Type 2 Diabetes Mellitus (intro)

Question 1

Type 2 DM accounts for what % of all diabetes cases?

Answer 1

90-95%

Question 2

What is type 2 DM?

Answer 2

Progressive metabolic disease characterized by insulin resistance & beta cell exhaustion in the pancreas

Question 3

Define carbohydrate metabolism

Answer 3

The process of breaking down carbs into glucose for energy (ATP production)

Question 4

Normal glucose regulation:

In presence of O2 breaks down to form ____ & ____

Answer 4

CO2 & water

Question 5

Normal glucose regulation:

What is the source of energy for cells?

Answer 5

Glucose

Question 6

Normal glucose regulation:

Where is glucose absorbed in the body?

Answer 6

Into the bloodstream at the intestines

Question 7

Normal glucose regulation:

We require a continuous supply of glucose for normal _____ function

Answer 7

Normal cerebral function

Question 8

Normal glucose regulation:

How does the body response to increase in blood sugar levels?

Answer 8

By stimulating the pancreas to release insulin which binds to cell surface membranes, making them more permeable to glucose

Question 9

Normal glucose regulation:

What happens to glucose after absorption?

Answer 9

Glucose is either used for energy, stored as glycogen in the liver, or converted to fat

Question 10

Fasting glucose regulation

Answer 10

Even during periods of fasting (i.e. sleep), a small amount of glucose is constantly secreted to maintain body functions (basal glucose production)

Question 11

Carbohydrate metabolism:

What happens when the body needs more energy?

Answer 11

The glycogen & fat can be converted back into glucose

Question 12

Carbohydrate metabolism:

Where can excess glucose be excreted?

Answer 12

In the urine (esp. after a high carb meal)

Question 13

Carbohydrate metabolism:

What happens in between meals?

Answer 13

In between meals the liver releases glucose into the bloodstream & the pancreas releases a small (basal) amount of insulin

Question 14

What is the most dense form of fuel storage?

Answer 14

Fats

Question 15

Fat Metabolism of triglycerides breaks down into what?

Answer 15

Glycerol molecules & 3 fatty acids

Question 16

Fat metabolism:

Glycerol molecule

Answer 16

Can enter glycolytic pathway & be used with glucose for energy

Question 17

Fat metabolism:

Fatty acids

Answer 17

Stored in tissue & can be used for energy (during starvation)

Question 18

What can happen if we are using fatty acids as an energy source?

Answer 18

Can lead to ketoacidosis (undesirable accumulation of ketones in blood)

Question 19

What are considered the building blocks of proteins?

Answer 19

Amino acids

Question 20

How are amino acids stored in the body?

Answer 20

Excessive AA can only be stored in limited amounts in the body

Question 21

What may be broken down for energy in the absence of carbs & fats

Answer 21

Proteins (NOT preferred source)

Question 22

What is glycolysis? & how does it work?

Answer 22

Glucose breakdown
Glycolysis pathway breaks down glucose into ATP & is vital for cellular function

Question 23

Explain how glucose molecule breaks down

Answer 23

Glucose breaks down into pyruvate, NADH, & ATP

Question 24

Is excess glucose in the bloodstream effective for energy use?

Answer 24

NO

Question 25

What is glycogenesis?

Answer 25

Process of **glycogen formation** when glucose supply exceeds need for ATP synthesis

Question 26

How long is glucose stored in the cells?

Answer 26

Stored in cells to saturation point for ~ 12-24 hrs

Question 27

The amount of glycogen formed is dependent on ____ ____

Answer 27

Energy demand (i.e. sitting vs. exercising)

Question 28

Where is glycogen mainly stored in the body?

Answer 28

Liver & muscles (i.e. skeletal)

Question 29

What is the reverse process of glycogenesis?

Answer 29

Glycolysis

Question 30

What is glycogenolysis?

Answer 30

Breakdown of stored glycogen to make glucose

Question 31

When does glycogenolysis occur?

Answer 31

When glucose levels become too low (i.e. prolonged starvation)

Question 32

Where does the process of glycogenolysis occur in the body? What is it in response to?

Answer 32

Occurs in the liver & muscle tissue in response to hormonal & neural signals: 1) epinephrine 2) glucagon 3) insulin

Question 33

What does glycogenolysis inhibit?

Answer 33

Glucogenesis

Question 34

What is gluconeogenesis?

Answer 34

Synthesis of glucose by the liver from non-carbohydrate sources

Question 35

Where does gluconeogenesis occur in the body?

Answer 35

Primarily the liver

Question 36

Gluconeogenesis: What happens in cases of starvation/ prolonged fasting?

Answer 36

**AA and fats are converted to glucose** 1) from stored fat to fatty acids &/or glycerol 2) AA to lactic acid

Question 37

Gluconeogenesis can lead to development of ____

Answer 37

ketones → which can lead to ketoacidosis

Question 38

Gluconeogenesis plays a role in...

Answer 38

acid-base balance

Question 39

What kind of functions does the pancreas have?

Answer 39

has BOTH endocrine (hormone-producing) & exocrine (digestive enzyme-producing) functions **Exocrine acini → digestive juices → duct → duodenum**

Question 40

Islets of Langerhans in the pancreas contains:

Answer 40

1) Beta cells → insulin; amylin 2) Alpha cells → glucagon 3) Delta cells → Somatostatin 4) F/PP cells → pancreatic polypeptide

Question 41

List 5 actions of insulin

Answer 41

1) Glucose uptake in muscle & adipose tissue 2) glycolysis 3) glycogen synthesis 4) protein synthesis 5) uptake of ions (esp. K+ and PO4)

Question 42

List 5 things insulin stops

Answer 42

1) Gluconeogenesis 2) glucogenolysis 3) lipolysis 4) ketogenesis 5) proteolysis

Question 43

What is insulin?

Answer 43

Hormone released by beta cells in Islets of Langerhans in the pancreas

Question 44

Insulin also play a role in producing ___ ___

Answer 44

Nitric oxide → helps maintain healthy endothelial tissue & support beta cell health

Question 45

Insulin is required by body cells to initiate what?

Answer 45

**active transport of glucose into the cell** 1) skeletal cells → store glucose as glycogen 2) adipose tissue → stops release of fatty acids 3) Liver → stops gluconeogenesis, starts producing glycogen & fat

Question 46

Insulin stimulates the ____, ____, & ____ of glucose

Answer 46

uptake, use & storage of glucose

Question 47

List 3 types of glucose regulating hormones

Answer 47

1) Amylin 2) Somatostatin 3) Counter-regulatory hormones - Epinephrine - Cortisol - Growth hormone

Question 48

How does amylin work?

Answer 48

Slows glucose absorption in the SI; suppresses glucagon secretion (manages postprandial blood sugar)

Question 49

How does somatostatin work?

Answer 49

Decreases GI activity; suppresses glucagon & insulin secretion. Secreted with heavy fat/ high carb meal

Question 50

How do counter-regulatory hormones work?

Answer 50

They counteract insulin & raise blood glucose levels when needed

Question 51

List 1 examples of an incretin. List 5 examples r/t incretins

Answer 51

1) Glucagon-like peptides (GLP-1) 2) growth hormone (GLP-1 can influence GH secretion) 3) cortisol (excess can impair GLP-1 signaling) 4) epinephrine (opposing effects on glucagon) 5) progesterone (r/t glucose homeostasis; can stimulate incretins) 6) estrogen (not fully understood)

Question 52

How do GLP-1's work? **Hint: 5**

Answer 52

1) Released after meals 2) stimulate insulin secretion 3) suppresses glucagon 4) delays gastric emptying 5) increases satiety

Question 53

How does estrogen work?

Answer 53

Increases beta cell activity, which may help explain the cardioprotective effects seen in premenopausal women

Question 54

After menopause, women are at increased risk of?

Answer 54

CV disease & type 2 DM, esp. with unhealthy lifestyle habits

Question 55

What secretes glucagon?

Answer 55

alpha cells in the pancreas

Question 56

Glucagon causes the liver to..

Answer 56

breakdown stored glycogen to produce glucose (glycogenolysis)

Question 57

List 2 things activated by glucagon

Answer 57

1) activation of gluconeogenesis in liver 2) activates lipase, to break down adipose tissue into fatty acids

Question 58

Question 1: When blood sugar level is high will insulin or glucagon be released?

Answer 58

Insulin

Question 59

Question 2: When are insulin levels their highest?

Answer 59

occur ~ one hour after meals

Question 60

Question 3: When are insulin levels their lowest?

Answer 60

Occur during fasting (i.e. overnight)

Question 61

Question 4: When do you have your highest glucagon levels?

Answer 61

Occur during fasting to help raise blood glucose levels

Question 62

What is normal glucose levels

Answer 62

70-100 mg/dL

Question 63

Pre-diabetic fasting glucose levels

Answer 63

101-125 mg/dL

Question 64

Diabetic fasting glucose levels

Answer 64

> 126 mg/dL

Question 65

Classifications of diabetes **Hint: 5**

Answer 65

**Type 1** 1) Type 1A → autoimmune destruction of pancreatic beta cells 2) type 1B → idiopathic diabetes **Type 2** **Pre-diabetes** **Gestational** **Drug induced**