Type 2 Diabetes

Question 1

glucose sources

Answer 1

intestinal absorption, glycogenolysis, gluconeogenesis

Question 2

In fasting state, glucagon levels increase/decrease

Answer 2

increase

Question 3

Glucagon

Answer 3

stimulates glycogenolysis and gluconeogenesis

Question 4

In fasting state, insulin levels increase/decrease

Answer 4

decrease

Question 5

During eating, insulin levels increase/decrease

Answer 5

increase

Question 6

Which tissues absorb glucose due to insulin?

Answer 6

muscle, liver, adipose

Question 7

Insulin resistance

Answer 7

reduced response to circulating insulin

Question 8

Insulin resistance hyperglycemia

Answer 8

liver, muscle, adipose glucose intake is low and liver glucose output is high –> hyperglycemia

Question 9

There is a _______ relationship between insulin secretion and insulin resistance

Answer 9

hyperbolic

Question 10

As one gains weight and becomes obese, it is possible to maintain glucose balance if ____

Answer 10

pancreas increases insulin output –> this ability drops off over time

Question 11

Prediabetes

Answer 11

impaired glucose tolerance, impaired fasting glucose

Question 12

Why do post-prandial sugars rise first after some years of prediabetes?

Answer 12

as ability to ensure high level of insulin secretion tapers off and starts declining, the body has a more difficult time coping with high carbohydrate load vs. simply shutting off liver glucose production –> post prandial sugars rise before fasting glucose

Question 13

First indicator of diabetes

Answer 13

rise in insulin

Question 14

By the time of diagnosis, ____% of beta cells are long gone.

Answer 14

50%

Question 15

normal fasting glucose

Answer 15

100 = more cardiovascular risk)

Question 16

2hr plasma glucose after 75gm CHO load

Answer 16

<140 mg/dL

Question 17

100<200 mg/dL

Answer 17

prediabetes

Question 18

T/F most people with prediabetes develop type 2 diabetes within 10 years

Answer 18

T

Question 19

First phase of insulin secretion

Answer 19

task is to take care of just-consumed CHO and shut down glucose production –> insulin in beta cell granules

Question 20

Second phase of insulin secretion

Answer 20

task is to maintain blood sugar that has been absorbed prior –> gradual increase in insulin

Question 21

___ phase of insulin secretion is missing in T2D.

Answer 21

first phase

Question 22

Deposition of ____ disrupts alpha/beta cell communication.

Answer 22

amyloid –> inappropriately high glucagon secretion stimulates liver production of glucose and therefore hyperglycemia

Question 23

intestinal hormones that are released in response to food ingestion

Answer 23

incretins

Question 24

Incretins

Answer 24

glucagon like peptide 1 (GLP1) and gastric inhibitory polypeptide (GIP) stimulate insulin secretion in the presence of glucose –> account for 60-70% of postprandial insulin response

Question 25

Incretin response

Answer 25

difference between insulin load from oral glucose and from iv glucose

Question 26

T/F response to GLP1 is preserved in diabetes

Answer 26

T

Question 27

GLP1 effect on glucagon

Answer 27

reduces glucagon -->reduces hepatic glucose output

Question 28

GLP1 effect on stomach

Answer 28

slows gastric emptying --> attenuates post-prandial hyperglycemia

Question 29

GLP1 effect on CNS

Answer 29

promotes satiety and reduction of appetite

Question 30

4 main defects in Type 2 Diabetes

Answer 30

decreased insulin action, decreased insulin secretion, inadequate glucagon suppression and excess hepatic glucose production, defective incretin response

Question 31

Risk factors for T2D

Answer 31

obesity, race, metabolic factors, lifestyle, genetics, gestational diabetes, intrauterine

Question 32

Nonspecific clinical presentation of T2D

Answer 32

fatigue, blurry vision, poor wound healing, dry mouth/skin, recurrent infections (candadiasis)

Question 33

Classic symptoms of T2D

Answer 33

polyuria/dipsia/phagia, unexplained weightloss

Question 34

Physical exam findings of T2D

Answer 34

obesity, skin changes, candidal infection, fundoscopic/neurologic (decreased sensation)/feet changes (ulcers)

Question 35

skin changes in T2D

Answer 35

acanthosis nigricans, skin tags, furuncles and carbuncles

Question 36

Diagnostic criteria for T2D

Answer 36

fasting glucose>126 on two separate occasions or random glucose>200 with classic sx or 2hr glucose test >200 or hba1c>6.5%

Question 37

_____ reflects average plasma glucose level over past 2-3 months

Answer 37

hemoglobin a1c

Question 38

After gastric bypass levels of _____ are highg

Answer 38

GLP1