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LMP301 > LMP301 Lecture 12: Diabetes > Flashcards

LMP301 Lecture 12: Diabetes Flashcards

Diabetes

1
Q

Diabetes is a(n) ___ disorder

A

endocrine

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2
Q

Effects of insulin binding to receptor

A
  1. Translocation of GLUT-4 to membrane
  2. Glycogen synthesis
  3. Glycolysis
  4. FA synthesis
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3
Q

Glucose -> glycogen through what process?

A

oxidation

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4
Q

In the fed state, liver removes ___% of glucose load

A

70

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5
Q

Excess glucose is…

A
  • converted to VLDL

- stored in adipose tissue

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6
Q

What happens in the fasting state?

A
  • glycogen breakdown

- gluconeogenesis

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7
Q

In gluconeogenesis, what are the starting materials?

A
  • glycerol
  • lactate
  • pyruvate
  • AA
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8
Q

What can increase blood glucose?

A
  • glucagon
  • GH
  • Adrenaline
  • Cortisol
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9
Q

GH is made in the…

A

a. pituitary

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10
Q

Cortisol is made in the…

A

adrenal gland

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11
Q

Synthesis / cleaving of insulin

A

pre-proinsulin -> proinsulin -> insulin

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12
Q

Composition of insulin

A

2 AA chains connected by disulfide links

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13
Q

Insulin inhibits…

A
  • lipid ketosis
  • somatostatin
  • glucagon
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14
Q

Insulin promotes…

A
  • glucose uptake
  • K+ and PO4^3- uptake
  • synthesis of protein
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15
Q

Besides gestational, type I, and type II diabetes, what other causes might there be?

A
  • genetic diseases cause defective B-cell
  • genetic diseases infect pancreas / other endocrine organs

e.g. hematochromatosis, Cushings’, pheochromocytoma

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16
Q

Complications of DM

A
  • microangiopathy
  • retinopathy
  • nephropathy
  • neuropathy
  • macroangiopathy
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17
Q

microangiopathy

A

small vessels being destroyed due to high level of glucose

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18
Q

neuropathy

A

damage to PNS

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19
Q

macroangiopathy

A

Diseases in large vessels due to high blood glucose

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20
Q

Diagnosis for DM.

What is used to confirm diabetes?

A

FBG >= 7
PG >= 11.1
OGTT >= 11.1

FBG or OGTT must surpass limit (just one)

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21
Q

FPG

A

fasting plasma glucose

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22
Q

PG

A

random plasma glucose

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23
Q

If testing for PG, what must be noted?

A

PG >= 11.1, but they must also display symptoms of

  • Polydipsia
  • Polyuria
  • Weight loss
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24
Q

OGTT

A

oral glucose tolerance test

  • give 75 g of glucose and measure PG 2h later
  • repeat on different day
  • only use when absolutely have to (ambiguous case)
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25
Q

What are the grey zones of diabetes?

A
  • IFG
  • IGT
  • IFG and IGT
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26
Q

IFG

A

impaired fasting glucose

- FPG is higher than normal, but >= 7

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27
Q

IGT

A

impaired glucose tolerance

  • normal FPG
  • OGTT is higher than normal, but not >=11.1
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28
Q

People (at risk for) diabetes should be screened for…

A
  • heart disease
  • hypertension
  • dslipidemia
29
Q

3 ways to monitor DM

A
  1. self-monitor of blood glucose / point-of-care testing
  2. microalbuminuria
  3. monitor mean glycemia
30
Q

What is used for self-monitor of blood glucose?

A

personal glucometers, which need whole blood sample

31
Q

microalbuminuria is an indicator of…

A

Nephropathy

32
Q

microalbuminuria

A

small amount of albumin found in the urine

33
Q

_____ = mean glycemia over long term

A

glycated hemoglobin (HbA_1c)

34
Q

What is an advantage of monitoring mean glycemia

A

See how patient has behaved over the past 3 months

35
Q

Many proteins become ___ due to hyperglycemia

A

glycated

36
Q

Structure of HbA_1c

A

glucose attached (non-enzymatically) to valine (at N term of HbA)

37
Q

HbA1c has the ___ concentration & lifespan as RBC, which is…

A

same

120 days

38
Q

HbA1c should be monitored every…

A

3 months

39
Q

Treatment target for HbA1c

A

=< 0.07

40
Q

Treatment target for mean plasma glucose

A

=< 9.5

41
Q

What parmacological management of diabetes is there?

A

antihyperglycemic agents can be used

42
Q

antihyperglycemic agents can be used to…

A
  • increase insulin sensitivity
  • increase insulin secretion
  • slow rate of carb absorption
43
Q

which drug: increase insulin sensitivity

A

metformin

44
Q

which drug: increase insulin secretion

A

sulfonylureas

45
Q

which drug: slow rate of carb absorption

A

a-glucosidase

46
Q

Insulin should be used to treat diabetes when…

A

no other options work

Usually given as insulin + another drug (do not want to be solely dependent on insulin)

47
Q

Complications of diabetes

A
  1. Diabetic ketoacidosis
  2. Hyperosomolar non-ketotic coma
  3. hypoglycemia
48
Q

symptoms of diabetic ketoacidosis

A
  • dehydration
  • vomiting
  • hyperventilation
49
Q

Why do some diabetics experience ketoacidosis?

A

Can’t use glucose, so use fat (ketones) as fuel for brain

50
Q

What hormones tend to be secreted in response to diabetic stress?

A
  • catecholamines
  • cortisol
  • GH
    (all agonist to insulin)
51
Q

Why do some diabetics experience dehydration?

A
  1. ketoacidosis causes vomiting

2. hyperglycemia causes glucosuria & osmotic diuresis

52
Q

How to manage diabetic ketoacidosis?

A
  • ASAP: give insulin and fluids
  • Give K+ to balance out effects of insulin
  • bicarb: neutralize acidosis
53
Q

Effect of insulin on K+

A

Insulin makes cells take up K+

54
Q

Who gets diabetic ketoacidosis?

A

type I

55
Q

Who gets hyperosmolar non-ketotic coma?

A

type I

56
Q

symptoms of hyperosmolar non-ketotic coma

A
  • hyperglycemia
  • osmotic diuresis / glucosuria
  • dehydration
  • unconscious
57
Q

hyperosmolar non-ketotic coma is a ___ disorder

A

chronic (develops over time)

58
Q

diabetic ketoacidosis is an ____ disorder

A

acute (happens very rapidly)

59
Q

why do people with hyperosmolar non-ketotic coma not have ketosis symptoms, but have hyperglycemia?

A

Residual insulin in body can prevent ketoacidosis symptoms, but not enough to prevent hyperglycemia

60
Q

Treatment of hyperosmolar non-ketotic coma

A

Show rehydration and insulin

61
Q

Of the 3 complications of diabetes, which is the most severe?

A

hypoglycemia is a clinical emergency

62
Q

symptoms of hypoglycemia

A
  • sweating
  • shaking
  • tachycardia
  • weak
  • nausea
  • confusion
  • coma
63
Q

biochemical diagnosis of hypoglycemia

A

<2.2

64
Q

Treatment of hypoglycemia

A

give glucose

65
Q

causes of hypoglycemia for diabetics

A
  • excess insulin
  • not enough carb intake
  • exercise
66
Q

Risk factors for developing diabetes

A
  • hypertension
  • dyslipidemia / overweight / abdominal obesity
  • other diseases (schizophrenia, PCOS, vascular)
  • family history
  • IGT or IFG
  • gestational DM or macrosomic infant
  • ethnicity
  • metabolic syndrome
67
Q

Which ethnic groups are at higher risk for diabetes?

A
  • aboriginals
  • hispanics
  • asians
  • s. asians
  • africans
68
Q

Metabolic syndrome: 3 of the following must be met…

A
  • waist circumference
  • TG
  • HDL
  • BP
  • FBG

LMP301 (18 decks)

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