Lecture 20: Gestational Diabetes Flashcards Preview

PSIO 469 Exam 04 > Lecture 20: Gestational Diabetes > Flashcards

Flashcards in Lecture 20: Gestational Diabetes Deck (58):
1

What is Gestational Diabetes Mellitus (GDM)?
(2)

- Glucose intolerance with onset or first recognition
- Insufficient pancreatic Beta-cell function

2

If a women who has a history of GDM, she is more likely to have worsen effects when pregnant.
T/F

True

3

Most, but not all women with GDM will develop diabetes ______ of pregnancy

outside

4

GDM is caused by?
(3)

- Insulin resistance (most common)
- Auto-immune disease (less common)
- Monogenic causes (single gene defect, rare)

5

What are 2 reasons for the rise in GDM?

- Increased screening during pregnancy
- Changes in diagnostic criteria

6

What explanations because of increased screening?

- More women are being screened
- Undiagnosed diabetes is being diagnosed first in pregnancy

7

What was the mean GDM percentage in 1991?
What is the mean GDM percentage in 2000?

- 5.1
- 6.9

8

Blood glucose homeostasis is maintained within the ____ ______.

Narrow Range

9

What is the normal range when fasting?

70-100mg/100ml or (3.9-5.5mmol/L)

10

What happens during Hypoglycermia when it is less than 2.5 mmol/L? (4)

Confusion, Drowsiness, Coma, Seizure

11

What happens during Hypoglycemia when it is less than 2.7 mmol/L? (7)

Nervousness, Sweating, Intense Hunger, Trembling, Weakness, Irregular Heart Rate, Difficulty Speaking

12

What happens during Hyperglycemia when it is greater than 14 mmol/L? (5)

Frequent Urination, Sugar in Urine, Frequent Thirst and Hunger, Ketoacidosis, Coma

13

Insulin is the only hormone capable of:

lowering blood glucose

14

Actions of insulin lowering blood glucose

-Promotes cellular uptake of glucose form the blood
- Promotes energy storage
- Promotes utilization for energy production

15

Which cells in the Islets of Langerhans sense blood glucose levels?

Pancreatic Beta Cells

16

When Blood glucose rises, Pancreatic Beta-cells:

Secrete insulin into systemic circulation

17

Starting with the uptake of glucose by the _____ transporter, the phosphorylation of glucose causes a rise in the ___:___ ratio

GLUT2
ATP; ADP

18

The rise in the ATP:ADP ratio ______ the potassium channel that _________ the membrane, causing the ______ channel to ____ up allowing calcium ions to flow ____.

inactivates
depolarizes
calcium
open
inward

19

The ensuing rise in levels of _____ leads to the ______ of insulin from storage _______

Calcium
exocytosis
granules

20

Insulin Structure
Insulin is a _____ hormone derived from ____

peptide; proinsulin

21

Insulin Structure
_-_______ is cleaved off during processing and packaged along with _____ in storage granules

C-Peptide
Insulin

22

Insulin Structure
C-peptide is _____ along with insulin from _______ ____-______.

released
Pancreatic Beta-Cells

23

This muscle is the principal site of whole-body glucose disposal

Skeletal

24

Less_____ is transported into _____ tissue than into _____ muscle but ____ is still an important tissue for glucose uptake

Glucose, adipose, skeletal, adipose

25

This is the main insulin-responsive glucose transporter

GLUT-4

26

GLUT 4 is both expressed in skeletal muscle and adipose
T/F

True

27

When insulin levels are low, GLUT-4 is stored in

Intracellular Vesicles

28

Insulin-Stimulated Glucose Uptake
_____ is stored in intracellular vesicles.

GLUT-4

29

Insulin-stimulated Glucose Uptake
Insulin binds to the _______ domain of its receptor in the _____ membrane, resulting in ______ of _____ portion of the receptor (a _____ kinase)

extracellular
plasma
phosphorylation
intracellular
Tyrosine

30

Insulin-stimulated Glucose Uptake
The activated ____ kinase phosphorylates insulin-receptor _______ such as the ___ molecules

Tyrosine
substrates
IRS

31

What are the IRS molecules being referred to ?

IRS-1
IRS-2
IRS-3
IRS-4

32

Insulin-stimulated Glucose Uptake
These insulin-receptor substrates form ______ with docking _____ such as ______ at its regulatory ___ by means of ___ domains

complexes
proteins; PI-3K
p85
SH2

33

Insulin-stimulated Glucose Uptake
____ is the constitutively bound to the catalytic subunit (____)

p85
p110

34

Insulin-stimulated Glucose Uptake
Activated of ____ is a major pathway in the mediation of insulin stimulated glucose transport and metabolism

PI-3K

35

PI-3K activates _______-______ kinases that participate in the activation of _____ ______ _ and typical forms of _____ _____ _____

phosphoinositide-dependent
protein kinase B
protein kinase C

36

Protein kinase B is aka?
Protein kinase C is aka?

- Akt
- PKC

37

Insulin-stimulated Glucose Uptake
____ stimulates glucose transport by pathways that are independent of _______ kinase and that may involve ________activated kinase

Exercise
phosphoinositide-3
5'-AMP

38

When is the Oral Glucose Tolerance Test used on pregnant women?

24th-28th week (end of second trimester)

39

What does the Oral Glucose Tolerance Test do?

- measure levels of glucose in the mother's blood following ingestion of sugary drink (100g dextrose)
- abnormal levels may indicate gestational diabetes

40

Postpartum blood glucose in GDM group was ____ to pregnant controls (______ insulin action resolves with delivery of baby)

similar
inadequate

41

Normal Glucose Regulation during Pregnancy
Normal pregnancy is characterized by _____ decrease in insulin mediated glucose uptake and a ___-____ increase in insulin secretion to maintain _____ in pregnant mothers

50%
200-250%
euglycermia (normal blood glucose levels)

42

Progressive insulin resistance begins near mid-pregnancy and progresses through the _____ trimester to levels that are approximate insulin resistance seen in ___-__ ________.

- third
- Type-2 Diabetes

43

Pancreatic Beta-cells normally ______ insulin secretion to compensate for _____ resistance of pregnancy

increase
insulin

44

Normal Glucose Regulation during Pregnancy
changes in circulating _____ levels over a course of pregnancy are quite _____ compared with ____ changes in insulin sensitivity.

glucose
small
large

45

Insulin Resistance may be due to:
(2)

- increased maternal adiposity
- Insulin-desensitizing effects of placental hormones

46

What is an example of placental hormones?

Human placental lacotgen or human chorionic somatomammotropin

47

Rapid abatement of insulin resistance after delivery suggests:

Major contribution from placental hormones

48

Abnormal Glucose Regulation with GDM
Insulin secretion is ____ to compensate for the insulin resistance, leading to _______ that is detected by routine glucose screening in pregnancy

inadequate
hyperglycemia

49

Abnormal Glucose Regulation with GDM
Gestational diabetes results from:

inability of pancreatic Beta-cells to make enough insulin

50

Increased insulin resistance with GDM
Glucose Infusion Rate (GIR) is ____ in pregnant women than in women with _____

higher
GDM

51

Increased Insulin Resistance with GDM
Lower GIR (__-__%) in women with GDM indicates ____ glucose uptake and _____ insulin resistance

30-40
less
more

52

Women who had GDM will have less insulin resistance post partum.
T/F

False, they will have more

53

What are some risk factors for GDM?
which one is not a modifiable risk factor

- Obesity
- Physical inactivity
- Diet in Saturated Fat
- Smoking
- Advance Maternal Age
- Family history of Diabetes (not modifiable)

54

What are some ways obesity increases risk of GDM?

- Increased Circulating levels of leptin
- increased inflammatory marker TNF-alpha and C-reactive protein
- Decreased levels of adiponectin
- Increased fat in liver and muscles
- Abnormal sub-cellular localization of GLUT4 transporters

55

What are some treatments in GD?

- Low-carb diet
- Exercise
- Maintain healthy pregnancy weight
- Monitor glucose levels
- If necessary, take daily insulin injections

56

What are some risks to the offspring of GDM mothers?

- Greater birth weight (macrosomia)
- Obesity
- Increased of Type 2 diabetes

57

____ is the most important risk factor for development of _________ in youth

Obesity
Type 2 diabetes

58

_____ has led to dramatic _____ type 2 diabetes among _____ and _____ over the past 2 decades

Obesity
increase
youth; adolescents