Week 2: Diabetes and Metabolism Flashcards
Give three examples of clinic space designs that are inclusive of all bodies
SDOH
Furniture appropriate for all (armless chairs)
Artwork that shows body diversity
Large enough blood pressure cuffs and hospital gowns
Define metabolic syndrome
≥3 of the following:
* Central or abdominal obesity
* High triglycerides
-150 milligrams per deciliter (mg/dL)
* Low HDL cholesterol
-Men < 40 and women < 50
* High blood pressure
-130/85 or more
* High fasting glucose
-100 mg/dL or more
If taking medication for said condition it counts i.e. hypertension meds
What are the waist circumference measurements indicating central obesity for men and women?
Men - greater than 40 inches
Women - greater than 35 inches
What are two major mechanisms causing hyperglycemia in uncontrolled diabetes mellitus?
- Uninhibited gluconeogenesis
- Insufficient glucose uptake into muscle & adipose
Name the four characteristic symptoms of hyperglycemia.
- Polyuria
- Polydipsia
- Polyphagia
- Fatigue
List two features of pathologic obesity.
- High visceral white adipose tissue (WAT)
- Impaired adipogenesis
- Insulin Resistance
- Ectopic lipid deposition
- Adipocyte dysfunction and/or deficiency
How frequently are HbA1c levels typically checked?
Every 3 months
an erythrocytes life span is ~118 days
What is the minimum fasting glucose level that is diagnostic for diabetes?
> 126 mg/dL
What minimum A1c level is diagnostic for diabetes?
> 6.5%
What is HbA1c?
Glycated hemoglobin
List two features of metabolically healthy obesity.
- High subcutaneous white adipose tissue (WAT)
- Adequate adipogenesis
- Healthy WAT remodeling
- Adipocyte function maintained
In the absence of significant insulin signaling, what else signals GLUT-4 vesicles to fuse with the plasma membrane of myocytes?
Physical activity stimulates GLUT-4 to move to the membrane of only the actively contracting muscle fibers.
Name three outcomes that can be used to assess improved health in a weight-neutral wellness intervention.
- Blood lipid levels
- Blood pressure
- Self-esteem
- body image
- depression
- quality of life
What enzyme is primarily responsible for releasing fatty acids from VLDLs?
Lipoprotein lipase (LPL)
What are two common side effects of sulfonylureas?
- Weight gain
- Hypoglycemia
How does insulin prevent ketoacidosis?
It inhibits lipases within adipocytes.
i.e. hormone-sensitive lipase (h-sl) and atl
Explain why sulfonylureas run the risk of causing hypoglycemia but GLP-1 agonists usually do not.
Sulfonylureas stimulate glucose-independent insulin secretion.
GLP-1’s require glucose for insulin to work so you have high blood sugar
This drug class blocks the clearance of GLP-1’s and GIP’s
DPP4 inhibitor (sitagliptin)
This drug class blocks glucose reabsorption in the proximal tubule by blocking sodium-glucose transporters
SGLT2 inhibitor
What is the major mechanism of action of Metformin?
- Major
-Reduces hepatic glucose output by inhibiting gluconeogenesis - Minors
-Increases insulin sensitivity
-Increases glucose uptake ‘
-Decreases intestinal absorption
lactic acid is a substrate for gluconeogenesis so acidosis can occur
What is the mechanism of action of sulfonylureas?
Increases insulin release from beta cells
What are the expected levels of triglycerides and HDL in people with metabolic syndrome?
- High triglycerides
- Low HDL
What are the expected C-peptide levels in newly diagnosed type 1 and type 2 diabetes?
- Low for type 1 (no insulin is made in T1DM and cleavage of C-peptide is done last to activate insulin)
- Typically normal-elevated for type 2
Give three physiologic processes that occur in response to a weight-loss diet that make it difficult to not regain weight.
- Reduced adipocyte size reduces leptin secretion
- Decreased eating reduces GLP-1 and increases ghrelin
- Decreased body weight decreases metabolic rate and therefore decreases caloric needs
