Endocrine 1

Question 1

What are the 3 big categories of insulin resistance? What are some examples?

Answer 1

a. making bad insulin
b. circulating insulin competition (receptors Abs, insulin Abs, inhibitors)
c. target tissue defects (receptor defect, post-receptor defect)

Question 2

Tell me the following about DM1 and DM2:

a. age of onset
b. weight
c. HLA link
d. concordance
e. Islet Abs
f. C-peptide level
g. ketoacidosis

Answer 2

a. 30
b. low, high
c. yes, no
d. 50%, 100%
e. yes, no
f. low, normal
g. yes, no

Question 3

Is insulin resistance due to a decrease in the number of receptors?

Answer 3

No.

Question 4

Is insulin resistance due to a decrease in the number of receptors?

Answer 4

No.

Question 5

What are two reasons for insulin resistance?

Answer 5

a. IR tyrosine kinase is impaired.

b. GLUT4 translocation/activation is impaired.

Question 6

What are the three big signs of metabolic disease?

Answer 6

a. HTN
b. obesity
c. hyperlipidemia

Question 7

What are the levels of hyperlipidemia in metabolic disease for HDL and triglycerides?

Answer 7

HDL 150

Question 8

What are the differences between DKA and HHNC for the following:

a. serum glucose
b. pH
c. HCO3
d. osmolarity

Answer 8

a. >250, >600
b. 7.3
c. 20
d. variable, >=330

Question 9

What are some causes of HHNC?

Answer 9

a. new DM2 dx
b. missed meds
c. infection
d. unknown

Question 10

What are the Dx criteria for DM2?

Answer 10

a. A1c > 6.5%
b. fasting glucose >= 126
c. random glucose > 200 with symptoms
* all should be rechecked*

Question 11

What are the Dx criteria for DM2?

Answer 11

a. A1c > 6.5%
b. fasting glucose >= 126
c. random glucose > 200 with symptoms
* all should be rechecked*

Question 12

How can you treat retinopathy?

Answer 12

anti-VEGFs like ranibizumab.

Question 13

What are the 4 acute complications to DM2?

Answer 13

a. hyperglycemia
b. DKA
c. HHNC
d. infection

Question 14

What are the 3 microvascular complications of DM2?

Answer 14

a. retinopathy
b. neuropathy
c. nephropathy

Question 15

what are the 3 macrovascular complications of DM2?

Answer 15

a. CVD
b. CAD
c. peripheral vascular disease

Question 16

what are the 3 macrovascular complications of DM2?

Answer 16

a. CVD
b. CAD
c. peripheral vascular disease

Question 17

What releases glucagon?

Answer 17

alpha cells in the islets of langerhans.

Question 18

Where are ketones produced? What is the effect of insulin on this process?

Answer 18

Produced in the liver.

Insulin decreases ketone production.

Question 19

Where are ketones produced? What is the effect of insulin on this process?

Answer 19

Produced in the liver.

Insulin decreases ketone production.

Question 20

Insulin causes decreases in what 5 substrate concentrations?

Answer 20

a. glucose
b. ketones
c. K+
d. FAs
e. triglycerides

Question 21

Glucagon causes an increase in what 2 substrate concentrations?

Answer 21

a. glucose

b. ketones

Question 22

What do catecholamines do to serum FFA levels?

Answer 22

increase… the release FFAs into circulation.

Question 23

What 4 things do glucocorticoids do?

Answer 23

a. mobilize FFAs
b. GLUCONEOGENIC
c. increase ketone synthesis
d. decrease in peripheral glucose use

Question 24

What 5 things do growth hormones do?

Answer 24

a. mobilize FFAs
b. favor ketogenesis
c. increase hepatic glucose output
d. reduce peripheral glucose use
e. promote protein synthesis

Question 25

Where is GLUT4 found? Is it insulin responsive?

Answer 25

Found in skeletal muscle, heart, and adipose cells. It is insulin sensitive.

Question 26

Where is GLUT4 found? Is it insulin responsive?

Answer 26

Found in skeletal muscle, heart, and adipose cells. It is insulin sensitive.

Question 27

Where is GLUT1 highly concentrated?

Answer 27

brain(!) and endothelial cells.

Question 28

Where is GLUT2 found, and what is it's major function?

Answer 28

Found in kidneys, liver, pancreatic beta-cells. It senses glucose levels in islets.

Question 29

What is special about GLUT5?

Answer 29

It has a high affinity for fructose.

Question 30

Where is GLUT3 found?

Answer 30

neurons and placenta.

Question 31

Where is GLUT3 found?

Answer 31

neurons and placenta.

Question 32

What are the two ways somebody can develop DM1? Gives examples?

Answer 32

a. Genes: HLA-linked | b. Environmental Insult: viral infection and/or damage to beta-cells.

Question 33

What is reduced in DKA, and what is increased?

Answer 33

Reduced: circulating insulin and its effects Increased: glucagon, catecholamines, cortisol, growth hormone

Question 34

Can you hold the insulin of DM1 pts ever?

Answer 34

No. Never. Never. Never.

Question 35

What are the 5 I's that precipitate DKA?

Answer 35

a. Infection b. Insulin (missed) c. Infarction d. Ishcemia e. Intoxication