S2 - Diabetes

Question 1

What is diabetes mellitus?

Answer 1

A condition in which blood sugar is highly elevated.

Question 2

What are the two main types of diabetes mellitus?

Which is more common in the U.S.?

Answer 2

Type 1 and type 2

Type 2 (90-95% of cases)

Question 3

Is the pancreas an endocrine or exocrine organ?

Answer 3

Both

Question 4

What are the primary endocrine secretions of the pancreas?

What are the clusters of endocrine cells called?

Answer 4

Insulin and glucagon secretion

Islets of Langerhans

Question 5

Which pancreatic cells secrete insulin?

Which pancreatic cells secrete glucagon?

Answer 5

Beta cells

Alpha cells

Question 6

What are the primary functions of insulin?

Answer 6

Decrease blood glucose by:

Increasing glucose transport into adipose and skeletal muscle tissues through GLUT-4 transporters

Increasing glycogenesis

Decreasing gluconeogenesis

Decreasing lipolysis

Question 7

What are the primary functions of glucagon?

Answer 7

Increase blood glucose by:

Increasing glycogenolysis (Glycogen breakdown)

Increasing gluconeogenesis (Protein breakdown)

Increasing lipolysis (Fat breakdown)

Question 8

What is the primary dysfunction in T1DM?

Answer 8

Insulin deficiency due to autoimmune destruction of pancreatic beta cells

Question 9

What is the primary dysfunction in T2DM?

Answer 9

Insulin insensitivity

Question 10

What is a hemoglobin A1c measurement?

What is it used for?

Answer 10

A measure of how much glucose has gotten ‘stuck’ on hemoglobin for the past 120 days (The lifespan of an RBC).

Used as a measure of long-term blood glucose control.

Question 11

What are the normal, pre-diabetic, and diabetic A1c readings?

Answer 11

Normal < 5.7%

Pre-Diabetic 5.7 - 6.4%

Diabetic > 6.4%

Question 12

Define hyperglycemia.

Answer 12

Elevated blood sugar

Question 13

What is a fasting plasma glucose (FPG) reading?

Answer 13

A measurement of an individual’s blood glucose levels during a fasting state

Question 14

What are the normal, pre-diabetic, and diabetic FPG readings?

Answer 14

Normal < 100 mg/dl

Pre-Diabetic 100 - 125 mg/dl

Diabetic > 125 mg/dl

Question 15

At what age does T1DM usually manifest?

At what age does T2DM usually manifest?

Answer 15

Early. Often between 12 and 18 Later in life

Usually after 35 or 40

Question 16

What are the cardinal signs and symptoms of diabetes? (Remember the 3 P’s)

Answer 16

Polyphagia (Excessive hunger)

Polydipsia (Excessive thirst)

Polyuria (Excessive urine production)

Question 17

Besides the 3 P’s, what are some other signs and symptoms of diabetes?

Answer 17

There are many systemic effects, including, but not limited to:

Peripheral neuropathy

Diabetic retinopathy

Infection and gangrene

Acanthosis nigricans

Weight loss (Mainly in T1DM)

Renal damage

Question 18

What is the extreme and life-threatening effect of T1DM?

Answer 18

Diabetic ketoacidosis (DKA)

Question 19

What is the extreme and life-threatening effect of T2DM?

Answer 19

Hyperosmolar Hyperglycemic Non-Ketotic Coma (HHNC)

Question 20

How is T1DM typically treated?

Answer 20

Insulin administration and diet adjustment

Question 21

How is T2DM typically treated?

Answer 21

Diet and weight loss; oral hypoglycemic medications as needed (E.g. metformin)

Question 22

What is the leading cause of death among individuals with T1DM?

Answer 22

Renal failure

Question 23

What is the leading cause of death among individuals with T2DM?

Answer 23

Heart failure

Question 24

Where does diabetes mellitus fall in as a leading cause of death in the U.S.?

Answer 24

7

Question 25

What geographic region in the U.S. has the highest prevalence of diabetes mellitus and in what racial group?

Answer 25

The Southeastern United States (The obesity/stroke/diabetes belt) African-Americans are at increased risk over other racial groups

Question 26

Which type of diabetes mellitus holds a stronger genetic disposition, type 1 or 2?

Answer 26

Type 2

Question 27

What factors can greatly increase one's chances of developing T2DM?

Answer 27

Obesity, metabolic syndrome, high-sugar and high-fat diet, family history

Question 28

What effect have gastric bypass surgeries been shown to have on obese patients with T2DM?

Answer 28

A complete cure of some patients' T2DM (As well as an average of 2/3 excess weight lost)

Question 29

What is diabetic ketoacidosis (DKA)?

Answer 29

Usually seen only in T1DM, glucose is unable to make it into the cells, the cells begin to starve, and lipids are broken down at a quick rate for energy production. Lipid breakdown leads to the production of ketone bodies that are acidic to normal blood pH. Blood pH drops and the individual enters a coma.

Question 30

What are the ketone bodies produced during DKA?

Answer 30

Beta-hydroxybutyrate and acetoacetate

Question 31

# Define hypoglycemia. What is a danger of extended periods of hypoglycemia?

Answer 31

Low blood sugar (\< 70 mg/dl) Brain damage

Question 32

What are the ABCs of diabetes control (After an individual has already been diagnosed)?

Answer 32

**A1c** \< 7% **Blood pressure** \< 130 / 85 **Cholesterol** LDL \< 100 mg/dl HDL \> 50 mg/dl (Women) \> 40 mg/dl (Men)

Question 33

At what BMI should most Americans start being screened for diabetes? Who else should be screened?

Answer 33

BMI ≥ 25 (Overweight) ≥ 45 years of age Family history of T2DM History of gestational DM

Question 34

What is the BMI at which members of the Asian population should be screened for diabetes?

Answer 34

23 | (*Screen at 23*)

Question 35

What is the technical term for glucose production through the breakdown of fat and protein?

Answer 35

Gluconeogenesis (glucose-new-production) (Promoted by glucagon; inhibited by insulin)

Question 36

What is the technical term for fat breakdown?

Answer 36

Lipolysis (Promoted by glucagon; inhibited by insulin)

Question 37

What is the technical term for glucose breakdown to pyruvate?

Answer 37

Glycolysis (Inhibited by glucagon; promoted by insulin)

Question 38

What is the storage form of glucose? Where is it found?

Answer 38

Glycogen Liver and skeletal muscle tissue

Question 39

What is the technical term for glycogen synthesis?

Answer 39

Glycogenesis (Inhibited by glucagon; promoted by insulin)

Question 40

What is the technical term for glycogen breakdown (producing glucose)?

Answer 40

Glycogenolysis (Promoted by glucagon; inhibited by insulin)