energy balance

Question 1

what is the primary control of insulin secretion

Answer 1

negative feedback between beta cells and glucose concentration in the blood

Question 2

what does diabetes refer to

Answer 2

large volume of urine produced by diabetics

Question 3

mellitus meaning

Answer 3

sweet urine- assocaited with hyperglycemia and glucose output in the urine

Question 4

insipiddus meaning

Answer 4

tasteless urine- diabetes that is not associated with hyperglucemia but with ADH deficiency

Question 5

IDDM

Answer 5

autoimmune destruction of B cells
in children or before 40 yrs
regular insulin injections required

Question 6

what happens in IDDM when insulin absence is occuring

Answer 6

glucagon release from a cells is triggered- glucose sensing fails in the a cells leading to additional glucose in the blood thorugh glucagon action

Question 7

what is possible therapy for IDDM

Answer 7

insulin and GHIH (somatostatin) to inhibit glucagon secretion

Question 8

what is A1C a measure

Answer 8

glycosylation state of hemoglobin

Question 9

how often is the turnover of Hb in RBC

Answer 9

every 3 months therefore testing is done every 3 months

Question 10

what is %glycosylation a function of

Answer 10

average glucose levels over time (1-3 months prior)

Question 11

what is the A1C value for non diabetics

Answer 11

5%

Question 12

what is the A1C value for diabetics

Answer 12

greater than 6.5-7%

Question 13

what is an important indicator of diabetes control

Answer 13

A1C monitoring

Question 14

why is uncontrolled glucose a problem

Answer 14

advanced glycation end products- AGEs- interfere with physiological systems such as arterial stiffness in diabetes mellitus

Question 15

gestational diabetes

Answer 15

gestational diabetes mellitus refers to glucose intolerance with onset or first recognition during pregnancy

Question 16

what is a risk during GDM- gestational diabetes mellitus

Answer 16

fetal malformations at early gestational time points

risk of macrosomia and metabolic complications with late gestation GDM

Question 17

what are the risk factors of GDM

Answer 17

> 35 yrs
on cortisol therapy
race
obesity
pre diabetic condition
T2DM in the family
PCOS

Question 18

how many pathways lead to type D diabetes

Answer 18

multiple

Question 19

what is a precursor state of diabetes type 2

Answer 19

prediabetes

Question 20

what can happen in type 2 diabetes

Answer 20

progress to type 1

Question 21

what is the normal fastsing range

Answer 21

less than 6mmol/L

Question 22

what does chronic over eating lead to

Answer 22

inc in blood glucose
inc in insulin secretion
dec sensitivity of target cells to insulin- insulin resistance

Question 23

what is type 2 diabetes assocaited with

Answer 23

hypertension and hyperlipidemia

Question 24

what is hyperlipidemia and hypertension

Answer 24

metabolic disease

Question 25

what percentage of people who develop type 2 diabetes are overweight

Answer 25

90%

Question 26

what is the smoking gun

Answer 26

B cells deteriorate during diabetes

Question 27

why do b cells deteriorate during diabetes

Answer 27

they are more vulnerable to the by products of their own metabolism bc they are the sensors for insulin release

Question 28

what are the by products of beta cells

Answer 28

ROS, endoplasmic reticulum stress, AGE

Question 29

what does chronic insulin secretion lead to

Answer 29

beta cell exhaustion leading type 2 to progress to type 1

Question 30

what are the insulin sensitizing drug class for type 2 DM

Answer 30

thiazolidinediones TZDS

Question 31

what improves A1C and glucose control

Answer 31

TZDS for type 2 DM

Question 32

what is TZDS mechanism of action

Answer 32

increased fat storage in the adipocyte, effectively reducing circulating FA, blood glucose and hyperinsulinemia

Question 33

what are the side effects of TZDS

Answer 33

bone density, cancer, CVD

Question 34

what are some estimates of adiposity

Answer 34

BMI and waist circumference

Question 35

waist circumference

Answer 35

used to determine regional adiposity helps estabolish if body fat is peripheral or central obseity gender specific higher risk of obesity associated illness

Question 36

high risk waist circumference sizes

Answer 36

more than 35 in women and 40 in men

Question 37

what provides accurate esitimate of body fat and health risk

Answer 37

BMI and waist circumference

Question 38

what does diabetes do to your lifespan

Answer 38

decreaeses it by 15 yrs you have the same health risk as someone 15 yrs younger than you

Question 39

Type 2 diabetes treatments

Answer 39

moderate energy intake exercise routine balanced physique: adipose to muscle ratio

Question 40

body energy

Answer 40

energy intake - energy output

Question 41

energy input

Answer 41

foods we eat, digest and absorb

Question 42

energy output

Answer 42

work and heat/ waste

Question 43

what is BMR dictated by

Answer 43

gender, lean muscle mass, level of activity, food ingestion, thyroid hormones and catecholamines, metabolic efficiency/ genetics

Question 44

what does food ingestion do to BMR

Answer 44

spike it

Question 45

appetite or hunger

Answer 45

desire for food

Question 46

satiety

Answer 46

sense of fullness or satisfaction

Question 47

what are the two control centres for the hypothalamus with regards to food

Answer 47

feeding centre satiety center

Question 48

what are the 4 types of input to the hypothalamus

Answer 48

neural input from the cerebral cortex neural input from the limbic system (amugdala, hypocampus, cinguate gyrus) peptide hormmones from the GI tract Adipokines from adipose tissue

Question 49

glucostatic theory

Answer 49

theory proposes that blood glucose levels ultimately control feeding and satiety centers

Question 50

lipostatic theory

Answer 50

theory that proposes that level of body fat regulates feeding and satiety centres discovery of several peptides from adipose tissue seems to support this theory

Question 51

Ghrelin resposne to body fat

Answer 51

inc to decreased body fat

Question 52

ghrelin and muscle mass

Answer 52

increase to increased muscle mass

Question 53

what is ghrelin impacted by

Answer 53

macronutrient content of meals and can be regulated by diet

Question 54

when is the highest ghrelin post prandial suppresion

Answer 54

carb then protein and finally fat fat is last bc it is used as a mechanism for weight gain associated with high fat diets

Question 55

leptin and obesity

Answer 55

does not work exogenously with majority of obese individuals and therefore it is not as significant as animal models leptin reistance occurs when there is high expose to high cituclating concentration

Question 56

contributions to net energy excess and adipose storage

Answer 56

adipokine imbalance lack of physical exertion variation in the efficiency of energy extraction from foods endocrine disorders such as hypothyroidism energy dense food availability; modern expecations genetics, mental health, eating behaviour

Question 57

what do calorie restricted diets do

Answer 57

significantly lengthen the life span of many species including humans

Question 58

metabolic syndrome

Answer 58

high blood glucose high blood pressure high triglycerides low HDL abdominal obesity