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Diabetes > Pathophysiology + Screening > Flashcards

Pathophysiology + Screening Flashcards

1
Q

Diabetes Mellitus is classified as a ____ disorder

A

Metabolic

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2
Q

DM is characterized by the presence of… due to these factors.

A

Presence of hyperglycemia, due to defective insulin secretion, insulin action, or both

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3
Q

The major cells of the pancreas involved with blood glucose control are the…

A

Islet cells

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4
Q

The two most important part of islet cells are:

A

Alpha + beta cells

Delta cells are not talked about much

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5
Q

Beta cells produce…

A

Insulin

And amylin (satiety)

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6
Q

Alpha cells produce…

A

Glucagon

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7
Q

Insulin is released in response to…

A

Elevated BG levels

Bring back up to normal euglycemia

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8
Q

Glucagon is released in response to…

A

Low BG levels

Bring back up to euglycemia

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9
Q

In terms of the fed and fasting states, insulin and glucagon are released…

A

Insulin = fed state
Glucagon = fasting state

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10
Q

Insulin works as a lock + key, meaning…

A

Insulin is the key to get glucose into cells

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11
Q

The major site of glucose uptake is…

A

Skeletal muscle

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12
Q

After insulin stimulates uptake of glucose in skeletal muscle, the glucose is then stored as…

A

Stored as glycogen +Glycogen, and used in energy metabolism (glycogenesis)

Insulin also stimulates production of proteins from AA’s

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13
Q

Formation of glucose from a non-carb source usually occurs in-between meals, via…

A

Proteins - amino acids converted to glucose via gluconeogenesis

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14
Q

Insulin is involved with the liver after meals via…

A

Stimulation of liver to store glucose as glycogen (glycogenesis)
And suppresses gluconeogenesis

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15
Q

In a fasting state, glucagon is involved with the liver via…

A

Glucagon stimulates liver to provide glucose by glycogenolysis (glycogen back into glucose) and gluconeogenesis (formation of glucose from non-carb, like amino acids)

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16
Q

If the amount of glucose entering the liver is greater than storage capacity for glycogen, insulin will help by…

A

Promoting glucose conversion to fatty acids, stored in adipose tissue

Glycerol phosphate + Free fatty acids stored as TG’s

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17
Q

In starvation or insulin deficiency, lipolysis can occur, which is when…

A

TG’s split back to glycerol and FFA’s, FFA metabolized and ketone bodies used as energy source

Insulin has antilypolytic properties

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18
Q

The brain has a strong connection to glucose as…

A

Glucose is its main energy source

does not depend on presence of insulin for use

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19
Q

Type 1 DM (T1DM) is characterized by…

A

An absolute lack of insulin secretion

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20
Q

T1DM is primarily caused by…

A

Autoimmune beta-cell destruction

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21
Q

Markers of immune destruction are often present in T1DM, which may include…

A

Islet cell antibodies, insulin antibodies, GAD antibodies

GAD = glutamic acid decarboxylase

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22
Q

After initiation of insulin, some T1DM patients go through a honeymoon phase, where…

A

Insulin secretion recovers temporarily + insulin requirements may be quite low

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23
Q

The honeymoon phase can occur ____ after initiation of insulin, and last for _____

A

Days-weeks following initiation, and last for months

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24
Q

An important factor about the honeymoon phase in T1DM patients is that…

A

The period is transient - so need to continue receiving insulin + monitor for hypoglycemia

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25
Q

Prediabetes is defined as…

A

An intermediate state between normal glucose levels and diabetes

Strong predictor of T2DM and CVD

26
Q

Diagnosis of prediabetes via fasting plasma glucose is…

Numbers

A

6.1-6.9 mmol/L

Impaired fasting glucose (IFG)

27
Q

Diagnosis of prediabetes after 2h prandial glucose is…

Numbers

A

7.8-11.0

Impaired glucose tolerance (IGT)

28
Q

Diagnosis of prediabetes based off of A1C is…

Numbers

A

6.0-6.4%

29
Q

Type 2 Diabetes results from a combination of…

A

Impaired insulin secretion and insulin resistance

Impaired secretion from too much resistance is common

30
Q

T2DM often manifests only in those who lose the ability to…

A

Produce sufficient qualities of insulin to maintain euglycemia in face of insulin resistance

31
Q

Key environmental factors that may lead to development of T2DM include…

A

Excessive caloric intake
Sedentary lifestyle

32
Q

There are many risk factors for T2DM development, but a key risk factor is…

A

Abdominal obesity

Insulin resistance is found in most obese people

BMI often correlates with degree of insulin resistance

33
Q

Impaired insulin secretion in response to food in T2DM occurs because of…

A

Impaired beta-cell function
Reduced stimulus from incretin hormones

Incretin hormones tells pancreas to pump out insulin

34
Q

Consequences of defective insulin secretion is…

A

Hyperglycemia

First, see elevated post-prandial, then elevated fasting

35
Q

Insulin resistance is simply classified as…

A

Lowered sensitivity to actions of insulin by target tissues

36
Q

Skeletal muscle is related to insulin resistance as…

A

Skeletal muscle is the primary site of insulin resistance, with decreased glucose uptake

37
Q

The liver is related to insulin resistance as…

A

It results in inability to suppress hepatic glucose production

38
Q

Adipose tissue is related to insulin resistance, as…

A

Adipocytes become resistant to anti-lypolytic effects of insulin, leading to increased lipolysis

FFA in circulation can end up stimulating liver glucose production, impair skeletal muscle sensitivity, and impair insulin release - WORSENING overall condition

39
Q

T1DM usually presents with…

Duration?

A

Acute symptoms of short duration

40
Q

Presentation of symptoms that usually occur in T1DM include…

A

Frequent urination, hunger, and thirst
Fatigue, blurred vision, infection

Body systems + cells are not receiving any energy source

Urination due to osmotic diuresis

41
Q

A serious complication that may arise after several days of T1DM symptoms is:

A

Diabetic ketoacidosis (DKA)

42
Q

Presentation of T2DM differs from T1DM, as…

A

Asymptomatic presentation is common and often discovered incidentally

43
Q

Possible symptoms or complications that may present with T2DM include:

A

Frequent urination, thirst
Established diabetic complications at diagnosis

Depends on how high BG is

44
Q

Gestational diabetes is a condition that…

A

Develops during pregnancy

45
Q

Cause of gestational diabetes is primarily due to…

A

Insulin resistance

46
Q

Gestational DM may cause complications, such as…

A

Increased risk of fetal hyperinsulinemia, hypoglycemia
Increased risk of developing T2DM in mother and child

47
Q

Are there any preventative measures for T1DM?

A

No successful preventive interventions so far

48
Q

The most effective measure of preventing T2DM is…

A

Lifestyle modifications

Medications may also help in some people with pre-diabetes

49
Q

Screening for T1DM is…

Good? Not good? And why?

A

Not recommended

Overall low prevalence, no identifiable intervention

50
Q

Screening for T2DM is…

Good? Not good? Why?

A

Important!

Large amount of people are undiagnosed

51
Q

Initial screening tests for T2DM should include…

A

FPG or A1C

52
Q

CANRISK is…

A

A risk assessment questionaire to help assess risk of having prediabetes or T2DM

Identify patients who should be referred to physicians for work-up

53
Q

Diagnosis of diabetes using FPG is…

A

FPG > 7.0 mmol/L

Fasting = no caloric intake for at least 8 hours

54
Q

Diagnosis of diabetes using A1C is…

A

A1C > 6.5%

55
Q

Diagnosis of diabetes using 2h PG in a 75g OGTT is…

A

> 11.1 mmol/L

56
Q

Diagnosis of diabetes using a random PG is…

A

> 11.1 mmol/L

57
Q

Disadvantages of using FPG for screening includes:

A

Inconvenience
Less sensitivity compared to OGTT

58
Q

Advantages of using A1C for screening includes:

A

Convenience
Better predictor of CVD
No day-to-day variability

59
Q

Disadvantages of using A1C for screening includes:

A

Cost
Not valid for all medical conditions/populations
Ethnicity + aging may alter A1C

60
Q

Advantages of using OGTT for screening includes:

A

Established standard, sensitive

61
Q

Disadvantages of using OGTT for screening includes:

A

Inconvenience
Taste, cost

Diabetes (5 decks)

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