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Flashcards in Diabetes: Science and Clinical Deck (98)
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1

The exocrine pancreas produces... [physiology]

watery, alkaline secretions and digestive enzymes to the duodenum

2

The endocrine pancreas has 4 groups of cells which are: [physiology]

1. beta cells (insulin)
2. alpha cells (glucagon)
3. D-cells (somatostatin)
4. F cells (pancreatic polypeptide)

3

Where are b-cells found? [physiology]

centrally within the islets of langerhans

4

Role of somatostatin [physiology]

released in response to increased BG and amino acides. slows rate of digestion to prevent excess nutrients in the plasma

5

Role of pancreatic polypeptide [physiology]

reduces appetite and food intake

6

promotes the acitivity of which enzyme [Insulin]

Glycogen synthase

7

inhibits the activity of which enzyme [Insulin]

lipase

8

[carbohydrates] insulin has 4 effects on carbohydrates

1. facilitates transport into cells via GLUT 4
2. stimulates glycogenesis
3. inhibits glycogenolysis
4. inhibits gluconeogenesis

9

[fat] insulin has 4 effects on fat

1. increases fatty acid uptake into adipose tissue
2. increased transport of glucose into adipose tissue via GLUT 4
3. Promotes use of fatty acid in reactions
4. inhibits lipolysis

10

[proteins] insulin has 3 effects on protein

1. promotes active transport of amino acids into muscles
2. increases amino acid incoporation into protein
3. inhibits protein degradation

11

main driver of release of insulin [insulin; physiology]

an increase in blood sugr

12

5 steps of insulin release in the cell [insulin; cellular release]

1. glucose enters b-cell via GLUT 2 facilitated diffusion
2. glucose is metabolised to G-6-P and then to ATP
3. ATP:ADP ratio increases causing ATP-K sensitive channel to close
4. reduced K exit depolarises cell and opens VGCC
5. Ca enters b-cell and stimulates release of insulin

13

insulin is produced as a polymer with what other protein [insulin]

C-peptide
*this can be measured in T1 diabetics to monitior the decrease in insulin production however may take 3-4 years to disappear so is not a reliable indicator

14

what is the physiological difficulty with diabetes mellitus? [DM; physiology]

An inability to produce any or sufficient endogenous insulin

15

Why do complications occur in DM? [DM; physiology]

As a result of high blood sugar as insulin is the only hormone able to reduce BG

16

Criteria for diagnosis from a random BG [DM; diagnosis]

>11.1 mmol/L with symptoms OR
7.8 - 11 mmol/L on two occassions with symptoms

17

Criteria for diagnosis from 2hr OGTT [DM; diagnosis]

>11.1mmol/L and above
7.8-11 is pre-diabetes

18

Criteria for diagnosis from FG [DM; diagnosis]

>7.0mmol/L

19

Criteria for diagnosis from HbA1c [DM; diagnosis]

48 mmol/L and above

20

Three forms of microvascular complications [DM; complications]

Retinopathy, neuropathy, nephropathy

21

Process underlying retinopathy [DM; Complications]

1. formations of microaneurysms in the eye.
2. proteins cause the BM of the eye to become thickened and more permeabel --> fibrous response --> destroys the retina

22

Process underlying nephropathy [DM; Complications]

Vascular disease in the kidney leads to kidney failure

23

Process underlying neuropthy [DM; Complications]

PVD may affect the nerves causing a loss of sensation and higher chance of foot ulcers

24

Forms of macrovascular complications [DM; Complications]

MI, Stroke and CVD - need to tightly control blood pressure as all vascular disease is accelerated, 50-70% of diabetics die from CVD

25

Pathophysiology of T1DM [T1DM]

Autoimmune destruction of the pancreatic b-cells leading to inability to produce insulin and control blood sugar. Usually occurs in adolescence but can occur at any age

26

Genetics associated with T1DM [T1; Science]

90% of T1DM carry HLA DR3+DR4; those with a first degree relative with T1DM have a 5-6% chance of developing the disease

27

Autoantibodies associated with T1DM [T1; science]

ICA (islet cell antibodies) and GAD (anti-glutamic acid decarboxylase)

28

What is LADA? [T1; science]

A form of T1 that presents in adults but presents with a slower onset and slower progression to insulin dependence

29

Symptoms associated with T1 (5/9 for 5*) [T1; symptoms]

Polyuria; polydipsia; weight loss; tiredness; ketosis; thirst; thrush; many and persistent infections; blurred vision

30

Treatment of T1 [T1; Treatment]

Insulin regimes, DAFNE