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Endocrine > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

(63 cards)

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1
Q

When glucose stimulates insulin secretion, you get regulated secretion of insulin in the form of _____

A

insulin and c peptide (96%) and proinsulin/intermediates (4%)

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2
Q

Insulin secretory vesicles

A

10k granules/beta cell

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3
Q

Secretory granules contain insulin and ____

A

zinc, proinsulin, proteolytic enzymes, iapp (islet amyloid polypeptide)

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4
Q

Glucose is taken up by the beta cell via ___

A

Glut2

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5
Q

Rate limiting step of glucose in beta cell

A

glucokinase

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6
Q

Insulin vesicle release are dependent on the contribution of ____ form voltage gated channels.

A

Calcium

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7
Q

______ is used diagnosticlaly to determine if someone is secreting insulin

A

c-peptide release

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8
Q

Insulin release in beta cell

A

glucose –> glut 2–> glycolysis –>atp/adp ratio increase –> atp sensitive potassium channel –> voltage gated ca channel –> calcium –> vesicle release

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9
Q

Stimulators of insulin secretion

A

nutrient load, vagus nerve (inhibited by sympathetics, cephalic phase sight/smell of food, gut hormons (GLP1/GIP)

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10
Q

Inhibitors of insulin secretion

A

starvation/hypoglycemia, glucagon, epinephrine, growth hormone, cortisol

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11
Q

The major regulator of insulin secretion is ___

A

glucose

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12
Q

If secretory stimulus persists, a ___ response follows which involves active synthesis of insulin in the beta cells

A

second/delayed

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13
Q

sulfonylureas stimulate/inhibit insulin secretion

A

stimulate

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14
Q

Insulin is a ____ hormone

A

anabolic

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15
Q

Principal metabolic function of insulin

A

increase rate of glucose transport into select cells in body

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16
Q

Type 1 diabetes subtypes

A

1a = autoimmune, 1b = non-autoimmune

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17
Q

Most T1D are auto/non auto immune

A

autoimmune

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18
Q

Gestational diabetes is a precursor of ____

A

t2d

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19
Q

LADA

A

latent auto-immune diabetes of adulthood –> adult age at diagnosis, initially appears as nonobese t2d –> initially controlled with meal planning with or without oral pills –> low c peptide concentration and antibody psotiive

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20
Q

monogenic diabetes

A

characterized by pancreatic beta cell dysfunction –> autosomal dominant

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21
Q

T1D or T2D? absolute insulin deficiency

A

t1d

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22
Q

T1D or T2D? abrupt onset

A

t1d

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23
Q

T1D or T2D? life long insulin injection

A

t1d

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24
Q

T1D or T2D? propensity for development of dka

A

t1d

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25
T1D or T2D? predominant under 30 yrs old
t1d
26
T1D or T2D? insulin resistance with relative insulin deficiency
t2d
27
T1D or T2D? gradual onset of hyperglycemia with decline of beta cell function
t2d --> initially silent
28
T1D or T2D? oral treatment
t2d
29
T1D or T2D? hhnk
t2d --> hyperosmolar hyperglycemic non-ketosis
30
T1D or T2D? dka
either
31
T1D or T2D? family history rare
t1d
32
T1D or T2D? family history common
t2d
33
T1D or T2D? first functional bnormality is decrease in insulin secretion
t1d
34
T1D or T2D? first functional abnormality is decreased insulin secretion and decreased response to insulin
t2d
35
T1D or T2D? insulinitis
t1d
36
T1D or T2D? amyloid deposition, fibrosis, beta cell mass reduction
t2d
37
T1D or T2D? absence of beta cells, increase in alpha and gamma cells
t1d
38
Dx of t2d
diabetes symptoms + glucose >200 or fasting glucose >126 or 2 hour glucose ogtt >200, a1c > 6.5
39
HbA1c
non enzymatic glycosylation of hemoglobin AA residues -- accumulates over 2-3 lifespan of rbc's
40
T/F HbA1c can be used for dx
T
41
highest risk ethnicity for t1d
n europe
42
peak ages for onset of t1d
5-7rs and onset of puberty
43
T/F t1d onset is more common in winter
T
44
Risk factor for t1d or not? viral infection
yes
45
Risk factor for t1d or not? immunization
yes
46
Risk factor for t1d or not? cows milk
yes
47
Risk factor for t1d or not? high socioeconomic status
yes
48
Risk factor for t1d or not? obesity
yes
49
Risk factor for t1d or not? d deficiency
yes
50
Risk factor for t1d or not? low birthweight
no
51
Ab measured during preclinical t1d
islent cell antibodies, insulin autoantibodies, antibodies to glutamic acid decarboxylase (GAD), antibodies to tyrosine phosphatase like proteins such as insulinoma associated protein (IA2)
52
The ____ has been identified as a candidate t1d autoantigen since 60-80% have autoantibodies to it.
ZnT8 cation efflux zinc transporter
53
Pathogenesis of t1d
chronic auto-immune insulitis --> high risk MHC class II genes encoding HLADQ induce presentation of peptides form islet autoantigens to CD4 and CD8 --> destruction of beta cells --> cellular infiltrate --> destruction of beta cells but not alpha or gamma cells
54
T/F there is often a concurrence of other auto-immunities with t1d
T
55
Tx of T1d
insulin replacement, education, adjust doses according to cho intake, exercise, blood glucose profile, test glucose levels, screen for complications
56
The ______ approach involves basal insulin to meet the insulin requirement to suppress hepatic glucose production between meals and bolus insulin to meet the insulin requirement after eating.
basal-bolus approach
57
Dx? Low blood pressure, high heart rate, plasma glucose 550, urine ketones +
type 1d + dka
58
DKA
no insulin --> starvation --> 1. liver production of glucose --> glucosuria --> polyuria --> dehydration 2. muscle --. increase plasma glucose and muscle wasting --> weight loss 3. adipose --> increase plasma FFA --> increase plasma Beta hydroxybutyrate and acetoacetate -->acidosis
59
Acute problems with DKA
hyperosmolar dehydration and acidosis
60
DKA tx adverse events
cerebral edema, hypokalemia
61
Tx of DKA
insulin + fluid/electrolyte
62
hypoglycemia
most common in t1d from overdose of insulin
63
relative hypoglycemia
patients with chronically high glucose suddenly have a reduction to normal or less high glucose

Endocrine (26 decks)

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