28: Endocrine Pancreas Flashcards
(32 cards)
where in pancreas are the majority of islets of langerhans
neck and tail
five steps of cellular insulin release
- GLUT2 takes glucose into Beta cells
- ATP is generated from glucose
- ATP inhibits membrane K channel
- Depol -> Ca influx
- Insulin release
what two things are made from proinsulin
insulin + C peptide
what is C peptide a marker for?
endogenous insulin
two major incretins
- GLP-1: glucagon-like peptide1
2. GIP: glucose-dependent insulin-releasing polypeptide
MOA of incretins
stimulate insulin release + inhibit glucagon release -> lowers blood sugar
molecule that inactivates incretins
DPP-4
why do Kussmaul respirations occur?
compensatory respiratory alkalosis bc of underlying metabolic acidosis
target A1C
6.5 or lower
effect on vasculature of glycated end products
- production of: VEGF, TGF-B, ROS
- procoagulant activity
- SM proliferation
- Matrix protein cross linking
unifying features of pancreating neuroendocrine tumors
grossly solid tan/yellow, mostly found in pancreatic neck and tail, secretory granules on EM
basal vs bolus insulin
- basal: long-acting insulin to achieve steady state control
- bolus: adjusted at mealtime and based on FSG and estimated carb count of meal
two other names for HHS: Hyperglycemic Hyperosmolar State
- NKHS: Non-Ketotic Hyperosmolar State
2. HNKC: Hyperosmolar Non-Ketotic Coma
123 rule for fluid replacement in DKA and HHS**
- DKA: 2-3L in first 1-3 hours -> 150ml/hr
2. when glucose reaches 250: switch to D5 1/2 NS at 100-200ml/hr
three things to be sure of before starting a DKA pt on long-acting insulin
- pt can eat (mental status improving, no N/V/abd pain
- anion gap normalized
- allow overlap timing of IV with SQ insulin by 30-60 minutes
major cause of mortality in DM2
CV disease
two things that can alter A1c results
- hemoglobinopathies
2. recent blood transfusions
three things to do at exams quarterly vs annually for diabetic pts
- quarterly: A1c, review SGM log, foot inspection
2. annually: dilated eye exam, urine protein screen, monofilament testing
foot care tips for diabetic pts
- daily inspection: use plastic mirror or family assistance if needed
- dont go barefoot
- moisturize but not between/under toes
- prescription shoes
- podiatry
for a diabetic pt, was is the single most additive risk for CV disease?
cigarettes
chr associated wth DM1
Chr 6
insulinitis
T cell and macrophage infiltrate on histo for DM1
three metrics to Dx DM2
- FPG: 126+
- 2hr glucose: 200+
- A1c: 6.5%+
mutation in MODY
glucokinase
