Pathophysiology Flashcards
What hormone mediates energy release during periods of fasting?
Glucagon.
Glucagon causes increase in circulating glucose by
1- breaking down stored glycogen into glucose
2-causing gluconeogenesis.
3- If prolonged, FFA are also broken down into ketone bodies (ketogenesis)
When is insulin secreted in the body?
In response to higher glucose levels after a meal
What is the action of insulin in the body when it secreted by the beta cells?
(Insulin levels rise and fall along with glucose levels).
It’s the STORAGE hormone. Reducing BG
1-glucose storing in cells and storing as Glycogen (synthesis in the liver and muscles) glycogenesis!
2- FFA stored as TG. IE: Lipid formation in adipose/fat cells
3- AA uptake and stored as protein (synthesis)
What two hormones are produced in the small intestine in response to food and what are their actions?
GLP1 (glucagon like peptide)
1-Stimulates insulin release from beta cells in a glucose dependant fashion.
2-Suppresses glucagon
3- Delays gastric emptying which increases satiation.
GIP (gastric inhibitory peptide) only stimulated insulin release
What are the counter regulatory hormones and what are their role?
Glucagon
Growth hormone
Catecholamines (epi and norepinephrine)
Cortisol
They balance the effect of insulin to maintain normoglycemia. They are released in response to low BG of in periods of stress such as exercise or illness.
How can you distinguish between a patient with LADA (latent autoimmune diabetes adults) and type 2 diabetes?
LADA will have at least 2 of the following:
Usually less than 50 years old
Acute symptoms
Low BMI
Personal or family Hx of autoimmune disease
How are LADA patients treated?
Can be initially managed by oral, but they rapidly progress to needing insulin. Usually within 3 years. Caution as they may be at increased risk of DKA.
How is excess energy stored in the body?
Liver and muscle as Glycogen
Adipose tissue as TG
Protein and amino acids
*this stored energy can be used during periods of fasting.
What is the first stage of type 2?
Loss of post prandial release of insulin.
What does the term insulin resistance refer to?
Loss of response/resistance to the metabolic effects of insulin, (in muscle fat and liver) including:
Peripheral uptake of glucose by skeletal muscle and glycogen synthesis
Suppressive effect on glucose production
Inhibitory effect on adipose breakdown (lipolysis)
Insulin resistance occurs predominately in what three areas of the body?
Liver
Skeletal muscle
Adipose tissue
What are the consequences of gestational diabetes?
Macrosomal infant Stillbirth Hypoglycemia Risk of birth trauma Neonatal hyperbilirubinemia.
Where is glucagon produced in the body?
Alpha cells of pancrease
What is amylin?
A hormone secreted WITH insulin in response to food. Levels are very low in type one people.
SLOWS gastric emptying and CHO absorption and increases satiety
Signs of hyperglycemia
Thirst Excessive urination Adb pain, n,v Acetone breath Blurred vision Change in appetite Dry itchy skin Slow healing cuts
What four hormones are released when we eat?
Insulin from pancreas
GLP/GIP from small intestines
Amylin from pancrease
Action of glucagon
INCREASE glucose in the body when levels are low. Ie: gluconeogenesis. Secreted by the pancrease
Three ways:
INCREASE GLUCOSE Breakdown of glycogen to
Glucose in first 8-12 hours of fasting.
THEN
Breakdown of protein from muscle to release AA to be used for gluconeogenesis
THEN if prolonged starving, breakdown of adipose to allow for CONVERSION of FFA to ketone bodies for energy.
How does the counteregulAtory hormone glucocorticoids increase BG?? Same way prednisone will cause increase BG. Two ways
INCREASE gluconeogenesis
DECREASE glucose use.
Why should all infants diagnosed with D before age 6 months have genetic testing??
To distinguish between type one and monogenic. Monogenic sometimes can be treated with SUs. Always a pattern of inheritance. NO islet antibodies like type one.
What two hormones are absent in type one?
Amylin and Insulin
Instructions for 75G OGGT
Fast for >= 10 hours Unrestricted diet and activity No smoking 1 hour before Relax for 30 min before Remain seated during test Some meds need to be stopped. Diuretics. NSAIDS. Steroids. BP meds. Check with Dr. Blood is checked 2 hours after
What is C peptide
C-peptide is measured to tell the difference between insulin the body produces and insulin that is injected into the body. Someone with type 1 or type 2 diabetes may have their C-peptide level measured to see if their body is still producing insulin.
