Diabetes Path

Question 1

diabetes is the ________ leading cause of death

Answer 1

seventh

Question 2

prevalence of diabetes in ethnicity

Answer 2

most to least

• American Indian/Alaska Native
• black
• Hispanic
• white
• Asian

Question 3

risk factors for type 1

Answer 3

genetic predisposition or autoimmune trigger

Question 4

risk factors for type 2

Answer 4

family history, overweight/obesity, sedentary lifestyle, race/ethnicity, American, previous pre-diabetes, gestational diabetes or baby <9lbs, hypertension, decreased HDL, increased TG, PCOS, vascular disease

Question 5

parts of proinsulin

Answer 5

A chain, B chain, C-peptide

Question 6

what creates active insulin

Answer 6

C-peptide cleavage

Question 7

C-peptide and insulin are

Answer 7

stored and co-secreted from secretory granules

Question 8

beta cells secrete

Answer 8

islet amyloid polypeptide (IAPP) or amylin

Question 9

amylin

Answer 9

further helps insulin release

Question 10

beta cell - fasting

Answer 10

cell membrane remains mostly polarized allowing very little calcium influx, incretin hormone levels are low

Question 11

fasting insulin

Answer 11

small basal amount of insulin is released to maintain euglycemia and glucose supply to muscle, fat, and liver

Question 12

is there always insulin being released?

Answer 12

yes, unless your beta cells don’t work

Question 13

fasting glucose is at it’s highest or lowest level?

Answer 13

lowest

Question 14

beta cell - fed

Answer 14

extracellular glucose concentrations increase; incretin hormone levels/binding increase

Question 15

food intake causes

Answer 15

an increase of glucose concentration

Question 16

glucose is transported into the beta cell by

Answer 16

GLUT2 - which is not insulin dependent

Question 17

glucose under goes glycolysis which yields

Answer 17

pyruvate - pyruvate enters the mitochondria yielding ATP

Question 18

increase in ATP causes

Answer 18

closure of ATP-dependent K+ channels

Question 19

K+ channel closure causes

Answer 19

depolarization of the cell

Question 20

Depolarization allows for

Answer 20

opening of calcium channels and calcium influx occurs

Question 21

increase intracellular calcium causes

Answer 21

migration of insulin secretory granules to the cell membrane and release of insulin

Question 22

after insulin is secreted, how much is destroyed by the liver?

Answer 22

half

Question 23

what happens to the remaining insulin

Answer 23

enters circulation and is able to bind to the receptor

Question 24

insulin binding to receptor causes a cascade of reactions

Answer 24

1) expression of GLUT4 transporters
2) GLUT4 is expressed on the surface of the cell in response to insulin binding to its receptor
3) this causes the cell to take up glucose

Question 25

fasting glucose homeostasis

Answer 25

decrease insulin which increases glucagon which increases glucose production which decreases uptake by fat/muscle and increases lipolysis

Question 26

fed glucose homeostasis

Answer 26

increases insulin which decreases glucagon which decreases glucose production which increases uptake by fat/muscle and increases lipolysis

Question 27

in glucose homeostasis there is a balance between

Answer 27

hepatic production and peripheral uptake/utilization

Question 28

overall fasting glucose homeostasis

Answer 28

undergo gluconeogenesis in the liver, undergo lipolysis to help generate more glucose

Question 29

overall fed glucose homeostasis

Answer 29

decrease glucagon as insulin goes up, stops stimulating liver to produce insulin, and increase uptake of fat

Question 30

Type 1 DM has

Answer 30

islet cell antibodies and activated lymphocytes in islets/lymph/circ

Question 31

T cells proliferate when

Answer 31

exposed to islet protein (presence of cytokines in protein)

Question 32

autoimmune targets

Answer 32

insulin, glutamic acid decarboxylase, Tyr phosphate, phogrin

Question 33

stages of type 2

Answer 33

normal, insulin resistance (hyperinsulinemia), impaired glucose tolerance (postprandial), type 2 diabetes mellitus (fasting)

Question 34

role of genetics in type 2

Answer 34

increased risk if present in single parent, genetic risk is polygenic, environment clouds the picture

Question 35

genetic predisposition of type 2

Answer 35

insulin signaling and obesity/fat distribution

Question 36

beta cell dysfunction precedes hyperglycemia by

Answer 36

10+ years

Question 37

primary cause of beta cell dysfunction is

Answer 37

poor metabolic environment

Question 38

glucotoxicity

Answer 38

oxidative metabolism of glucose leads to production of reactive oxygen species, which are normally quickly detoxified