Diabetes

Question 1

Glucagon

Answer 1

Inhibited by insulin

Hypoglycemia states

Stimulates:
Gluconeogenesis
Glycogenolysis
Lipolysis
Insulin secretion

Question 2

Insulin

Answer 2

Allows glucose to move out of blood into sk.m. and adipose tissue

Pre-proinsulin -> proinsulin -> insulin and c-peptide

Hyperglycemia triggers release

Anabolic effects:
Increased glycogen synthesis
Increased TG synthesis
Increased protein synthesis

Binds insulin receptor on cells – tyrosine kinase -> GLUT 4 transports on membrane

Question 3

C-peptide

Answer 3

Differentiate T1DM and T2DM cause of hypoglycemia

No c-peptide: exogenous insulin
Insulinoma – high c-peptide

Question 4

Insulin release mechanism

Answer 4

Glucose enters beta cell via GLUT2
Metabolized to ATP

Elevated ATP closes K+ channel -> depolarizes cell
Voltage gated Ca2+ channels open, calcium influx -> release of insulin

Question 5

GLUT1

Answer 5

No insulin required

Brain and RBCs

Question 6

GLUT2

Answer 6

Insulin independent

Beta cells, liver, sm. intestine
Renal cells

Question 7

GLUT4

Answer 7

Insulin response

Adipose tissue, sk.m.

Question 8

Cotton wool spots

Answer 8

DM, HTN, AIDS

Question 9

Draw out insulin formulations

Answer 9

Page 664

Meal time- short acting:
Aspart
Glulisine
Lispro

Regular insulin peaks 3 hrs, done by 9 hrs

NPH – peaks 6 hrs, mostly done by 12 hours

Long acting – 24 hours
Glargine
Detemir

Question 10

PPAR gamma

Answer 10

Peroxisome proliferator activated receptor gamma

Regulates fatty acid storage and glucose metabolism

Target for –glitazone diabetic drugs