B5-002 Diabetes Mellitus Metabolism

Question 1

core defects of type 2 diabetes

2

Answer 1

• insulin resistance
• B cell dysfunction

Question 2

translocates to the cell membrane to take up glucose

Answer 2

GLUT4

Question 3

what 2 stimuli cause translocation of GLUT4 in muscle?

Answer 3

insulin
muscle contraction

Question 4

in a healthy condition, insulin and muscle contraction have an […] effect on glucose transport

Answer 4

additive

Question 5

in an insulin resistance individual, insulin and muscle contraction have a […] effect on glucose transport

Answer 5

synergistic

farmers requiring less glucose then sedentary workers

Question 6

hepatic insulin resistance is commonly linked to

Answer 6

fatty liver

Question 7

insulin binds receptors on hepatocytes to turn off

Answer 7

gluconeogenesis

Question 8

lipids in the liver cells are thought to prevent insulin from “turning off” […] in fatty liver

Answer 8

gluconeogenesis

Question 9

hepatic glucose production is […] in DM 2 patients

Answer 9

elevated

Question 10

dysregulation of […] plays a prominent role in DM 2 pathology

Answer 10

hepatic glucose production

Question 11

critical locations for post prandial glucose disposal in DM2

2

Answer 11

skeletal muscle
liver

Question 12

hepatic glucose uptake is […] in DM 2

Answer 12

suppressed

Question 13

what contibutes to elevated postprandial glucose in DM2 patients?

Answer 13

HGP is not suppressed to the same degree as a healthy control

Question 14

dysregulated hepatic glucose metabolism contributes to:

2

Answer 14

elevated fasting glucose
elevated post prandial glucose

Question 15

as insulin sensitivity decreases, […] increases to compensate

Answer 15

beta cell insulin production

Question 16

when beta cells are no longer able to compensate, this causes

Answer 16

DM 2 or
impaired glucose tolerance

Question 17

primary genetic component of DM 2

Answer 17

beta cell ability to compensate

Question 18

post prandial glucose exursions are tightly linked to

Answer 18

CVD risk

Question 19

higher glucose post […] is linked to higher CAD risk

Answer 19

2 hr OGTT

Question 20

swings in glucose in circulation cause […] in various tissues

Answer 20

oxidative stress

Question 21

why might it be important to do both a fasting glucose and 2 hr OGTT?

Answer 21

impaired fasting glucose and impaired glucose tolerance can occur separately

Question 22

[…] should lead to the highest glucose responses to a meal or OGTT

Answer 22

combined IFG/IGT

Question 23

GLP-1 levels are […] in patients with DM 2

Answer 23

decreased

either reduced production or increased DPP4 breakdown

Question 24

L cells produce

2

Answer 24

GLP-1
GIP

incretins

Question 25

why is C reative protein used as a marker of insulin production?

Answer 25

it is more stable than insulin

Question 26

GLP-1 induced insulin secretion is [...] in DM2

Answer 26

reduced

Question 27

isoglycemic infusion of glucose stimulated insulin normally in DM2 patients. This suggests....

Answer 27

incretins (GLP, GIP) are critical for normal insulin response

Question 28

[...] levels are much higher in the portal vein than in systemic circulation

Answer 28

insulin

Question 29

the pancreas dumps insulin and glucagon into the [...]

Answer 29

portal vein

Question 30

the liver takes up [...] of insulin, lowering what is seen in systemic circulation

Answer 30

50-85% | insulin degrading enzyme

Question 31

insulin injections cannot mimic

Answer 31

high insulin levels in portal vein

Question 32

most adequate therapy for controlling hepatic glucose production and hepatic glucose storage

Answer 32

combination pre-meal and post-meal insulin

Question 33

in most patients [....] goes up over time despite use of anti-hypeglycemic agents

Answer 33

HbA1C | lifestyle interventions are critical

Question 34

greater than [...] of walking a day dramatically lowers the risk of DM2

Answer 34

21 min

Question 35

[...] steps/day confers a level of protection against DM2

Answer 35

3,500

Question 36

most powerful regulation of insulin sensitivity

Answer 36

daily activity

Question 37

both standing and light activity even 20 min lowers

Answer 37

glucose and insulin | improves insulin sensitivity

Question 38

impaired fasting glucose is believed to be driven by

Answer 38

increased hepatic glucose production

Question 39

impaired glucose tolerance is attributed to

Answer 39

impaired glucose uptake

Question 40

most powerful risk factors for development of DM2 | 5

Answer 40

* obesity * physical inactivity * genetics * ethnicity * age

Question 41

ingested glucose stimulates L cells to produce

Answer 41

GLP-1

Question 42

signals pancreatic beta cells to produce greater insulin levels during postprandial conditions

Answer 42

GLP-1

Question 43

[....] is integral for a higher insulin response in post prandial conditions

Answer 43

GLP-1 production and glucose sensing | thats why lower response for IV vs oral

Question 44

DM2 patients with supressed GLP-1 responses have impaired [...] response

Answer 44

insulin

Question 45

primary cause of fatty liver

Answer 45

obesity

Question 46

increased transaminases and elevated fasting glucose may indicate

Answer 46

fatty liver

Question 47

glucose levels > 200 two hours after OGTT test, but a normal A1C is caused by

Answer 47

glucose intolerance

Question 48

stimulates pancreatic beta cell insulin production

Answer 48

GLP-1

Question 49

association between "insulin sensitivity" and "beta cell insulin secretion in response to glucose"

Answer 49

disposition index

Question 50

exercise is most effective at improving beta cell insulin production in individuals who are

Answer 50

early in their prognosis and have lower HbA1C

Question 51

what patients would be least responsive to effects of exercise?

Answer 51

individuals who have had diabetes for prolonged period of time or have very high HbA1C

Question 52

postprandial surges in glucose or large swings are more tightly linked to

Answer 52

oxidative stress --> CVD risk