Test 3 - Quiz 7 - Diabetes Flashcards
What is type I diabetes?
Insulin-dependent diabetes mellitus
What are the immunological symptoms of type I diabetes?
Autoimmune disease - loss of beta-cells producing insulin
Genetically linked
Juvenile onset
What is type II diabetes?
Non-insulin-dependent diabetes mellitus
What are the characteristics of type II diabetes?
Insensitivity to insulin
Lifestyle and genetics
Adult onset, though becoming more prevalent in juveniles
What is gestational diabetes?
Develops during pregnancy - fetus induces changes in metabolism
*Chances of getting type II diabetes greatly increases for later in life
Diabetes dysregulates what?
Balanced insulin and glucagon signaling
- Alpha - glucagon
- Beta - insulin
- Delta - somatostatin
Type I and II have different causes, but the symptoms of uncontrolled disease are _____________.
SIMILAR
What are some key characteristics of type I diabetes?
Circulating insulin is absent
Target tissues fail to properly absorb nutrients
*This leads to a dysregulated metabolic state of extreme fasting and starvation
The autoimmune disorder is caused by what?
95% immune-mediated
5% idiopathic (spontaneous and cause unknown)
Because insulin cannot get to the target tissues, what ensues?
Body is in “starvation,” and starts beta-oxidation for energy. This results in increased ketone body formation, and ketoacidosis will soon follow.
Prolonged fasting does what to ACTH, leptin, corticosterone, insulin, and glucagon?
Increased ACTH, corticosterone, and glucagon
Decreased leptin and insulin
What are the 3 ketone bodies?
Acetoacetate
Acetone
D-beta-hydroxybutyrate
Insulin deficiency leads to what?
Reduced glucose uptake.
Reduced glucose uptake leads to what?
Cellular energy deficiency
Elevated blood glucose
Fatty acid oxidation
Elevated blood glucose leads to what?
Osmotic diuresis (excessive urination)
FA oxidation leads to what?
Liver gluconeogenesis
Liver ketone bodies
Liver ketone bodies lead to what?
Elevated blood ketones
Elevated blood ketones lead to what?
Increased blood acidity
Osmotic diuresis
Osmotic diuresis leads to ____________, which then leads to reduced blood volume, and electrolyte imbalance.
Dehydration
Reduced blood volume can lead to what?
Tachycardia
Coma
*It also feeds forward to elevate blood glucose, elevate blood ketones, and increase blood acidity
What are the 3 coordinated interventions for type I diabetes?
Insulin administration
Glucose monitoring
Diet
What is the desired target range that diabetics want for fasting blood glucose?
80-140 mg/dl
What are the two current approaches to insulin administration?
Injections
-Several per day
-Two types: basal and bolus
—Basal - insulin maintains low-level systemic insulin
—Bolus - insulin given when food is consumed
This is scaled to carb consumption
Pump
- Dose given when food consumed
- Scaled to consumption and activity
Generally, what is type II diabetes?
Progressive increase in fasting glucose due to reduced insulin sensitivity followed by a degeneration of insulin production
What are the 5 things that type II diabetes is tied to?
Heterogeneous disorder and most prominent form of diabetes
Closely tied to obesity and visceral adiposity
Lifestyle factors play a role in development
Strong genetic link
High incidence in developed countries
What are 3 possible mechanisms of insulin insensitivity?
Adipokine signaling
Ectopic lipid storage and free FAs
Inflammatory signaling
___________ ____________ may drive type II diabetes insulin insensitivity.
Adipose signaling
__________ fill adipocytes until enlarged. Once enlarged, adipocytes produce _________ ___________ _________.
Triglycerides
Macrophage chemotaxis protein (MCP-1)
What infiltrates adipose tissue in response to MCP-1?
Macrophages
Macrophages produce what in adipose tissue that favors export of fatty acids?
TNF-alpha
Adipocytes export FA to ____________, where what forms?
Muscle
Ectopic lipid deposits
Ectopic lipid interferes with ________ movement, and that produces what?
GLUT4
Insulin resistance
What are three ways that type II diabetes is managed?
Lifestyle
- Reduced carb consumption
- Prevent glucose swings
- Increase physical activity
- Maintain healthy body weight
Oral Hypoglycemics
- Increase insulin secretion
- Increase insulin sensitivity
- Decrease carbohydrate absorption
Insulin
-Required when beta-cell mass degenerates (Once the disease progresses to that point
What do sulfonylureases do?
Increase beta-cell insulin secretion
What do metformins do?
Uncouples oxidative phosphorylation
*This reduces liver gluconeogenesis and lipogenesis
What do peroxisome proliferator-activated receptor agonists (PPARs) do?
Increase glucose transporter expression
What do alpha-glucosidase inhibitors do?
Prevent carbohydrate absorption
What are the 5 primary methods for detecting diabetes?
Urinalysis
Glucose monitoring
HBA1c
Glucose tolerance test
C-peptide test
*TEST - If a patient fails the urinalysis (glucose present in urine), fails glucose monitoring, and passes the C-peptide test, what do they have?
Type II.
Insulin is still being produced because C-peptide is present, but excess glucose is present in the urine.
What are the neuroglycopenic symptoms of hypoglycemia? (8)
Exhaustion Loss of lucidity Irritability Blurred vision Dizziness Headache Loss of speech Coma and death
What are the autonomic symptoms of hypoglycemia? (5)
Increased heart rate Sweating Trembling Nausea Hunger
What are the causes of hypoglycemia? (4)
Excess insulin
Activity
Insufficient food
Illness
What are treatment options for hypoglycemia? (5)
Sugar Test blood sugar Test again Call 911, if necessary GLUCAGON -This would increase gluconeogenesis resulting in more glucose being put into the blood
What are the signs of hyperglycemia? (6)
Headache Nausea Thirst, dry mouth Excessive urination Ketones Blurred vision
What are the causes of hyperglycemia? (5)
High blood sugar Lack of insulin Inactivity Excess food Illness
What are the treatment options for hyperglycemia? (4)
Insulin
Oral hypoglycemic
Activity
Diet
What are 5 long-term diabetic complications?
Cardiovascular disorders Blindness Kidney disease Neurologic complications -Neuropathy -ED Impaired wound healing/amputation
