Diabetes Clinical Demonstration Flashcards
(38 cards)
What is carbohydrate
- stored as
- circulates as
- metabolised as
- Stored as glycogen
- Circulating as glucose
- Metabolised as glucose
What is lipids
- stored as
- circulates as
- metabolised as
- Stored as triglyceride
- Circulates as Non-esterfified fatty acids (NEFA), ketones, triglyceride
- Metabolised as NEFA, ketones
what is the most important fact that causes the switch between using glucose and lipids as an energy source
- insulin
What is the energy supply mostly derived from when you are in the fasting state
• Most energy supply coming from lipid oxidation
is insulin high or low in the fasting state and what is the plasma glucose level
low insulin
- normal plasma glucose is 5 mmolar
describe what is being metabolised in the fasting state
- No glucose being stored, glucose being mobilised from glycogen
- Glucose being metabolised by brain, red blood cells & skin
- High plasma fatty acids being oxidised by most other tissues
what is activated in the fasting state
• Some ‘stress’ (hormones e.g. cortisol & sympathetic) – increase with prolonged fast
when is the fed state
1-2 hours after a meal
Where is the most energy supply coming from in the fed state
• Most energy supply coming from glucose
is insulin high or low in the fed state and what is the plasma glucose like
- High insulin
* Plasma glucose 7-8 mmolar
describe what happens to glucose and fatty metabolism for insulin
- Most glucose being stored as glycogen (but oxidation also increases)
- Low fatty acids
- Glucose being taken up by skeletal muscle (& metabolised by brain, red blood cells, skin as before)
- Low stress hormones
how is increased fuel met when you need it in exercise
• Increased fuel needs met by increased oxidation of both lipid and glucose
what is insulin and plasma level in glucose
- Low insulin
* Normal plasma glucose 5 mmolar
what is metabolised in exercise
- No glucose being stored, glucose being mobilised from glycogen
- High fatty acids
- Glucose being metabolised by skeletal muscle, brain, red blood cells, skin & others.
- Aerobic & anaerobic .
- High ‘stress’ hormones
How does ketoacdisois happen
- Ketone bodies of keto acids caused when you release fatty acids but don’t oxidise them completely
- Get partial oxidation and ketone bodies build up
- Get ketoacidosis
What fuels are used in the brain
• Brain, glucose under all conditions. Aerobic only. (ketones during starvation only)
what fuels does red blood cells and skin use
• RBC & skin anaerobic glucose only
what fuels does skeletal muscle use
• Skeletal muscle (cardiac muscle similar) – this can change
– Resting state, mostly fatty acids,
– Exercise state, mostly fatty acids (but glucose oxidation increases too)
– Fed state, glucose
(can do both aerobic & anaerobic)
How much insulin is produced per day
• About 30 units of insulin per day
what causes an increase in insulin requirement
• Insulin requirement increased in obesity or couch potatoes, less in active, fit people
What is the percentage of beta cell function left in diabetes
• Diabetes always <30% of beta-cell function left, Type 1 usually about 10% when they present, usually <5% in most patients
what is type 1 diabetes
- autoimmune condition in which insulin is completely deficient and is not really present
- it is absolute
what is type 2 diabetes
- a condition in which insulin is deficiency or there is a resistance to insulin
i. e. may still be making 40 units per day, but need more - it is relative
what causes type 1 diabetes
- Autoimmune destruction of beta-cells in islets of Langerhans in pancreas
- Familial, some genetics sorted out (cell surface antigens & immune response elements)
