Pathophysiology

Question 1

What hormone mediates energy release during periods of fasting?

Answer 1

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)

Question 2

When is insulin secreted in the body?

Answer 2

In response to higher glucose levels after a meal

Question 3

What is the action of insulin in the body when it secreted by the beta cells?

Answer 3

(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)

Question 4

What two hormones are produced in the small intestine in response to food and what are their actions?

Answer 4

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

Question 5

What are the counter regulatory hormones and what are their role?

Answer 5

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.

Question 6

How can you distinguish between a patient with LADA (latent autoimmune diabetes adults) and type 2 diabetes?

Answer 6

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

Question 7

How are LADA patients treated?

Answer 7

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.

Question 8

How is excess energy stored in the body?

Answer 8

Liver and muscle as Glycogen

Adipose tissue as TG

Protein and amino acids

*this stored energy can be used during periods of fasting.

Question 9

What is the first stage of type 2?

Answer 9

Loss of post prandial release of insulin.

Question 10

What does the term insulin resistance refer to?

Answer 10

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)

Question 11

Insulin resistance occurs predominately in what three areas of the body?

Answer 11

Liver
Skeletal muscle
Adipose tissue

Question 12

What are the consequences of gestational diabetes?

Answer 12

Macrosomal infant
Stillbirth 
Hypoglycemia 
Risk of birth trauma 
Neonatal hyperbilirubinemia.

Question 13

Where is glucagon produced in the body?

Answer 13

Alpha cells of pancrease

Question 14

What is amylin?

Answer 14

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

Question 15

Signs of hyperglycemia

Answer 15

Thirst
Excessive urination 
Adb pain, n,v
Acetone breath
Blurred vision
Change in appetite
Dry itchy skin 
Slow healing cuts

Question 16

What four hormones are released when we eat?

Answer 16

Insulin from pancreas
GLP/GIP from small intestines
Amylin from pancrease

Question 17

Action of glucagon

Answer 17

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.

Question 18

How does the counteregulAtory hormone glucocorticoids increase BG?? Same way prednisone will cause increase BG. Two ways

Answer 18

INCREASE gluconeogenesis

DECREASE glucose use.

Question 19

Why should all infants diagnosed with D before age 6 months have genetic testing??

Answer 19

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.

Question 20

What two hormones are absent in type one?

Answer 20

Amylin and Insulin

Question 21

Instructions for 75G OGGT

Answer 21

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

Question 22

What is C peptide

Answer 22

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.