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32 Cards in this Set
- Front
- Back
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Absolute deficiency in insulin secretion
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Type 1
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Relative deficiency in insulin secretion
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Type 2 DM
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Banting and Best discovered what in 1921?
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Insulin
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What percentage of the US population has diabetes?
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13%
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Normal fasting blood glucose?
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<100 mg/dL
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Normal values for 2 hour post glucose load test?
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<140 mg/dL
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Pre-diabetes: fasting blood glucose levels
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100-125 mg/dL
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Pre-diabetes: 2 hour post glucose load.
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140-199 mg/dL
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Diabetes: fasting glucose levels?
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> or = to 126 mg/dL
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Diabetes: 2 hour post glucose load levels
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> or = to 200 mg/dL
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Diabetes: random glucose levels
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> or = to 200 mg/dL with symptoms
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What are four substances that increase serum glucose levels?
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1. cortisol
2. glucagon 3. growth hormone 4. catecholamines |
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The secretion of insulin occurs in response to what?
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1. Glucose
2. Amino acids Incretins, drugs such as sulfonylureas. |
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What are the sequence of events in glucose-mediated insulin release?
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Glucose diffuses into beta cells via GLUT2 transporters --> Glucose is converted to Glucose 6 phosphate by glucokinase --> G6P is metabolized via glycolsis --> pyruvate up --> ATP up --> ATP/ADP ratio up --> cell surface ATP-sensitive K channels (KATP) close --> depolarization of cell --> voltage-dependent Ca channels (VDCC) open --> Ca influx into cell --> rise in intracellular Ca triggers exocytosis of insulin
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Sulfonylureas: target?
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Causes closing of the ATP-sensitive K channels in the membrane of the beta cells --> --> --> stimulation of insulin secretion.
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Insulin mainly causes glucose to go into what tissue?
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Muscle
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Where does gluconeogenesis come from?
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From muscle proteins.
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Insulin action in the fed state:
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Insulin is high:
1. Glucose --> glycogen 2. Lipoprotein --> lipogenesis 3. Inhibits protein degredation, accelerats aa transport into cells, and stimulates protein sythesis. |
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Insulin action in the fasted state:
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Insulin is low, glucagon is high
1. Glycogenolysis (the amount of glycogen in the liver only covers the body's energy needs for several hours) 2. Gluconeogenesis: New glucose forms from muscle proteins. 3. Releases free fatty acids from triglycerides in the adipose tissue. |
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What is the "preferred" fuel in starvation?
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Fatty acids.
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What leads to ketonuria?
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Lipolysis --> free fatty acids --> ketonemia --> ketonuria
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What is the incretin effect?
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Giving glucose oral stimulates higher levels of insulin secretion compared with IV insulin.
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What are two incretins?
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GLP-1 (glucagon like peptide 1)
GIP (Glucose-dependent insulinotropic polypeptide) |
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The incretin effect is impaired in ____________ patients.
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The incretin effect is impaired in TYPE 2 DM patients.
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Classic three symptoms of diabetes
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Polyuria
Polydipsia Nocturia Also increased appetite and polyphagia |
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What is type 1A diabetes?
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Autoimmune
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What is type 1B diabetes?
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Idiopathic
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What is a predisposing factor to type 1 DM?
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HLA DR3, 4 haplotypes
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Risk of developing diabetes mellitus if one parent is affected? Both?
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25% 50-100%
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What is a monogenic form of insulin resistance?
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A mutation in the linsulin receptor (e.g. lipoatrophic diabetes)
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What are some clues to differentiating Type 1 DM from Type 2 DM?
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1. Age of onset
2. Family history 3. Occurrence of ketoacidosis (implies absolute insulin deficiency) 4. Markers of autoimmunity 5. BMI: 80% of patients with type 2 diabetes are obese. |
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What is the most common disease associated with type 1 DM?
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Autoimmune thyroiditis
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