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BSNC 2000 > Metabolism & Diabetes > Flashcards

Metabolism & Diabetes Flashcards

(127 cards)

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1
Q

Normal blood glucose levels

A

4-7 mmol/L

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2
Q

Glycogen

A

long-term storage of glucose

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3
Q

Where is glycogen produced

A

skeletal muscle

liver

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4
Q

Glycogenolysis

A

breakdown of glycogen to glucose in the liver

maintain blood glucose livers between meals (fasting state)

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5
Q

Glycogenesis

A

conversion of glucose –> glycogen

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6
Q

Gluconeogenesis

A

glucose synthesis from non-carbohydrate sources (fatty acids & amino acids)

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7
Q

Glycolysis

A

breakdown of glucose –> ATP production

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8
Q

Hypoglycemia definition

A

abnormally low blood glucose levels

<4.0 mmol/L

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9
Q

Hyperglycemia definition

A

abnormally high blood glucose levels

>10.0 mmol/L

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10
Q

Hypoglycemia symptoms

A 
early:
tremors
mood changes (irritability, anxiety)
nausea
hunger
cool, clammy skin 
weakness, fatigue
dizziness, vision changes
tachycardia

late:
decreased LOC
confusion, inattention
seizures 
behavior changes, lack of coordination
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11
Q

Hyperglycemia symptoms

A 
hunger
thirst
dehydration
fatigue 
kussmaul respirations 
reduced weight
poor wound healing 
polyuria
blurred vision 
fatigue (high blood glucose, low cellular glucose)
paresthesia
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12
Q

Polyphagia

A

increased hunger

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13
Q

Polydipsia

A

increased thirst

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14
Q

Blood glucose tests

A 
glycated hemoglobin (HgbA1C)
random blood glucose test
oral glucose tolerance test 
fasting glucose test (>8 hours)
capillary blood glucose monitoring (self-monitoring)
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15
Q

Glycated hemoglobin

A

glucose adheres to hemoglobin molecules

used to measure average blood glucose levels over a 3 month period

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16
Q

Lifespan of RBC’s

A

120 days

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17
Q

Insulin

A 
hormone produced by pancreatic B cells
increases glycolysis
increases glycogenesis
increases lipogenesis
increases protein synthesis
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18
Q

Glucagon

A 
hormone produced by pancreatic alpha cells 
increases glycogenolysis 
increase gluconeogenesis 
increase lipolysis 
increase ketogenesis
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19
Q

Counterregulatory hormones

A

sympathetic catecholamines - epinephrine, norepinephrine
cortisol
glucagon
growth hormone

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20
Q

Diabetes definition

A

metabolic disorder resulting in body’s inability to blood glucose levels. can be caused by insulin deficiency or resistance

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21
Q

Type 1 Diabetes

A 
10% of cases 
early onset
absolute insulin deficiency
usually requires insulin therapy
results from autoimmune destruction of pancreatic b cells
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22
Q

Type 2 Diabetes

A

90% of cases
adult onset
relative insulin deficiency + insulin resistance
can be managed with lifestyle changes, pharmacologic treatment
eventually may require insulin therapy

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23
Q

Insulin resistance

A

cells are unable to respond to insulin leading to impaired glucose regulation
can be caused by decreased # of insulin receptors or glucose transporters

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24
Q

Causes of Hypoglycemia

A 
poor nutrition
medication (too much insulin)
insulin antagonist deficiency 
increased exercise 
stress (mental, physical, illness)
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25
Ketogenesis
free fatty acids are converted into ketones by the liver | distributed in the bloodstream to be used as an alternate energy source by body cells
26
Diabetes complications
endothelial injury --> atherosclerosis nephropathy peripheral neuropathy perfusion issues --> decreased wound healing development of chronic conditions (stroke, hypertension, hyperlipidemia) retinopathy
27
Diabetes & Vascular changes
glucose is inflammatory --> damage endothelium & basement membrane cause stiffening/thickening of blood vessels --> reduced compliance
28
Diabetic Ketoacidosis
``` hyperglycemic state >13.8 mmol/L more common with type-1 diabetes low serum bicarbonate low arterial pH urine/serum ketones ```
29
Types of diabetes
Type 1 Type 2 Gestational Other
30
Ethnic groups at risk of T2DM
Indigenous African Hispanic/Latino Asian
31
Modifiable Risk Factors
``` Diet (high fat, high calorie) Weight Exercise Chronic conditions (HTN, malabsorption, vitamin D deficiency) Chronic stress Medication ```
32
Non-modifiable risk factors
Age | Family history/genetics
33
Acanthosis nigricans
velvety darkening of skin | commonly found in neck, axilla, groin folds
34
Diagnostic tests
``` blood glucose tests antibody testing lipid analysis renal function CRP protein ```
35
15/15 Rule
used to treat hypoglycemia 15 grabs of quick-acting carbohydrate every 15 min severe hypoglycemia = 30 g carb
36
Types of Insulin
short-acting intermediate long-term rapid-acting
37
Macronutrients
large organic molecules carbohydrates proteins fats
38
Micronutrients
vitamins & minerals | act as enzyme co-factors
39
Major Minerals
``` Calcium Phosphorous Magnesium Sodium Potassium Chloride ```
40
Older Adult Malnutrition RF
``` impaired chewing (dentures, muscle weakness) decreased saliva production, dysphagia decreased sense of taste/appetite elongated esophagus impaired swallowing d/t muscular atrophy decreased metabolic function of liver, pancreas, gallbladder chronic conditions medications socioeconomic status ```
41
Underweight BMI
<18.5
42
Overweight BMI
25-29.9
43
Obesity Class I BMI
30-34.9
44
Obesity Class II BMI
35-39.9
45
Obesity Class IV BMI
>40
46
Protein deficiency
impaired tissue repair | decreased liver proteins (clotting factors, inflammatory proteins, plasma proteins)
47
Carbohydrate deficiency
weight loss due to gluconeogenesis | ketoacidosis
48
Fat deficiency
impaired plasma membranes | decreased steroid hormone synthesis?
49
Folate
important for CNS development
50
Carotenoids
help prevent macular degeneration
51
Vitamin A
important for vision
52
Obesity & Chronic Conditions
``` T2DM Coronary heart disease Hypertension Stroke Respiratory problems Sleep apnea Fatty liver disease Gallbladder disorder Asthma ```
53
Nutritional Diagnostic Tests
``` serum albumin & pre-albumin (low albumin = low protein intake) blood glucose tests lipid profile (total cholesterol, triglyceride) ```
54
Islet of langerhans cells
beta cells alpha cells delta cells F/PP cells
55
Delta cells
release somatostatin | inhibits insulin/glucagon release & slows down gastric motility for adequate absorption
56
F/PP cell
produce pancreatic polypeptide | regulates GI secretions, liver glycogen storage, pancreatic release
57
Proinsulin
insulin formed in beta cells by cleaving proinsulin --> | insulin & C-peptide
58
Glucose cellular transport
glucose cannot cross the plasma membrane (large particle) | requires glucose transporter (protein carrier) to cross the cell membrane
59
Glucose transporters
``` GLUT-4 = skeletal & adipose tissue GLUT-2 = beta cells & liver cells GLUT-1 = loc in brain. does not require insulin activation ```
60
Sodium glucose cotransporters
``` SGLT-1 = small intestine SGLT-2 = renal tubule ```
61
Postprandial
following a meal
62
Lipase
enzyme that breaks down triglycerides --> glycerol + fatty acids
63
Amylin
co-secreted with insulin by beta cells 1) decrease postprandial glucagon secretion 2) promoting satiety 3) decreasing gastric emptying (slows glucose absorption)
64
Incretins
GI hormones released after a meal | consist of glucagon-like peptide 1 (GLP) and Gastric inhibitory peptide (GIP)
65
Epinephrine function
maintain blood glucose levels during stress increase metabolism increase glycogenolysis in liver & skeletal muscle decrease insulin release increase lipolysis of adipose tissue
66
Growth Hormone function
increase protein synthesis increase lipolysis decrease cellular uptake of glucose
67
T2DM Impaired Beta Function
1) reduced b cell mass 2) increased apoptosis, reduced regeneration 3) beta cell exhaustion (d/t hyperinsulinemia)
68
High FFA Complications
``` pancreatic beta cell dysfunction decrease glucose uptake decreased glycogen storage decreased hepatic insulin sensitivity non-alcoholic fatty liver disease ```
69
Adiponectin
hormone released by adipose tissue increase tissue sensitivity to insulin decreased triglyceride content increased free fatty acid energy use increase in adipose tissue = decreased adiponectin production
70
Acute Diabetic Complications
diabetic ketoacidosis hyperglycemic hyperosmolar state (HHS) hypoglycemia
71
Hyperglycemic Hyperosmolar State (HHS)
``` increased osmolarity of blood hyperglycemia >33.3 mmol/L shift in fluid compartments (ICF --> ECF) results in pseudohyponatremia (d/t fluid dilution) dehydration polyuria polydipsia hunger hypotension, tachycardia ```
72
DKA S/S
``` hyperglycemia > 13.8 mmol/L polyuria polydipsia nausea/vomiting fatigue stupor/coma abdominal pain/tenderness fruity breath hypotension, tachycardia Kussmaul breathing ```
73
DKA Treatment
increase blood volume increase tissue perfusion reduce blood glucose treat acidosis, F/E imbalances
74
Somogyi Effect
insulin-induced hypoglycemia --> increase in counterregulatory hormones usually occurs overnight --> hyperglycemic in the morning
75
Dawn Phenomenon
high fasting blood glucose between 5am-9am w/o preceding hypoglycemia related to circadian rhythm of glucose tolerance?
76
Eye complications
retinopathy glaucoma cataracts
77
CNS complications
``` dizziness/syncope impaired sensory/motor function (d/t damage to myelin) --> increased risk for injury, foot ulcers decreased somatic sensation painful diabetic neuropathy autonomic neuropathy ```
78
Vascular complications
atherosclerosis microangiopathy --> cerebral infarction, hemorrhage hypertension
79
GI complications
impaired gastric emptying diarrhea constipation
80
GU complications
urinary retention UTI erectile dysfunction
81
Autonomic neuropathy
sympathetic/parasympathetic dysfunction decreased vasomotor function (controls HR & smooth muscle tone) decreased cardiac response inability to empty bladder --> stasis, infection impaired GI motility sexual dysfunction
82
Diabetic FPG (mmol/L)
>/= to 7.0
83
Diabetic A1C %
>/= to 6.5%
84
Prediabetic A1C %
6.0-6.4
85
First line treatment for T2DM
Metformin decrease risk of diabetes-rel deaths does not cause weight gain excreted unchanged by kidneys
86
Sulfonylureas Pharmacodynamics
MOA: bind to K+ channels on pancreatic B-cells increase insulin production increase number of insulin receptors increase insulin receptor sensitivity increase effect of ADH on renal cells (collecting duct)
87
CVD treatment for Diabetic pts
statin acei/arb asa
88
White fat
long-term storage of adipoctyes
89
Brown fat
fat tissue with metabolic properties | generate heat
90
Glucagon-like peptide 1 (GLP-1)
released by L cells in distal small intestine 1) stimulate insulin secretion (glucose dependent) 2) inhibit glucagon secretion 3) inhibit gastric emptying 4) promote satiety 5) increase insulin sensitivity
91
Gastric Inhibitory peptide (GIP)
aka glucose-dependent insulinotropic polypeptide released by K cells in jejunum 1) stimulate insulin secretion (glucose dependent) 2) increase postprandial glucagon release
92
Factors stimulating hunger
ghrelin | low blood glucose
93
Factors promoting satiety
``` incretins (GLP-1, GIP) CCK insulin fatty meals leptin ```
94
Somatostatin
released by pancreatic delta cells | decrease insulin & glucagon release
95
Obesity phenotype
central, abdominal (apple) | peripheral (pear)
96
Basal insulin
Background insulin. Used to maintain blood glucose levels in fasting state. Longer-acting
97
Prandial Insulin
Shorter-acting. Used to maintain blood glucose levels in a fed state. Prevent spike in blood sugar after meals
98
Types of basal insulin
take effect in a few hours. longer half-life. intermediate-acting long-acting
99
Types of prandial insulin
take effect in under an hour. shorter half-life. rapid-acting short-acting
100
Intermediate Insulin PK
ex: insulin NPH onset: 1-2 hours peak: 5-8 hours duration: 14-18
101
Long-acting Insulin PK
ex: insulin glargine onset: up to 6 hours peak: unknown duration: 30 hours
102
Short-acting Insulin PK
ex: insulin regular (IV only), humulin R onset: 0.5-1 hour peak: 2-4 hours duration: 5-8 hours
103
Rapid-acting Insulin PK
ex: insulin aspart, lispro onset: 10-15 min peak: 60-90 min duration: 4-5 hours
104
Correctional insulin
insulin that is administered on an ad-hoc basis, when fasting blood glucose levels exceed clinical parameters uses rapid-acting or short-acting insulin used as an adjunct with basal insulin
105
Insulin:Glucagon ratio
hormone levels are determined in relation to one another decreased insulin = relative increase in glucagon increased insulin = relative decrease in glucagon
106
Insulin & Alcohol
alcohol increases insulin secretion and gluconeogenesis | risk factor for hypoglycemia
107
Basal metabolic rate
energy used to maintain body processes at rest (temperature, autonomic function, muscle tone, etc)
108
Energy expenditure
basal metabolism 60% physical activity 25% non-exercise activity 7% (ADLs) food digestion 8%
109
Antidiabetic drug classes
``` sulfonylureas biguanides dpp-4 inhibitors thiazolidiediones sglt-2 inhibitors human amyliln incretin mimetic meglitinide GLP-1 agonist ```
110
Sulfonylureas MOA & TE
MOA: bind to K+ channels on pancreatic B cells causing depolarization --> insulin release. increase # of insulin receptors on cell membrane. increase effect of ADH --> dilute blood glucoses by increasing water retention. increase insulin production decrease insulin resistance inhibit glucose absorption from the GI tract and glycogenolysis *targets the pancreas
111
Biguanide MOA & TE
MOA: acts on the liver to decrease glucose production. increases cellular uptake of glucose. decreases GI absorption of glucose. increases sensitivity to insulin. lowers blood glucose but does not cause blood *targets the liver
112
Obesity assessment
``` BMI (>25 overweight, >30 obese) waist circumference (measures abdominal obesity) height, weight measurements health history cardiometabolic risk age SE status blood pressure lab tests (lipid profile, blood glucose, ALT) ```
113
BMI equation
kg/height^2
114
Risky waist circumference
``` >/= 102 cm in men >/= 88 cm in women ```
115
Obesity co-morbidities
``` obstructive sleep apnea non-alcoholic fatty liver disease T2DM hypertension cardiovascular disease osteoarthritis GERD polycystic ovary syndrome ```
116
Obesity treatment
first line: lifestyle modifications medications (manage chronic conditions) bariatric surgery (extreme)
117
5 A's of obesity
``` ask for permission to discuss weight assess risk factors/health status advise on health risks agree on realistic goals assist with appropriate resources & healthcare providers ```
118
Obesity & cardiometabolic risk assessment
``` blood pressure (both arms) blood glucose (A1C, fasting blood glucose) lipid panel (total cholesterol, triglycerides, LDL/HDL) ALT (nonalcoholic fatty liver disease) ```
119
Osmotic Diuresis
increased excretion in water
120
Drug-drug Insulin interactions
beta-blockers: can mask symptoms of hypoglycemia corticosteroids, thyroid supplements, estrogen: may increase insulin demand alcohol, ace-is, mao-i's, oral hypoglycemic agents: decrease need for insulin
121
Drug-drug Metformin interactions
acute/chronic alcohol ingestion or iodine contrast media: increase risk of lactic acidosis digoxin, morphine, CCBs, vancomycin: compete for elimination pathways furosemide: may increase fx of metformin nifedipine: increased absorption
122
Cardiovascular benefits of Metformin
decrease lipid profile (triglcyerides) decrease body weight modulate endothelial function
123
Drug-drug Glyburide interactions
diuretics, corticosteroids, oral contraceptives, estrogen, thyroid: may decrease fx alcohol, androgens, clarithoycin, MAOis, NSAIDS, warfarin: may increase risk of hypoglycemia beta-blockers: may mask symptoms of hypoglycemia
124
Neuroglycopenia
shortage of glucose in the brain. usually caused by hypoglycemia
125
Severe hypoglycemia
<2.8 mmol/L | may cause unconsciousness
126
Treatment for severe hypoglycemia
IV: administer D50% W SC: glucagon
127
Diabetes foot care
``` annual foot exam daily inspection for wounds, sores, infection trim toenails ---> file sharp edges avoid going barefoot well-fitting shoes, change socks daily ```

BSNC 2000 (9 decks)

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