Theme 3: Diabetes

Question 1

C-peptide

Answer 1

this part is removed when converting proinsulin to insulin. this is a good measure of insulin synthesis for type 1

Question 2

tests for type 1

Answer 2

c peptide and insulin autoantibody levels

Question 3

in the absence of insulin in the liver… this is bad because

Answer 3

the unopposed action of glucogon promotes gluconeogenesis. This causes too much PROTEOLYSIS AND LIPOLYSIS

Question 4

In the muscle, without insulin

Answer 4

the muscle does not receive any of the glucose that it needs for energy. because the muscle is so energy deprived, the ATP dependent transporters fail, and K+ leaks out of the cell and is lost in the urine. Thus, DIABETIC KETOACIDOSIS

Question 5

Long term effects of no inuslin on brain, muscle and beta cells

Answer 5

The brain will down regulate glucose transporters because there is a massive amount of free glucose in the blood. The uscle will start to breakdown because of no energy, with a negative nitrogen balance and K loss. Also the beta cells will begin to die off because of glucose toxicity. Thus, poly urea, polydipsia, volume depletion, low HCO3, low pH, plasma K levels iwll be normal or even high, because it is not in the cell where it should be.

Question 6

Unrestrained lipolysis and ketogenesis…

Answer 6

because of lack of insulin

Question 7

Symptoms of untreated T1DM

Answer 7

Polyuria and polydipsia
Volume depletion (5+ liters), postural hypotension,
tachycardia
Loss of body fat and muscle, muscle weakness
Deep shallow breathing, breath smells of acetone

Labs (blood) glucose high, HCO3- low, pH low,
K+ normal or even high but body severely depleted

Question 8

Osmotic diuresis with diabetes

Answer 8

because plasma glucose levels are really high and the renal threshold for glucose reabs at the kidney is 180.. thus becaue the urine becomes hyperosmotic, more water and salt is lost in the urine.

Question 9

ketones

Answer 9

acetoacetic acid, beta hydroxybutyrate, acetone (thus sweet acetone breath)

Question 10

Acidosis

Answer 10

acid produced from lipolysis (fat) and ketogenesis (liver) is initally buffered, by bicarb in the blood– this generate Co2, Kussmaul breathing– eventually this is overcome and blood pH becomes acidic

Question 11

patient considerations for T1

Answer 11

life expectancy is now near normal, but not a normal life; with injected insulin, there is a risk of hypoglycemia always present, balanced with concequences of long term hyperglycemia

Question 12

T2DM

Answer 12

common cause of early death (kidney failure, blindness, MI, stroke.)
usually asymptomatic

Question 13

t2dm risk factors

Answer 13

asian american, latino, pacific islanders at a higher risk,
insulin resistance most commonly caused by obesity
low birth weight, fetal malnutrition
sleep disturbance
WESTERN LIFESTYLE HAS A BAD EFFECT

Question 14

t2dm and central obesity

Answer 14

increased bmi increases insulin demand

Question 15

insulin resistance and obesity

Answer 15

fact cells in obesity recruit INFLAMMATORY CELLS with release of cytokines. and these infl cytokines contribute to insulin resistance. c-reactive protein predicts risk for t2d and vascular disease

Question 16

Insulin resistance due to inflammation from obesity, but not all people with insulin resistance on these cells get diabetes

Answer 16

80% are still non diabetic. they are able to make more insulin an do not get diabetes. Thus the genetic predisposition to t2 d is based on the beta cell response to insulin resistance. Those who develop diabetes have a LOWER BETA CELL MASS

Question 17

T2dm when insulin demand is greater than insulin availability.. THUS WEIGHT LOSS

Answer 17

weight loss and lowered bmi helps with diabetes because it will lower the insulin demand to a level that is below insulin availability

Question 18

Type 1 diabetes- ethnic risk factor.

Answer 18

caucians are at higher risk. it is an autoimmune diease. 1.5 million are affected in the US (30 mill t2dm)

Question 19

t2dm

Answer 19

any type of insulin resistance, wether due to obesity, pregnancy, etc.

Question 20

diabetes treatment

Answer 20

everyday, avoid high levels of blood glucose in order to prevent longer micro and macro vascular complications

Question 21

other causes if increased insulin risk in addition to obesity

Answer 21

corticosteroid treatment, liver disease, muscle wasting diseases, pregnancy.

Question 22

t2d patient considerations

Answer 22

do not make them feel guilty, this has a genetic component like male pattern balding.
changes in lifestyle is importnat for treatment, but this only comes with EDuCATION and help by explaining the context of their inheriting the genetic predisposition.
life expectancy is normal with appropriate care.

Question 23

Clinical signs of diabetes

Answer 23

increased thirst, frequent urination, fatigue, weight loss
Kussmaul breathing pattern
Acetone breath
Obese
Acanthosis nigricans
Serum glucose more than 100
High/Normal Potassium (when acute?)
Diabetic Ketoacidosis, low pH
With anion gap.. 
Glycosuria
family history
Increased risk of yeast infections

Associated with hypertension?

Look up stuff in Costanzo brs and physic!

Question 24

diabetes treatment

Answer 24

everyday, avoid high levels of blood glucose in order to prevent longer micro and macro vascular complications

Question 25

C-peptide

Answer 25

this part is removed when converting proinsulin to insulin. this is a good measure of insulin synthesis for type 1

Question 26

other causes if increased insulin risk in addition to obesity

Answer 26

corticosteroid treatment, liver disease, muscle wasting diseases, pregnancy.

Question 27

t2d patient considerations

Answer 27

do not make them feel guilty, this has a genetic component like male pattern balding.
changes in lifestyle is importnat for treatment, but this only comes with EDuCATION and help by explaining the context of their inheriting the genetic predisposition.
life expectancy is normal with appropriate care.

Question 28

Clinical signs of diabetes

Answer 28

increased thirst, frequent urination, fatigue, weight loss
Kussmaul breathing pattern
Acetone breath
Obese
Acanthosis nigricans
Serum glucose more than 100
High/Normal Potassium (when acute?)
Diabetic Ketoacidosis, low pH
With anion gap.. 
Glycosuria
family history
Increased risk of yeast infections

Associated with hypertension?

Look up stuff in Costanzo brs and physic!

Question 29

C-peptide

Answer 29

this part is removed when converting proinsulin to insulin. this is a good measure of insulin synthesis for type 1

Question 30

C-peptide

Answer 30

this part is removed when converting proinsulin to insulin. this is a good measure of insulin synthesis for type 1