Module 9: Diabetes Pathophysiology Flashcards by Lyssa Redoble

This is a group of diseases characterized by high blood glucose concentrations resulting from defects in:

Insulin secretion
Insulin action
Or both

diabetes mellitus

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Galactose and most fructose are converted to _________.

glucose

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If we don’t get glucose from CHO (food), the liver will make new glucose out of non-CHO substrates like lactate or AAs. What process is this called?

Gluconeogenesis

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T/F: Glucose is the universal fuel source for every cell of the body.

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T/F: RBCs can ONLY use glucose for fuel.

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T/F: RBCs have mitochondria and go through glycolysis.

F (they don’t have mitochondria)

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________ is termed a LOW blood glucose.

Hypoglycemia

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_________ is termed a HIGH blood glucose.

Hyperglycemia

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T/F: Hyperglycemia increases a person’s risk for atherosclerosis and CVD.

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Hyperglycemia can cause microvascular complications in the vessels of the eyes and kidneys, leading to ____________and the _____________.

retinopathy, nephropathy

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Hyperglycemia can cause damage to nerves called ______________.

neuropathy

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Those with DM may have amputated toes and/or feet due to ________ damage and poor ______________ to those extremities.

nerve, circulation

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The key regulators of blood glucose are the 2 peptide hormones: ______________ and __________.

glucagon, insulin

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Insulin is synthesized and secreted by _______________ of the __________.

beta-cells, pancreas

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Glucagon is synthesized and secreted by _________________ of the __________.

alpha-cells, pancreas

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After eating CHO, blood glucose levels _________ and the pancreatic __________ cells secrete ___________ into the blood.

increase/rise, beta, insulin

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Insulin stimulates _______________ uptake by cells. Then blood glucose returns to normal.

glucose

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Without insulin, glucose can’t enter the cells leading someone to become _____________.

hyperglycemic

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If blood glucose decreases/drops, then the pancreas secretes ____________.

glucagon

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Glucagon stimulates the ___________ to break down glycogen and release that glucose into the _________.

liver, blood

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______________ stimulates the liver to synthesize glucose from non-CHO (i.e. lactate & AAs).

Glucagon

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When blood glucose levels ________________, insulin is secreted from pancreatic _____________ __________. This acts to __________ blood glucose levels.

increase/rise, beta cells, lower/decrease

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T/F: The prevalence of diabetes increases with age.

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T/F: The prevalence of diabetes is more common among those who are underweight.

F (more common in overweight and obese people)

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T/F: Obesity is a major risk factor for Type 2 DM.

This type of diabetes is a stage of IMPAIRED glucose homeostasis (i.e. impaired fasting glucose, impaired glucose tolerance, etc.) This indicates they're at a HIGH RISK for developing diabetes.

Prediabetes

This type of diabetes only accounts for about 5 - 10% of cases.

Type 1

Type 1 was previously called Insulin-dependent Diabetes Mellitus (IDDM) or "_____________ onset".

juvenile

Type 1 diabetes is caused by destruction of the ____________ - secreting __________ cells of the pancreas; usually due to an autoimmune dysfunction.

insulin, beta

In Type 1 diabetes, the ______ cells lose their ability to produce ____________, leading to absolute insulin deficiency.

beta, insulin

T/F: Someone with Type 1 diabetes would required exogenous insulin to live.

Type 2 diabetes was previously called Non-insulin Dependent Diabetes Mellitus (NIDDM) and "___________ onset".

adult

This type of diabetes develops during pregnancy.

Gestational diabetes

In gestational diabetes, the hormones produced during pregnancy cause insulin _____________. SO the amounts of insulin needed are _________ to control blood glucose levels.

resistance, increased

T/F: Gestational diabetes can go away when once the baby is born.

T/F: A woman who had gestational diabetes is NOT at risk for developing Type 2 diabetes.

F (they're at a much greater risk)

IFG stands for impaired _________ _________.

fasting glucose

FPG stands for fasting ____________ glucose.

plasma

IGT stands for impaired glucose ____________.

tolerance

T/F: Brain cells can use ketone bodies, but prefers glucose.

What is the FPG of those with prediabetes (above normal)?

> 100 mg/dL and < 126 mg/dL

Those who have Prediabetes have an elevated plasma glucose after ________g glucose load (> 140 and < 200mg/dL).

In the initial onset of Type 1 DM, affected persons are usually __________, have abrupt onset of symptoms before the age of _____.

lean, 30

This "phase" is after the dx of Type 1 DM and correction of hyperglycemia and metabolic derangements, when the person may not need much exogenous insulin and can maintain normal blood glucose for up to 1 year.

Honeymoon phase

Type 1 DM may be due to an ____________ disorder. Where the body destroys its own ____-cells in the pancreas as if they're foreign antigens.

autoimmune, beta

Idiopathic means that the cause is __________.

unknown

-Hyperglycemia - Excessive thirst (polydipsia) - Frequent urination (polyuria)/glycosuria - Significant wt loss - Electrolyte disturbance - Ketoacidosis Are all sx of which type of diabetes?

Type 1

Polydipsia is excessive _________

thirst

Polyuria is frequent __________

urination

Normally when the kidneys filter blood, all the glucose is reabsorbed in the __________ tubules.

renal

____________ is the presence of glucose in the urine.

Glycosuria

In ketoacidosis, the cells resort to burning ________ for fuel instead of glucose. Beta oxidation of FAs are done to an extent that it leads to the formation of ____________ bodies.

fat, ketone

Is Type 1 or Type 2 Diabetes more common?

Type 2

T/F: Type 2 Diabetes has a cure.

Type 2 Diabetes is due to a progressive loss of ______ -cell insulin secretion, frequently on the background of ________ resistance.

beta, insulin

T/F: Someone with Type 2 DM would rarely experience ketoacidosis.

In Type 2 DM, ATP is NOT required for glucose uptake. But it requires ___________ proteins to enter the cell.

transport

Glut - 4 transporter is a ________ protein that facilitates ___________ uptake from the blood into muscle and fat cells.

transport, glucose

People with Type 2 DM have higher than normal levels of insulin, but their cells are not responding to it. This is called what???

Insulin resistance

Insulin resistance may be due to decreased tissue ______________ or not ____________ to insulin.

sensitivity, responsive

When the pancreas can no longer keep up and produce enough insulin, then blood glucose levels will ________ initially after meals, but also eventually in the ________ state too.

increase, fasted

Type 2 DM begins with ___________ resistance.

insulin

Increased __________ ___________ production (from the liver) causes increased FPG in Type 2 DM.

hepatic glucose

T/F: Someone may go years without signs & sx of Type 2 DM.

- Insidious onset - Often goes undiagnosed for yrs - Hyperglycemia - Polydipsia - Polyuria - Polyphagia/hyperphagia - Weight loss (occasionally) These are the sx of which type of DM?

Type 2

- Family hx of DM - Older age - Obesity, particularly intra-abdominal obesity - Physical inactivity - Prior hx of gestational DM - Impaired glucose homeostasis - Higher risk among certain racial/ethnic groups (African American, Latino, Native American, Asian American, Pacific Islander) These are the risk factors of which type of diabetes?

Type 2

- Insulin resistance - Compensatory hyperinsulinemia - Abdominal obesity - Dyslipidemia (elevated TG, low HDL) - HTN These are characteristics of _____________ syndrome.

metabolic

Metabolic syndrome is a risk factor for _________.

CVD

What are the methods of DM Dx?

- Fasting plasma glucose (FPG) - Random plasma glucose - Oral glucose tolerance test (OGTT) 2-hr Plasma Glucose - Hemoglobin A1C (HbA1c)

How is a FPG blood test performed?

No calories for at least 8 hrs

How is a random plasma glucose blood test performed?

At any time of day

How is an oral glucose tolerance test (OGTT) 2-hr plasma glucose test performed?

pt is fasted and takes a 2 hr blood draw AFTER oral glucose load of 75 g glucose

A Hemoglobin A1C (HbA1c) blood test provides an estimate of __________ blood glucose over the past few ___________. This test measures _____________ __________.

average, months, glycosylated hemoglobin

HbA1c is a measure of how much __________ adheres to hemoglobin of ________ blood cells.

glucose, red

T/F: The higher a person's blood glucose, the higher their HbA1c.

The ADA recommends for people aged ______ years and older to be screened for DM, and repeat every ________ yrs.

35, 3

T/F: High risk persons should be screened for DM at a younger age and more frequently.

Recommendation for glycemic control (in nonpregnant adults w/DM) of HbA1c level is _______%.

< 7.0%

Recommendation for glycemic control (in nonpregnant adults w/DM) of PREPRANDIAL CAPILLARY PLASMA GLUCOSE level is __________ mg/dL (4.4 - 7.2 mmol/l).

80 - 130

Recommendation for glycemic control (in nonpregnant adults w/DM) of PEAK POSTPRANDIAL CAPILLARY PLASMA GLUCOSE level is _________ mg/dL (< 10.0 mmol/l).

< 180