Lecture 23 - Nutritional Aspects of Diabetes Mellitus Flashcards

Jan 30, 2019 (29 cards)

1
Q

What is the mechanism for secondary diabetes?

A

Hyperglycemic hormones (such as cortisol) contribute to insulin resistance

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2
Q

What percentage of those afflicted with DM have Type 2 DM?

A

90%

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3
Q

At what percentage of normal insulin output (or beta cell “capacity”) do symptoms of diabetes mellitus appear?

A

Less than 20% beta cell capacity

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4
Q

What is thought to cause the gradual beta cell destruction seen in Type I diabetes?

A

immunological event/trigger such as a viral illness

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5
Q

What are the three classic signs of Type 2 DM?

A

polydipsia, polyuria, and polyphagia

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6
Q

Why is weight loss seen more in Type I diabetics as opposed to Type 2 diabetics?

A

Increased lipolysis and muscle proteolysis due to decreased insulin

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7
Q

The muscle breakdown seen in Type 1 diabetes leads to what physiologic consequence with respect to homeostasis?

A

Negative nitrogen balance

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8
Q

What causes the polyuria in diabetes?

A

Hyperglycemia –> glycosuria –> osmotic diuresis –> polyuria

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9
Q

What are the three main risk factors for Type 2 DM?

A

1) age
2) sedentary lifestyle
3) abdominal obesity

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10
Q

What is the threshold for diagnosing insulin resistance?

A

> 200 IU of insulin/day

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11
Q

What are the three effects of insulin resistance on adipocytes?

A

1) increased leptin
2) decreased adiponectin
3) increased secretion of pro-inflammatory cytokines

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12
Q

What are the two hormones needed for insulin sensitivity?

A

1) adiponectin

2) leptin

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13
Q

What are other effects of insulin resistance on serum biomarkers?

A

Increased free fatty acids. Decreased glucagon-like peptide (GLP-1). Increased IL-6 and TNF-alpha secretion

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14
Q

Which GI hormones produce increased insulin secretion?

A

Incretins

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15
Q

When Type II DM is diagnosed insulin levels are [decreasing/peaking/increasing]?

A

Peaking

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16
Q

What causes insulin levels to fall in Type 2 DM?

A

beta cell fatigue

17
Q

How does insulin deficiency affect glucose release uptake and release in the body?

A

1) Liver: increased glucose release

2) Muscle/fat: decreased uptake of glucose

18
Q

Where are GLUT-4 receptors predominantly found?

A

Heart, muscle, and fat

19
Q

What are the four characteristics of atherogenic profile?

A

1) increase in LDL-B (small, dense LDL)
2) decrease in HDL levels
3) increase in TAG, decrease in LPL activity
4) increase in circulating free FAs

20
Q

What are the two serum markers for insulin resistance?

A

1) increase in serum free fatty acids

2) increase in TAG:HDL ratio

21
Q

What are the three ways to diagnose DM?

A

1) fasting plasma glucose above 126 mg/dl
2) random blood glucose over 200 mg/dl with symptoms
3) HbA1c above 6.5%

22
Q

What is considered the gold standard in diagnosing DM?

A

oral glucose tolerance test

23
Q

How do you perform a OGTT?

A

1) fasting state
2) administer 75 gm of glucose (weight-adjusted)
3) serial serum glucose measurements every 30 minutes for two hours

24
Q

What is a normal fasting blood glucose? 2 hour post-glucose test?

A

fasting: less than 100

2 hour post-prandial: less than 140

25
What are the diagnostic criteria for prediabetes?
1) fasting blood glucose 100 to 126 2) OGTT between 140-200 3) HbA1c between 5.7 and 6.4%
26
How does sulfonylurea work?
Stimulates endogenous insulin secretion
27
How does metformin work?
Improves insulin sensitivity
28
What is the definition of impaired fasting glucose?
fasting blood glucose between 100 and 126
29
What is the definition of impaired glucose tolerance?
OGTT between 140 and 200