Carb Metabolism In Diabetes

Question 1

Insulin synthesis

Answer 1

. Created equal amounts of insulin and C-peptide

Question 2

C-peptide levels helps monitor ___ insulin

Answer 2

Endogenous insulin

Question 3

Endogenous versus exogenous insulin

Answer 3

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

Question 4

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

Answer 4

Chronically high blood sugar

Question 5

Peripheral neuropathy

Answer 5

. Lack of nerve sensation in extremities

. Can have phantom pains

Question 6

Nephropathy

Answer 6

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

Question 7

Retinopathy

Answer 7

. 95% patients w/ DM develop blindness

. Periodic eye exams done

Question 8

Atherosclerosis in relation to diabetes

Answer 8

. 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

Question 9

Impaired circulation in relation to DM

Answer 9

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

Question 10

Is insulin inductively in GLUT 2?

Answer 10

No

Question 11

GLUT 4 characteristics

Answer 11

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

Question 12

SGLT glucose transporter characteristics

Answer 12

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

Question 13

High intracellular glucose leads to ___

Answer 13

. Protein glycation and polyglot pathway

Question 14

Protein glycation (glycosylation)

Answer 14

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

Question 15

Polyol pathway

Answer 15

. 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

Question 16

Type I diabetes

Answer 16

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

Question 17

Type II diabetes

Answer 17

. 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

Question 18

Gestational diabetes

Answer 18

. 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

Question 19

Potential causes for inc. in type II diabetes in youth

Answer 19

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

Question 20

DM 1 vs 2 prevalence in US

Answer 20

1: 10%
2: 90%

Question 21

DM 1 vs 2 nutritional state

Answer 21

1: thin
2: overweight at diagnosis

Question 22

DM 1 vs 2 speed of onset

Answer 22

1: fast
2: slow

Question 23

DM 1 vs 2 acute complications

Answer 23

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

Question 24

DM 1 vs 2 genetic component

Answer 24

1: partial
2: strong

Question 25

DM 1 vs 2 treatment

Answer 25

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

Question 26

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

Answer 26

Glucose lowering

Question 27

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

Answer 27

Anti-lipolysis

Question 28

Common theories of DM 1 cause

Answer 28

. 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)

Question 29

Molecular mimicry

Answer 29

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

Question 30

Role of genetics in DM 1

Answer 30

. 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

Question 31

DM 2 causes

Answer 31

. Obesity (BMI>30) that accompanies metabolic syndrome | . Secondary to another disease

Question 32

Metabolic syndrome

Answer 32

. 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

Question 33

Insulin resistance

Answer 33

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

Question 34

Role of genetics in DM 2

Answer 34

. Concordance rate 100% for identical twins | . Correlated w/ familial factors

Question 35

Symptoms of DM 1

Answer 35

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

Question 36

Symptoms of DM2

Answer 36

. None | . When present resemble mild symptoms of DM 1 (polyuria, polydipsia, weight loss (over long period)

Question 37

Results of intensive treatment for DM 2

Answer 37

. Reduced risk for eye, kidney, and nerve diseases | . Inc. risk of hypoglycemic episodes that required assistance

Question 38

Single most important predictor of diabetes

Answer 38

. Overweight/obesity

Question 39

Normal, prediabetic, and diabetic ranges for HBA1C

Answer 39

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

Question 40

Definitions used to diagnose DM

Answer 40

. 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)

Question 41

Oral glucose tolerance test

Answer 41

. 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

Question 42

Prediabetes

Answer 42

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

Question 43

Brittle diabetes

Answer 43

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

Question 44

Kussmaul respirations

Answer 44

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