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Biochemistry > Carb Metabolism In Diabetes > Flashcards

Carb Metabolism In Diabetes Flashcards

1
Q

Insulin synthesis

A

. Created equal amounts of insulin and C-peptide

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2
Q

C-peptide levels helps monitor ___ insulin

A

Endogenous insulin

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3
Q

Endogenous versus exogenous insulin

A

Endogenous: produces by one’s body
Exogenous: insulin taken as medication

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4
Q

Causative agent of long term damage seen in diabetes type I and II

A

Chronically high blood sugar

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5
Q

Peripheral neuropathy

A

. Lack of nerve sensation in extremities

. Can have phantom pains

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6
Q

Nephropathy

A

. Kidney disease
. kidney tests: BUN and creatinine
. Presence of protein can be indicative of loss of kidney function

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7
Q

Retinopathy

A

. 95% patients w/ DM develop blindness

. Periodic eye exams done

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8
Q

Atherosclerosis in relation to diabetes

A

. Poorly controlled DM assoc. w/ high serum triglyceride levels and high cholesterol levels
. Develops at faste rate and with greater severity than if you don’t have DM
. Tests: blood tests for serum lipids

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9
Q

Impaired circulation in relation to DM

A

. Basement membrane thickening leads to vascular problems, leaky capillaries, and micro aneurysms

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10
Q

Is insulin inductively in GLUT 2?

A

No

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11
Q

GLUT 4 characteristics

A

. Found in muscle and fat
. Passive transport
. Insulin inducible
. Direction from blood to cells

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12
Q

SGLT glucose transporter characteristics

A

. Intestine and renal tubules
. Na glucose cotransporter
. Directions intestinal lumen to cells

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13
Q

High intracellular glucose leads to ___

A

. Protein glycation and polyglot pathway

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14
Q

Protein glycation (glycosylation)

A

. Protein + glucose protein:glucose -> advanced glycosylation
. Glycosylated proteins: Hb, lens proteins, collagens, myelin
. Abnormal glycosylation products crosslink abnormally and responsible for basement membrane thickening

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15
Q

Polyol pathway

A

. Only occurs in cells w/ reductase
. Glucose + NADH -> sorbitol + NAD
. Sorbitol and other sugar alcohols cause osmotic problems for cell
. Cells affected: nerves, retina, lens, aorta, and kidney

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16
Q

Type I diabetes

A

. Pancreas produces little or no insulin at all (<10%)

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17
Q

Type II diabetes

A

. Pancreas produces some insulin, but tissues don’t respond to it normally
. Insulin produces more than normal or less than normal depending on disease progression

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18
Q

Gestational diabetes

A

. Subset of type II
. Occurs during pregnancy, disappears after birth of baby
. Occurs in 9.2% of American pregnancies
. Many women developer type II diabetes later in life

19
Q

Potential causes for inc. in type II diabetes in youth

A

. Genetics
. Lack of availability
. Lack of ability to exercise safely

20
Q

DM 1 vs 2 prevalence in US

A

1: 10%
2: 90%

21
Q

DM 1 vs 2 nutritional state

A

1: thin
2: overweight at diagnosis

22
Q

DM 1 vs 2 speed of onset

A

1: fast
2: slow

23
Q

DM 1 vs 2 acute complications

A

1: ketoacidosis common
2: hyperosmolar episode (ketoacidosis rare)

24
Q

DM 1 vs 2 genetic component

A

1: partial
2: strong

25
Q

DM 1 vs 2 treatment

A

1: diet, exercise, insulin
2: diet, exercise, oral hypoglycemic agents, insulin

26
Q

What type of biological activity of insulin needs the largest amounts of insulin?

A

Glucose lowering

27
Q

What biological activity of insulin requires the lowest amounts of insulin?

A

Anti-lipolysis

28
Q

Common theories of DM 1 cause

A

. Autoimmune antibodies to pancreatic beta-cells
. Pancreatic disease/cancer/surgery (causes loss of synthesis ability or tissues that make insulin are removed from body creating DM)
. Genetic defect in insulin/insulin receptor (rare, result in infant death)

29
Q

Molecular mimicry

A

. Infectious agents have e valves surface proteins that resemble host proteins
. Enables them to escape detection by host defenses

30
Q

Role of genetics in DM 1

A

. Concordance rate is 50% for identical twins
. Some HLA haplotypes are more highly represented in DM 1 and some that are less represented
. Both genetic and environmental factors contribute

31
Q

DM 2 causes

A

. Obesity (BMI>30) that accompanies metabolic syndrome

. Secondary to another disease

32
Q

Metabolic syndrome

A

. Set of conditions that inc. risk for cardiovascular disease
. Most possess at least 3:
Abdominal obesity (waist >40 in men, 35 in women)
High bp (130/85 or higher)
Fasting blood glucose of 110 or higher
Triglyceride level of 150 of higher
Low HDL cholesterol (<40 men, <50 women

33
Q

Insulin resistance

A

. normal to high insulin blood levels but don’t react normally
. Requires 100+ units/day to maintain control (healthy needs 40-50 units)

34
Q

Role of genetics in DM 2

A

. Concordance rate 100% for identical twins

. Correlated w/ familial factors

35
Q

Symptoms of DM 1

A 
. Polyuria
. Polydipsia (excessive thirst) 
. Polyphagia (excessive hunger)
. Weight loss (15 lbs or more)
. Ketogenesis and ketoacidosis 
. Fasting blood glucose over 126 (7.0 mM)
36
Q

Symptoms of DM2

A

. None

. When present resemble mild symptoms of DM 1 (polyuria, polydipsia, weight loss (over long period)

37
Q

Results of intensive treatment for DM 2

A

. Reduced risk for eye, kidney, and nerve diseases

. Inc. risk of hypoglycemic episodes that required assistance

38
Q

Single most important predictor of diabetes

A

. Overweight/obesity

39
Q

Normal, prediabetic, and diabetic ranges for HBA1C

A

Normal: 2-5.6%
Pre: 5.7-6.4
DM: 6.5-15% (good glycemic control <7%, poor control 9% or higher)

40
Q

Definitions used to diagnose DM

A

. Patients who possess fasting glucose of over 126 (7.0 mmol/L)
. Patients who possess classic symptoms of DM in addition to casual plasma glucose over 200 (11.1 mmol/L)
. Patients w/ HBA1C ver 6.5%
. Patients w/ abnormal oral glucose tolerance test (2 hr reading over 200 (11.1 mmol/l using 75g dissolved glucose in wateR)

41
Q

Oral glucose tolerance test

A

. Patient given 75g glucose following overnight fast

. Blood samples taken at 30 min, 1, 1.5, 2, 2.5, and 3 hours analyzed for glucose

42
Q

Prediabetes

A

Patients have levels of glucose above normal but not high enough to be DM

43
Q

Brittle diabetes

A

Poorly controlled diabetes where glucose levels vary widely btw very high and very low

44
Q

Kussmaul respirations

A

. Symptoms of diabetes ketoacidosis where patients breath abnormally w/ deep respiration’s
. Compensatory mechanism for high metabolic acid
. Acetone detected on breath

Biochemistry (64 decks)

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