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Flashcards in Type 1 Diabetes Deck (63):
1

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

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

2

Insulin secretory vesicles

10k granules/beta cell

3

Secretory granules contain insulin and ____

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

4

Glucose is taken up by the beta cell via ___

Glut2

5

Rate limiting step of glucose in beta cell

glucokinase

6

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

Calcium

7

______ is used diagnosticlaly to determine if someone is secreting insulin

c-peptide release

8

Insulin release in beta cell

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

9

Stimulators of insulin secretion

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

10

Inhibitors of insulin secretion

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

11

The major regulator of insulin secretion is ___

glucose

12

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

second/delayed

13

sulfonylureas stimulate/inhibit insulin secretion

stimulate

14

Insulin is a ____ hormone

anabolic

15

Principal metabolic function of insulin

increase rate of glucose transport into select cells in body

16

Type 1 diabetes subtypes

1a = autoimmune, 1b = non-autoimmune

17

Most T1D are auto/non auto immune

autoimmune

18

Gestational diabetes is a precursor of ____

t2d

19

LADA

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

20

monogenic diabetes

characterized by pancreatic beta cell dysfunction --> autosomal dominant

21

T1D or T2D? absolute insulin deficiency

t1d

22

T1D or T2D? abrupt onset

t1d

23

T1D or T2D? life long insulin injection

t1d

24

T1D or T2D? propensity for development of dka

t1d

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