week 10 part 1

Question 1

diabetes mellitus

Answer 1

a chronic disorder of metabolism characterized by elevated plasma glucose levels resulting from defects in insulin secretion, insulin action or both

Question 2

extrapulmonary issue

Answer 2

limits lung expanison
- spinal disorder or disorder of muscle weakness

Question 3

pulmonary fibrosis

Answer 3

result of long-term exposure to irritants
-decreased barriers permeability at alveoli
-decreased compliance (more effort for inspiration, dyspnea and cough)

Question 4

pulmonary edema

Answer 4

fluid collect around and in alveoli
this will impact the efficiency of diffusion
- increased fluid out of capillaries and into the interstitial fluid
-inflammation within the lungs
-low blood plasma protein levels
-pulmonary hypertension
(left-sided heart failure)

Question 5

pulmonary embolus

Answer 5

a blood clot that blocks the flow of blood
-within deep veins
- risk factors - dehydration/trauma
-symptoms of chest pain, dysnea

Question 6

consequences of insulin deflict

Answer 6

• result in a decreased glucose uptake into many cells for metabolic and anabolic processes
  -insulin is required for translocation of the GLUT-4 glucose transporter to the cell surface
  –glucose enters through this transporter in muscle

Question 7

how are insulin and glucose linked

Answer 7

insulin increases the ability for cells to take up glucose

Question 8

what does not require insulin for glucose transport

Answer 8

liver, red blood cells, and brian(they have a different transporter for glucose)
- but insulin is still important for anabolic processes in the tissue

Question 9

3 types of diabetes mellitus

Answer 9

type I and type II and gestational diabetes

Question 10

gestational diabetes

Answer 10

Type II diabetes develops during pregnancy but
disappears after delivery

Question 11

signs and symptoms of diabetes

Answer 11

Polyuria (frequent urination)
* Polydipsia (thirst)
* Polyphagia (hunger)
* Weight loss (T1DM) / weight gain (T2DM)
* Fatigue
* Additional acute symptom: ketoacidosis (serious) – more common in T1DM

Question 12

T1DM

Answer 12

onset of symptoms usually abrupt and dramatic

Question 13

why do you think polyuria is a symptoms of diabetes

Answer 13

because the kidneys need to excrete excess glucose

Question 14

diabetic ketoacidosis

Answer 14

ketone bodies are produced as a byproduct of fat breakdown
- made in the liver and used for ATP production in cels around the body
- excess can be excreted in urine
(meaning if there is too much ketone present in the blood at one time – metabolic acidosis

Question 15

ketone bodies byproduct

Answer 15

fatty acid metabolism

Question 16

diabetic ketoacidosis symptoms

Answer 16

Nausea/vomiting, fruity breath (acetone), deep breathing,
lethargy, confusion, coma

Question 17

Complications of ChronicHyperglycemia

Answer 17

1. retinopathy-microvascular damage to high blood glucose
2. nephropathy-nerve degeneration due to ischemia
3. vascular disease –atherosclerosis

Question 18

type 1 diabetes

Answer 18

• characterized by autoimmune destruction of Beta cells of the pancreatic islets leading to a lack of insulin (beta cells break down over time)
  (possible predisposing factors: genetic and environmental )

Question 19

Type I Diabetes: Progressive Loss of β
Cell Mass

Answer 19

Question 20

insulin treatment

Answer 20

the goal is to replace insulin and to tightly monitor blood glucose levels
ex with pumps or injection

Question 21

type II diabetes

Answer 21

• non-insulin-dependent diabetes
• characterized by abnormal insulin secretion and action
• insulin resistance and beta cell destruction
• leads to chronic hyperglycemia

Question 22

T2DM Diagnosis & Monitoring: The Glucose Tolerance
Test

Answer 22

• fasting blood glucose at least 126mg/dl (this is high)
• oral glucose tolerance test
  also monitoring long-term blood glucose levels measuring
  -Glycated Hemoglobin
• Gives a good reflection of the blood glucose profile
  over the past 8-12 weeks

Question 23

T2DM - Symptoms

Answer 23

• commonly asymptomatic
  -symptoms are subtle, occur late in the disease
• long term consequences very serious

Question 24

T2 risk factors

Answer 24

-genetics
* nutrition
* physical inactivity
* Age (over age 45)
* Obesity
* Previous gestational diabetes or gave birth to child > 9 lb
* Dyslipidemia: elevated blood lipids (LDL, TG, total Chol)
* Could be a result of genetic and/or lifestyle factors
lifestyle factors

Question 25

Two defects characterized in T2DM

Answer 25

1. impaired insulin action in liver skeletal muscle and adipocytes (insulin resistance) 2. impaired insulin secretion (loss of b cell mass and function) these both lead to chronic hyperglycemia

Question 26

Etiology & Pathogenesis of T2DM

Answer 26

genetic predisposition + overnutrition, obesity = insulin resistance causes increased stress on B cells

Question 27

potential mechanism of insulin

Answer 27

- primarily due to defects in the signal transduction pathways leading to GLUT-4 expression at the cell surface - insulin receptor downregulation (due to chronic increase in blood insulin

Question 28

insulin resistance at insulin primary at liver

Answer 28

- over production of glucose by the liver in both the fasting and fed states - increased gluconeogenesis

Question 29

insulin resistance at insulin primary Skeletal Muscle

Answer 29

* Impaired glucose uptake during fed state * Primarily due to impairments in insulin signal transduction pathway

Question 30

insulin resistance at insulin primary adipose tissue

Answer 30

Increased lipolysis  Increased FFA production  Spills over into blood & peripheral tissues * Contributes to atherosclerosis risk

Question 31

treatment option for T2DM

Answer 31

1. diet and exercise 2. insulin injections 3. oral hypoglycemic drugs 4. incretin-based therapies

Question 32

obesity

Answer 32

- complex multifactorial disease - characterized by BMI - diet composition & physical activity status * The location matters.... * Visceral (abdominal) adiposity is associated more highly with chronic disease risk factors * Metabolic health matters... * Adipose tissue is an endocrine organ that can impact metabolism and inflammatory status

Question 33

epidemic obesity

Answer 33

-driven by charges in the global food system -combined with either local environmental factors variation within the population due to interaction between environment and individual factors

Question 34

obesity pathophysiology

Answer 34

adipose tissue is active - with autocrine& endocrine functions - produces adipose-derived cytokines adipokines - some adipokines are protective but many are pathogenic are they accumulated result Chronic low-grade inflammation  Leptin resistance (leptin is a hormone that normally suppresses appetite and increases energy expenditure)  Insulin resistance

Question 35

obesity treatment

Answer 35

goal: weight loss of body weight in first 6 months treatment modalities multimodal lifestyle intervention that includes dietary modification increase PA Pharmacotherapy – Drugs that aim to reduce food intake e.g. by decreasing hunger, slow gastric emptying, reduce absorption of fat * Medical Devices: * Intragastric balloons * Vagus nerve blocker (specific to GI area)  suppresses neural communication between stomach and brain  increased satiety

Question 36

Typical Progression of Metabolic Syndrome (MetS)

Answer 36

genetic predisposition --accumulated body fat -- develop MetS-- progression to diseases