Hormonal regulation of intermediary metobolism IV.

Question 1

I. Phases of fasting
1. What are the 4 phases of fasting?

Answer 1

0. Postpandrial phase
1. Interdigestive phase/Early fasting (0-24 hrs)
2. Short-term fasting (24-72 hrs)
3. Long-term fasting (>72 hrs)

Question 2

I. Phases of fasting
2A. What happen in Postpandrial phase?

Answer 2

1. High insulin level
   a. Storage of nutrients
   - Glycogen synthesis
   - Protein synthesis
   - Lipogenesis
   b. + non-obligatory glucose utilizing tissues also use glucose for energy production
   - Glycolysis

Question 3

I. Phases of fasting
2B. What is the Goal of Postpandrial phase?

Answer 3

1/ Storage of nutrients
2/ To prevent the high levels of transport nutrients (glucose)

Question 4

I. Phases of fasting
3A. What happen in liver during Interdigestive phase/Early fasting (0-24 hrs) phase?

Answer 4

Question 5

I. Phases of fasting
3B. What happen in muscle during Interdigestive phase/Early fasting (0-24 hrs) phase?

Answer 5

Question 6

I. Phases of fasting
3C. What happen in fat tissue during Interdigestive phase/Early fasting (0-24 hrs) phase?

Answer 6

Question 7

I. Phases of fasting
3D. During 1. Interdigestive phase/Early fasting (0-24 hrs), does plasma glucose cc. reduce?

Answer 7

Plasma glucose cc. does not reduce

Insulin↓
glucagon↑
cortisol = but necessary

Question 8

I. Phases of fasting
4. What happen here?

Answer 8

Question 9

I. Phases of fasting
5A. What happen in liver during 2. Short-term fasting (24-72 hrs)?

Answer 9

Question 10

I. Phases of fasting
5B. What happen in muscle during 2. Short-term fasting (24-72 hrs)?

Answer 10

Question 11

I. Phases of fasting
5C. What happen in FAT TISSUE during 2. Short-term fasting (24-72 hrs)?

Answer 11

Question 12

I. Phases of fasting
6. Does Plasma glucose cc. decrease during 2. Short-term fasting (24-72 hrs)?

Answer 12

Question 13

I. Phases of fasting
7. What are the important values during muscle proteolysis?

Answer 13

7-12 g Nitrogen
Corresponding to 50-75 g protein
Daily weight loss: 250-375 g

Question 14

I. Phases of fasting
8A. What happen in liver during 3. Long-term fasting (>72 hrs)?

Answer 14

Question 15

I. Phases of fasting
8B. What happen in muscle during 3. Long-term fasting (>72 hrs)?

Answer 15

Question 16

I. Phases of fasting
8A. What happen in liver during 3. Long-term fasting (>72 hrs)?

Answer 16

Question 17

I. Phases of fasting
8C. What happen in FAT TISSUE during 3. Long-term fasting (>72 hrs)?

Answer 17

Question 18

I. Phases of fasting
9. What happen to plasma glucose cc. during 3. Long-term fasting (>72 hrs)?

Answer 18

Question 19

I. Phases of fasting - 3. Long-term fasting (>72 hrs)
10. Does Gluconeogenesis happen in kidney?

Answer 19

Yes

Question 20

I. Phases of fasting - 3. Long-term fasting (>72 hrs)
11. How does proteolysis occur in 3. Long-term fasting (>72 hrs)?

Answer 20

Proteolysis is reduced by time
- Urea exretion reduces (10-15 g → 1g by the 6. week)
- When insreases again→ perimortal proteolysis

Question 21

I. Phases of fasting - 3. Long-term fasting (>72 hrs)
12. Explain the peak of ketogenic capacity

Answer 21

Peak of ketogenic capacity on the 3rd day
- BUT the uptake of keton bodies decreases continously
- Concentration of keton bodies increases for weeks (2-3 mM)

Question 22

I. Phases of fasting
13. Make a schematic diagram about hepatic glucose release during glucose production in starvation

Answer 22

Question 23

I. Phases of fasting
14. Make a schematic diagram about renal glucose release during glucose production in starvation

Answer 23

Question 24

I. Phases of fasting
15. Make a schematic diagram about Glucose consumption of the body during prolonged fasting

Answer 24

Question 25

I. Phases of fasting 16. Make a schematic diagram about Anorexia nervosa

Answer 25

Question 26

II. Catabolic response to stress 1. Make a schematic diagram about Catabolic response when catecholamines are involved

Answer 26

Question 27

II. Catabolic response to stress 2. Make a schematic diagram about Catabolic response when glucocorticoids are involved

Answer 27

Question 28

II. Catabolic response to stress 3. What are these points when it comes to Stress induced hyperglycemia?

Answer 28

Question 29

II. Catabolic response to stress 4. What are Metabolic changes during physical exercise?

Answer 29

Question 30

III. Disturbances of the intermediary metabolism 1. What are the 2 types of Diabetes mellitus?

Answer 30

Type 1 Insulin dependent IDDM, T1D Juvenile Type 2 Non insulin dependent NIDDM, T2D

Question 31

III. Disturbances of the intermediary metabolism 2A. What are the features of diabetes type 1?

Answer 31

1/ Insulin dependent diabetes mellitus 2/ Type 1, IDDM 3/ An autoimmune process deteriorates the β cells of the Langerhans islets

Question 32

III. Disturbances of the intermediary metabolism 2B. What are the molecular events of diabetes type 1?

Answer 32

1/ After 60%- β-cell loss exogenous hyperglycemia -> blood glucose level ↑ only after carbohydrate consumption (reduced carbohydrate tolerance) 2/ Later endogenous hyperglycemia -> even the fasting blood glucose level is higher; the source of the glucose during fasting is the inappropriately high gluconeogenesis.

Question 33

III. Disturbances of the intermediary metabolism 2C. Make a schematic diagram about Abnormal metabolic processes in insulin dependent diabetes mellitus

Answer 33

Question 34

III. Disturbances of the intermediary metabolism 2D. What are the classic symptoms of diabetes type 1

Answer 34

* Weight loss * Polyuria * Polydipsia * Pluritus * Confusion/coma

Question 35

III. Disturbances of the intermediary metabolism 3. Diagnosis of DM - the evaluation of the oral glucose tolreance test -> Draw the glucose curve of diabetes mellitus and normal range

Answer 35

Question 36

III. Disturbances of the intermediary metabolism 4A. What are the Rules of OGTT?

Answer 36

*It should be performed in the morning after at least 10 hours of fasting. *Unrestricted, but minimum 150 g glucose containing diet must be consumed during the previous 3 days of the test. *The patient should have average physical activity during the previous days. *The examination should be done in resting conditions without physical activity and smoking. *Any circumstances that can alter the results of the examination (infections, drugs, etc.) should be taken into consideration – in some cases the postponement of the OGTT may be warranted. *75 g glucose is required for the test which should be disolved in 250-300 ml of water, and should be consumed within 5 minutes. (For children 1.75 g/body weight kg, but maximum 75 g is suggested.) *For the categorization of carbohydrate metabolism, the measurement of the 0- and 2-hour values is sufficient.

Question 37

III. Disturbances of the intermediary metabolism 4B. When is OGTT contraindicated?

Answer 37

If fasting glucose is ≥7mmol/L the OGTT is contraindicated!

Question 38

III. Disturbances of the intermediary metabolism 5A. What are the important values in Evaluation of the OGTT?

Answer 38

Question 39

III. Disturbances of the intermediary metabolism 6. Make a schematic diagram about type 2 diabetes and normal range blood glucose cc.

Answer 39

Question 40

III. Disturbances of the intermediary metabolism 7. What is Degree of hemoglobin glycation (HbA1c) ?

Answer 40

Degree of hemoglobin glycation (HbA1c) reflects the average blood glucose level over a prolonged previous period (3-4 months)

Question 41

III. Disturbances of the intermediary metabolism 7B. What are the important values of Degree of hemoglobin glycation (HbA1c) ?

Answer 41

Question 42

III. Disturbances of the intermediary metabolism 7c. What is Target value in treatment? (Degree of hemoglobin glycation (HbA1c))

Answer 42

7% (6-8%)

Question 43

III. Disturbances of the intermediary metabolism 8A. What are the characteristics of Type 2 diabetic?

Answer 43

1/ Type 2 or non insulin dependent diabetes mellitus (T2D, NIDDM) 2/ Most abundant endocrine disorder: high plasma glucose level despite of high plasma insulin concentration 3/ Relative insulin deficiency/ insulin resistance -> complex metabolic disorders affecting many tissues 4/ Heterogeneous etiology, multicomponent: – Obesity,eatinghabits,geneticfactors,etc. – Can be caused by: overproduction / administration of hormones that increase glucose levels (glucocorticoid, GH, T3 ...: secondary diabetes) 5/ In later stages, insulin secretion decreases (β-cells are depleted)

Question 44

III. Disturbances of the intermediary metabolism 8B. What are the molecular events in plasma in obesity?

Answer 44

1/ In obesity, greater insulin secretion is required to ensure the same blood glucose levels 2/ Daily changes of plasma : glucose, C peptide, insulin levels 3/ in normal weight and obese patients.

Question 45

III. Disturbances of the intermediary metabolism 8C. What are the expression that Determination of insulin resistancy and ß cell function?

Answer 45

HOMA-IR and HOMA %B index

Question 46

III. Disturbances of the intermediary metabolism 8D. How to use HOMA-IR index?

Answer 46

Question 47

III. Disturbances of the intermediary metabolism 8E. How to use HOMA %B index?

Answer 47

Question 48

III. Disturbances of the intermediary metabolism 9/ Make a schematic diagram about Insulin resistance, ß-cell dysfunction and the appearance of the disease?

Answer 48

Question 49

III. Disturbances of the intermediary metabolism 10/ What does Increased body mass index show?

Answer 49

+ correlation with the non-insulin dependent diabetes mellitus (NIDDM)

Question 50

III. Disturbances of the intermediary metabolism 11/ ___ and ___ correlates to central obesity

Answer 50

Insulin resistance and T2D correlates to central obesity

Question 51

III. Disturbances of the intermediary metabolism 12. What is the Progression of type2 diabetes

Answer 51

Question 52

III. Disturbances of the intermediary metabolism 13. Describe Gestational diabetes mellitus (GDM)

Answer 52

* Gestational diabetes mellitus is a carbohydrate metabolism disorder diagnosed during pregnancy * Incidence is 2-6 % * General screening is performed between the 24-28th gestational week with a standard OGTT with 75g glucose * GDM is diagnosed if fasting glucose ≥7 mmol/l (recently ≥ 5.6mmol/l) and/or 2 hour glucose ≥ 7.8 mmol/l. * Six weeks after delivery OGTT should be performed to reconsider the diagnosis * Short and long term complications - Mother: delivery complications, cesarean section, later diabetes and cardiovascular diseases - Child: LGA, hypoglycemia, later obesity, diabetes, cardiovascular diseases

Question 53

III. Disturbances of the intermediary metabolism 14A. What are the options to ameliorate NIDDM?

Answer 53

1/ Diet 2/ exercise 3/ sulfanylurea 4/ GLP (analogues) dipeptidyl peptidase inhibition 5/ TZD (tiazolidin-dion drugs) 6/ biguanidins (metformin) 7/ SGLT- inhibition 8/ insulin

Question 54

III. Disturbances of the intermediary metabolism 14B. Why is diet an option to ameliorate NIDDM?

Answer 54

reduces the lipid content of the adipose tissue -> increases adiponectin secretion ↑, in other insulin target tissues triglicerid ↓ (insulin resistance ↓) , resistin, TNFα and IL6 secretion ↓ 8/ insulin

Question 55

III. Disturbances of the intermediary metabolism 14C. Why is excercise an option to ameliorate NIDDM?

Answer 55

excercise => GLUT-4 translocation to the plasma membrane, blood plasma [glucose]↓

Question 56

III. Disturbances of the intermediary metabolism 14D. Why is sulfanylurea an option to ameliorate NIDDM?

Answer 56

* sulfanylurea -> KATP inhibition -> insulin secretion↑

Question 57

III. Disturbances of the intermediary metabolism 14D. Why is GLP (analogues) an option to ameliorate NIDDM?

Answer 57

Question 58

III. Disturbances of the intermediary metabolism 14E. Why is TZD (tiazolidin-dion drugs) an option to ameliorate NIDDM?

Answer 58

Question 59

III. Disturbances of the intermediary metabolism 14F. Why is SGLT- inhibition an option to ameliorate NIDDM?

Answer 59

* SGLT- inhibition -> plasma [glucose]↓