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BRS1 - Valentine > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

(47 cards)

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1
Q

Where are GLUT4 normally found?

A

Myocytes and adipocytes

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2
Q

Describe the structure and properties of GLUT4

A

Highly insulin responsive

Lies in vesicles

Recruited and enhanced by insulin

7 fold glucose uptake

Has outer hydrophobic chain and inner hydrophilic chains

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3
Q

How does insulin affects gluconeogenesis in the fed state?

A

Inhibits gluconeogenesis

Inhibits break down of proteins to gluconeogenic amino acids

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4
Q

What hormones are active in the starving state and what do they do

A

Cortisol- stimulates gluconeogenesis

Glucagon- stimulates gluconeogenesis and breaking down of proteins to gluconeogenic amino acids.

This all increase HEPATIC glucose output

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5
Q

What are the 3 fuel stores and list them in order of mass and energy per kg. What is their respective time in order to deplete

A

Carbs- 16 HOURS

Protein- 15 days

Fats - 30-40 days

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6
Q

What enzyme is responsible for breakdown of triglycerides in plasma so that they can enter adipocytes? What hormone stimulates this enzyme

A

Lipoprotein lipase

Breaks TG down into glycerol and NEFA

They enter adipocytes

Insulin stimulates the lipoprotein lipase

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7
Q

Once glycerol and NEFA are in adipocytes; describe the role of insulin intracellularly

A

Stimulates uptake of glucose into cell which can be converted to NEFA

Stimulates lipogenesis in adipocyte to make Trig

Inhibits break down of Trig in adipocyte

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8
Q

In adipocytes what describe the role of GH and cortisol intracellularly

A

Stimulate lipolysis

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9
Q

What is the significance of the hepatic portal system?

A

Quick flow of blood from heart to gut and liver. Hence quicker response time

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10
Q

When are glycogen storage used up?

A

10 hour fast

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11
Q

What can the brain can or cannot metabolise?

A

CANNOT- NEFA (fats) Can- ketone bodies and glucose(preferred)

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12
Q

What hormones affect formation of ketone bodies?

A

Insulin- inhibits formation of ketone bodies by inhibiting lipolysis

Glucagon- stimulate formation of ketone bodies

More NEFA uptake

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13
Q

Describe how glycogen is formed and hormones that affect hepatic glycogenolysis?

A

Glucose taken up by cell and converted to glucose 6- phosphate

Then converted to glycogen

Insulin stimulates formation of glycogen

Glucagon stimulates glycogenolysis- which can lead to secretion of glucose from LIVER

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14
Q

Describe what hormones affect muscle cell uptake of glucose

A

Insulin stimulate uptake

Glucagon and GH- inhibit uptake of glucose‘

Muscle cell DO NOT RELEASE glucose into bloodstream

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15
Q

Describe what happens in fasting sate

A

LOW insulin: glucagon ratio

Increased hepatic glcuose output

Increased lipolysis; hence more ketone bodies

More proteinolysis- gluconeogenic amino acids

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16
Q

Describe what happens in the fed state?

A

Stored insulin released; high insulin to glucagon ratio

NO hepatic glucose output

Increased protein SYNTHESIS

LIPOGENESIS

Glycogenesis

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17
Q

What are the tests required to diagnose diabetes mellitus

A

Fasting glucose levels- more than 7mmol/L

HbA1c

Random glucose test- more than 11.1mmol/L

Oral glucose tolerance test: fasting then 75g glucose load with jelly babies. check glucose 2 hours later

Urine test- for ketone bodies; or blood for ketone bodies

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18
Q

What is needed to confirm diagnosis of diabetes mellitus

A

A diagnosis requires 2 positive tests OR 1 positive test +osmotic symptoms

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19
Q

Describe the pathophysiology of type 1 diabetes

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A

Autoimmune condition.
Absolute insulin deficiency

So increased lipolysis, proteinolysis and hepatic glucose output and ketone bodies

Can lead to ketoacidosis

20
Q

What are the presentations of type 1 diabetes

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A

Weight loss

Hyperglycaemia

Glycosuria, nocturia, polyuria, polydipsia

Ketones in blood and urine

21
Q

What are the useful diagnostic test to confirm type 1 diabetes ?

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A

C-peptide; it should be lower. C peptide amount can be used to figure dosage of insulin required Autoantibodies

Presence of ketone bodies

22
Q

What is the problem of administering too much insulin. Explain why?

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A

Will lead to hypoglycaemia

Less hepatic glucose output and MORE glucose enter into muscle cell

23
Q

What are the body’s counterregulatory response to hypoglycaemia? What will it lead to?

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A

Increased glucagon, catechoalmines, cortisol, growth hormone

Lead to increased lipolysis and HGO due to increased glycogenolysis and gluconeogenesis

24
Q

Despite the body’s counter regulatory response to hypoglycaemia; why might insulin induced hypoglycaemia still present in those with Type 1 diabetes

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A

Too much insulin to overpower counters

Impaired awareness of hypoglycaemia- the body can’t recognise it’s symptoms

25
What are the autonomic symptoms of hypoglycaemia
Sweating Pallor Shaking Palpitations
26
What are the Neuroglycopenic symptoms of hypoglycaemia?
Slurred speech Poor vision Confusion Seizures Loss of consciousness - ALL AFFECT BRAIN
27
What is severe hypoglycaemia
When person needs 3rd party asssiatnce to treat the episodE
28
Describe the pathophysiology in type 2 diabetes?
INSULIN resistance residing in LIVER, MUSCLE and adipose tissue
29
Why doesn’t ketogenesis occur in type 2
There’s enough insulin to suppress ketogenesis and proteolysis
30
What intermediate pathways are affected in type 2?
Glucose and fatty acids.
31
What are the 2 pathways that occur when insulin binds to insulin receptor? What are their roles? Which one can be insulin resistant?
P13k-Akt pathway - metabolic actions MAPK pathway- growth and proliferation PI3k-Akt pathway can be insulin resistance ; lead to increased insulin secretion for it to work
32
What can insulin resistance lead to?
* High Trig * Low HDL * Hypertension * Increased waist circumference- more than 102cm in men; due to increased deposits of fats * Increased fasting glucose * Increased adipokines
33
What are the presentation of Type 2?
Hyperglycaemia Overweight- some people Abnormal lipids Less osmotic symptoms Insulin resistance - may lead to insulin deficiency
34
What’s are the risk factors for type 2?
Age; Increased BMI Polycystic ovary syndrome Family History Ethnicity Inactivity
35
What are the dietary requirements for people with type 2?
* Control total calories * Reduce calories as fat and refined carb * Increase calories as complex carb; to lower glycaemic index * Increase soluble fibre * Decrease sodium
36
What are the management options for type 1
Exogenous insulin Self monitoring of glucose levels Structured education Technology- insulin pump
37
What are the management options for type 2
Diet and exercise Oral medication: Metformin Structured education May need insulin later
38
What are the complications if diabetes isn’t managed properly?
Retinopathy Neuropathy- lead to amputation Nephropathy CVD
39
In fasting state after 10 hours what is the contribution of hepatic gluconeogenesis to overall HGO
25%
40
In myocyte describe the roles of the following hormones: IGF-1, GH, cortisol
IGF1-1- stimulate protein synthesis GH- stimulate protein synthesis from gluconeogenic amino acid Cortisol; stimulate proteinolysis to form gluconeogenic amino acids
41
Describe the role of insulin in myocyte
Inhibit proteinolysis Stimulate protein synthesis Inhibit oxidation of amino acids
42
In type 1, explain why there’s osmotic symptoms
Renal threshold passed; more glucose in urine, water follow urine to create a lot of urine. Blood is still very concentrated; hyperglycaemia. Sends signal to brain to dilute blood hence makes you thirsty-polydipsia
43
Is family history important in diagnosis type 1
Yes, type 1 is autoimmune disease; may have a genetic predisposition. Having an autoimmune disorder or gene increase change of developing another one
44
What is diabetes incipitus? How can it be treated? What may be the cause?
Lack of vasopressin; too much urine Can be treated by given AVP or drink too much fluid May be caused by head trauma or autoimmunity
45
Describe the whole process of how insulin and cortisol and GH affects adipocytes. Draw it
46
Draw the axis of what different factors affects hepatic gluconeogenesis? What hormones are present in fed and starving state
47
Draw the axis of how insulin and other hormones affects muscle cells

BRS1 - Valentine (54 decks)

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