Q6 - DM

Question 1

Pancreas: AGBIADS

Answer 1

Alpha cells - glucagon
Beta cells - insulin/amylin
Delta cells - somatotropin.

Question 2

Glucagon is a _________ hormone.
Insulin is a ________ hormone

Answer 2

Catabolic (Break down)
Anabolic (BUILD)

Question 3

Things that stimulate glucagon release:
Inhibit glucagon release:

Answer 3

Stim: low glucose, SNS, amino acids
Inhibit: high glucose, insulin.

Question 4

Glycogenesis - formation of glycogen from glucose
Gluconeogenesis - formation of new glucose from something other than carbs.
Glycolysis - breakdown of glucose into pyruvate
Glycogenolysis - breakdown of glycogen into glucose.

Question 5

Measuring ______ can indirectly measure serum insulin synthesis.

Answer 5

C-peptide (cleaved in insulin synthesis)

Question 6

things that stimulate insulin?
Inhibit?

Answer 6

Stim: increase in blood glucose. PSNS, amino acids, GI hormones
Inhibit: low blood glucose, high insulin, SNS, prostaglandins.

Question 7

Insulin in the liver:
_____ glucose uptake
____ glycogenesis
______ Glycogenolysis
____ Glycolysis
_____ gluconeogensis

Answer 7

As an anabolic hormone:
Increase for storage
Increase for storage
Decrease (into glucose in storage)
Increase (into pyruvate for energy extraction)
Decrease (

Question 8

Cells that don’t require GLUT4 transporters? How is this relavent in DM?

Answer 8

Brain, RBCs, kidneys and lense of eye. Still affected by high blood glucose levels in DM.

Question 9

Insulin signaling involves _______ receptors on cell surfaces through the body. What things can decrease the sensitivity of this receptor?

Answer 9

Tyrosine Kinase.
Age, weight, abdominal fat

Question 10

Obesity alters________ which _______ gluconeogenesis, insulin resistance and _______

Answer 10

Adiponectin
Increases
Inflammatory mediators

Question 11

GLUT4 is the only glucose transporters requiring ____ to fxn. Other GLUTs (1,2,3,5 and SGLT1) are ________

Answer 11

Insulin.
Insulin-independent.

Question 12

What does amylin do?

Answer 12

Delay gastric emptying, suppress glucagon, satiety. Prevent hyperglycemia and regulate glucose levels.

Question 13

Pancreatic polypeptide is _____ in pts with DM. What does it do?

Answer 13

Increased.
Decreases pancreatic secretion of fluid and HCO3 which promotes gastric acid secretion and antagonizes cholecystokinin.

Question 14

What is the incretin effect? What are incretins? How can they be impaired?

Answer 14

GIP/GLP1 - increase glucose uptake, increase insulin secretion, decrease glucose production, decrease glucagon secretion). This effect is suspected to be impaired in type II diabetes; DPP-4 enzymes degrade incretins

Question 15

Gestational GDMA1 - diet controlled insulin issue.
GDMA2 - need intervention to control blood sugar

Question 16

Symptoms of T1DM appear with loss of _______% of B cells

Answer 16

80-90

Question 17

adaptive immunity is stimulated and cause Bcell destruction and apoptosis.

Question 18

Insulin inhibits glucagon, which is impaired
Insulin normally stimulates fructose 2,6 bisphosphate, which stimulates glycolysis and inhibits gluconeogenesis -> this physiology is impaired
Glucagon normally inhibits 2,6 bisphosphate, which inhibits glycolysis and stimulates gluconeogenesis -> this is exacerbated

Question 19

Initially with T2DM, there is a period of ______ insulin secretion caused by _____. You’ll have hyperinsulinemia before all the cells tire out and then start decreasing insulin secretion

Answer 19

Hyper
Insulin resistance.

Question 20

B cells secrete insulin and _______.
_______ deficiency causes increased glucagon.
Alpha cells then become less responsive to glucose inhibition.

Answer 20

Amylin
Amylin

Question 21

Criteria for dx of metabolic syndrome looks at: (3/5)

Answer 21

Waist circumference (>40m and >35F)
Plasma triglycerides >150
Plasma HDL <40M and <50W
BP >130/>85
Fasting glucose >100 <126 A1c >5.7-6.4

Question 22

2 ketones form acetylCo-A and used for energy.

Question 23

Catecholamines, cortisol, glucagon, GH (insulin counterregulatory hormones) are ________ in DKA?

Answer 23

Increased

Question 24

In DKA, excessive gluconeogenesis by liver using increased fatty acids and glycerol from fat catabolism = hyperglycemia, ketone bodies, low pH, metabolic acidosis

Question 25

In DKA, Respiratory tries to compensate for acidosis by _______

Answer 25

Kussmaul respirations.

Question 26

transient ______ in K levels in DKA, then _____ K with treatment (due to H/K pump)

Answer 26

Increase,
Drop/Hypo

Question 27

HHNS - serum osm 320. - severe dehydration, _______K due to osmotic dieresis then insulin. AKI.

Answer 27

HYPO

Question 28

What is the polyol pathway?

Answer 28

Conversion of glucose to Sorbitol to fructose
In DM -> all the areas that are affected are not able to use sorbitol, so it accumulates as deposits.

Question 29

Body is using all of it’s oxygen to try to convert glucose so there’s end tissue hypoxia

Question 30

Glycation of mitochondrial respiratory chains by AGEs is a cycle that results in more reactive oxygen species, which damage microvasculature and promote accelerated atherosclerosis

Question 31

3 stages of Diabetic retinopathy

Answer 31

1 - nonproliferative - increased capillary permeability, dilation, micro aneurysm, hemorrhages.
2 - preproliferative. - ischemia leading to “cotton wool spot” infarcts
3 - proliferation (neovascularization, fibrous tissue, poss retinal detachment or hemorrhage into vitreous humor.

Question 32

Kidneys in DM:

Answer 32

Low RBF and filtration, tubulointerstitial fibrosis, hyperfiltration 2* to tubular reabsorption of glucose, loss of autoregulation and anemia = hypoxia.

Question 33

DM kidney issues lead to microalbuminuria (proteinuria)-> hypoproteinemia, decreased plasma oncotic pressure, = fluid overload, anasarca and HTN

Question 34

Uremia develops at GFR ________

Answer 34

<10

Question 35

Somatic neuropathy _____
Autonomic neuropathy _______

Answer 35

Somatic = muscle groups, Charcot arthropathy, distal neuropathies
Autonomic = delayed gastric emptying, diarrhea, bladder dysfxn, impotence, orthostatic, high HRV.