index (GI) times the carbohydrate content in the serving divided by 100
• total carbohydrate intake regualtion is best way to acheive glycemic control

Question 10

INsulin resistance leads to..

Answer 10

• Insulin resistance is composed of:
  
  • High Triglycerides
  • Low HDL
  • Hyperglycemia
  • Hypertension
  • central obesity

Question 11

Macronutrient recommendations for diabetics

Answer 11

• Carbohydrates = 45-65% of total calories
• THINK MEDITERANIAN DIET
• to reduce CVrisk, limit intake of saturated and trans fattya cid and cholesterol
• With nephropathy, limit protein to 10% of total calories