Endo 1-6 Type Ii Diabetes

Front 1

Epidemiology of type II DM

Back 1

Most common type.
Tons in Pima Indians (>40%)
Many undiagnosed

Front 2

Will stem cell research have much benefit for type II diabetes>?

Back 2

no, but yes for type I

Front 3

Is diabetes a modifiable or unmodifiable risk factor for CAD and PAD?

Back 3

unmod
(treating diabetes doesn't seem to lower risk of getting these)

Front 4

Usual dx of type II DM

Back 4

30-40

Front 5

Will pts gain or lose weight before sx of type II DM?

Back 5

Gain

Front 6

Concordance of type II DM in identical twins

Back 6

about 100%

(type 1 is less genetic)

Front 7

Which diabetic needs to go to the eye doc immediately?

Back 7

type II

because they probably have had this disease for quite some time.

Front 8

Labs of type II DM

Back 8

fasting gluc > 126
glucosuria
proteinuria (mild)
hematuria
increased VLDLs
low HDLs

Front 9

Risk factors of type II DM

Back 9

age>40
obesity
prior gestational diab
prior glucose intol
fam hx
Hispanic, black, american indians
poor
urban dwelling
high sat fats

Front 10

with impaired gluc tol...

Back 10

2 hour plasma gluc after 75g load is over 140 and more likely to develop type II DM

Front 11

glucose tol _____ as you get older

Back 11

decreases

Front 12

simple things that help with type II DM

Back 12

diet, lifestyle mod

Front 13

Timeline of type 1 diabetes

Back 13

hyperglycemia in the teens and in 5-6 yeras they stop making it.
by the time of dx, there is almost no insulin secretion.

Front 14

timeline of type 2 diabetes

Back 14

hyperglycemia around age 30-40
during pubberty they were making more than avg insulin but then this declines AND THEN blood sugar rises.

Front 15

Medications of type II DM - general feature of their dosing

Back 15

you constantly have to increase them because they work less well over time.

Front 16

genes that can get busted in type II DM

Back 16

there are many.

Front 17

insulin tolerance test

Back 17

testing how much of a drop of blood glucose you get after certain doses of insulin

Front 18

HOMA calculation

Back 18

measures insulin resistance IN POPULATIONS

measures ratio of glucose to insulin in a fasting state.

Front 19

frquent samples of IV glucose tolerance test

Back 19

measures how fast glucose is removed per unit time.

Front 20

Gold standard test for insulin responsiveness

Back 20

glucose clamp technique
give a continuous fixed dose of insulin and then give enough glucose to maintain glucose concentration

pts without diabetes (insulin sensitive) will need more glucose.

Front 21

Where is most insulin-mediated glucose disposal?

Back 21

in the muscle.

so diminished glucose disposal rates during insulin clamp indicates a decreased response of muscle to insulin.

Front 22

Where does glucose go in the blood

Back 22

80% taken up by the liver.

The rest is disposed under direction of insulin to mostly muscle, and some to fat
(there is just simply more musc than fat)

Front 23

Worst way to measure insulin resistance

Back 23

fasting insulin level because it is influenced by weight, age, pre-diabetes, medications, stress.

Front 24

Does insulin regulat glucose input in the liver?

Back 24

no, but it does for glucose output from the liver.

Front 25

GLucose output in pts with type II DM

Back 25

more gluconeuogenesis and glycogenolysis

Front 26

What is a good measure of liver glucose output?

Back 26

fasting glucose

Front 27

insulin and fat tissue

Back 27

insulin regulates glucose uptake by fat, but fat only takes up a little glucose after a meal.

insulin mainly regulates output of FFAs from fat cells. and high FFA levels cause/enhance insulin resistance.

Front 28

facts that determine hepatic glucose output

Back 28

substrate avail (alanine, lactate, glycogen, acetyl coa)

cofactors-NADH
hepatic [] of gluconeogenic enzymes

glucagon, catechol, growth hormone)

glycogen storage pathway enzymes

Front 29

islet cell phases in type II DM

Back 29

0-normal
2-pre-diabetes and borderline beta cell mass
3-loss of insulin sensitive
4-amylin found in islets and more reduced beta cell mass
5-severe reduction in beta cell mass.

Front 30

as pts gain weight...

Back 30

they acquire even more resistance to insulin which just makes everything even worse.

Front 31

incretins

Back 31

released by GI tract in response to food

augments insulin release, decreases glucagon release, slow gastric empyting.

less release of incretins in pts with type II DM

half life of them is very short.

Front 32

Glucose toxicity

Back 32

the idea that chronic hyperglycemia leads to more insulin resistance and less insulin secretion.

Front 33

clinicaly application of glucose toxicity

Back 33

give a pt insulin to make their glycemic levels normals. so now their body is re-adjusted to having normal glycemic levels.

so you need to scale back the supplemental insulin dose or else the pt will get hypoglycemia!

Front 34

Pima indians

Back 34

no obesity until forced onto reservations with provided food.

(genetically very good at storing calories)

Front 35

acanthosis nigricans

Back 35

a skin disorder where it is dark like a football on neck and underarms

a good sign of insulin resistance. (type II DM)

Front 36

why is it so imp to determine type i vs. ii?

Back 36

very diff tx
with i - need insulin therapy for life.

Front 37

diagnostic diff from type II DM and type I

Back 37

islet cell antibodies - type i

obesity and acanthosis nigricans - type ii

Front 38

MODY 2 glucokinase gene (GCK)

Back 38

on chrom 7 - aut dom

means maturity onset diabetes of the young

glucokinase normally phosphorylates glucose in the islet cell and serves as the glucose sensor.

with mutation, the sensor is set at a higher level.

Front 39

Other causes of type II DM

Back 39

Pancreatitis via hemochromatosis (damage to islet cells)

endocrine disorders that impair insulin sensitivity - acromegaly, cushing's, pheochromocytoma

endocrine disorders that inhibit insulin secretion - glucagonoma, somatostatinoma, hyperaldosteronism.

Front 40

Drugs that induce diabetes

Back 40

Be esp careful with these drugs if pt with impaired glucose tolerance

prednisone, beta blockers - impair gluc sensitivity

pentamidine - impair insulin release

impair both release and sensitivity - cyclosporine, FK 506, thiazides

increase nutrient flux - niacin, TPN.

Front 41

stopped flashcards at slide

Back 41

67

Front 42

resistance to insulin at muscle leads to...

Back 42

post meal hyperglycemia

Front 43

resistance to insulin at fat leads to...

Back 43

release of FFAs

Front 44

resistance to insulin at liver leads to...

Back 44

greater hepatic glucose output

Front 45

binding of insulin to receptor

Back 45

normal in type 2 diabetes

Front 46

metabolic syndrome

Back 46

to ID people without diabetes

insulin resistance
high levels of TGs
low HDL levels
HTN
high risk of atherosclerosis.

Front 47

adiponectin

Back 47

sets insulin sensitivity

levels are low in the obese and pts with type 2 diabetes

Front 48

amylin

Back 48

accumulates in pts with type 2 diabetes (in the islets)

Front 49

antagonist against interleukin 1...

Back 49

called anakinra. showed improvement in pts with type 2 diabetes

made them secrete more insulin

shows a role for imflammation in type 2 diabetes

Front 50

glp-1 released from...

Back 50

L cells of the ileum.

Front 51

gastric bypass..

Back 51

results in increased of previously depressed levels of glp-1

Front 52

which comes first? weight loss of improvement of type 2 diabetes?

Back 52

improvement of type 2 diabetes

Front 53

pts with type 2 diabetes die from...

Back 53

accelerated macrovascular disease (e.g. atherosclerotic disease), not microvascular.

Front 54

2 diet approaches

Back 54

high complex carbs/low fat diet

high monounsat fat diet - this one has better diab control but less compliance.

Front 55

Unique tx goals of type II diabetes

Back 55

Glycemia (ideally A1c<6; practically <8)

BP under 135/85

Wt reduction

Minimize risk factors for atherosclerosis.

Front 56

Rule of thumb for conv a1c to blood gluc

Back 56

mult by 20

Front 57

two definite things to restrict in diabetic diet

Back 57

Simple sugars and sat fats.

Front 58

Role of gastric bypass

Back 58

Immediate caloric reduction so insulin sec is better matched to intake

Less FFAs and food intake so hepatic gluc output is reduced

Inc in GLP-1 levels

Serves as a definite cure/delay of type II Diabetes.

Front 59

Tx scheme

Back 59

Diet
exercise
diabetes education

Front 60

chart at end of ppt and notes

Back 60

v. important and good.

Front 61

why is risk of complic greater in type i diabetics?

Back 61

they get the disease at a younger age and have more extreme glycemic changes.