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83 Cards in this Set
- Front
- Back
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The body requires a minimum of ___ mg of glucose per day
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190 mg
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How many people have DM in the US?
How many deaths/yr? |
18 million (5-6%)
150,000 deaths/yr |
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Name three ADA diagnostic criteria for DM
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polyuria
polydipsia weight loss |
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ADA diagnosis of DM requires a random plasma glucose of ?
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>200 mg/dl
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ADA diagnosis requires a fasting glucose of ?
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>126 mg/dl
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ADA diagnosis requires a glucose tolerance test of ? 2 hrs after ingestion
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>200 mg/dl
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__ percent of pts with DM have type 2 and ___ percent of these pts require insulin
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90%, 20-30%
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Type 3 DM is due to ___ factors, including decreased insulin in____ and ___ disease
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secondary
CNS Alzheimers |
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Type 4 DM is also ____ and occurs in ___% of ___
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gestational
4% of pregnancies |
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Impaired fasting glucose is defined as
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110-125 mg/dl
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The most common causes of morbidity and mortality for
Type 1: Type 2: |
1: renal failure
2: macrovascular disease |
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Risk factors for
Type 1: Type 2: |
1: genetic, viruses, family hx
2: family hx, ethnicity, obesity, lifestyle |
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The Nurses' Health Study showed that people with DM at baseline had a ___x risk of MI/stroke
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5x
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The A (alpha) cells of the pancreas account for __%?
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20%
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The B (beta) cells of the pancreas account for __%?
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75%
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The D (delta) cells of the pancreas account for __%?
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3-5%
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The F (PP) cells of the pancreas account for __%?
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<2%
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The A (alpha) cells of the pancreas produce?
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Proglucagon
Glucagon |
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The B cells of the pancreas produce?
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Proinsulin
Insulin C-peptide Amylin |
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The D cells of the pancreas produce?
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Somatostatin
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The F cells of the pancreas produce?
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Pancreatic Polypeptide
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A cells function
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Mobilizes fuel via gluconeogenesis and glycogenolysis in liver
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B cells function
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Promotes fuel storage, promotes growth
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D cells function
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Inhibits secretory cells
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F cells function
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Facilitates digestive process
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In diabetes, A cells secrete ___ and B cells secrete___
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A: (dysfunction) too much glucagon
B: (lack): not enough insulin |
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At time of diagnosis of type 2 DM , the pancreatic function is at ___% of normal
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50%
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Type 1 diabetes is an extensive and selective ___ of B cells of the pancreas
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LOSS
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Type 1A diabetes is a ___ disease an accounts for __%
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autoimmune disease, 90%
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What % of patients with type 1A have Abs to islet cell antigens at diagnosis?
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80%
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Are the Abs in type 1A directed at cytoplasmic Ags, membrane Ags, or insulin?
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ALL
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Type 1B is ___ and accounts for __%
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Non-immune/Idiopathic, 10%
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Pro insulin is converted to ___ and insulin in the ____
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C-peptide, golgi
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insulin is ___AAs, 2 peptide chains (A and B) linked by ___
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51 AAs, disulfide bridges (3)
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Proinsulin is stored in ___ as 2 atoms of ___ and 6 molecules of ___
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Beta cells, 2 atoms of Zn and 6 molecules of insulin
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The A chain of insulin is ___AAs
The B chain of insulin is ___AAs What gets cut out? |
A:21 AAs. a Lys and Arg are removed before AA1.
B: 30 AAs. 2 Arg's are removed after AA30 |
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Insulin and C peptide are released in ___ amts./
C peptide has no known function but can serve as a ___ |
equal amts
index of insulin secretion |
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Insulin is degraded by ___
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hydrolysis of disulfide bonds then proteolysis (insulinase)
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Insulin is cleared by the liver ___% and kidney ___%
half life of ___ |
liver 60
kidney 40 t1/2 3-9 min |
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Glucose binds GLUT__ on beta cells, is internalized and oxidized to ___ via ___
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GLUT2, ATP via TCA cycle
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High ATP levels open/close the ATP dependent ___ channels, trapping the ion inside the cells.
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close, K+
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Decreased K flow causes ____ of the cell which opens voltage gated ____ channels
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depolarization, Ca++
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Increased/Decreased Ca levels stimulate exocytosis of insulin granules into the blood
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Increased
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What drug blocks ATP dependent K channels on B cells stimulating insulin release?
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Sulfonylureas
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Insulin stimulates glucose uptake into target tissues by GLUT__
Insulin initiates phosphorylation cascade within cells, translocates glucose transporters from inside of cell to cell surface |
GLUT 4
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Glucose enters the cell thru ___
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facilitated diffusion
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Insulin receptor is a ___ receptor...cascade results in ____ being translocated to surface
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tyrosine kinase
GLUT 4 |
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GLUT 1 location
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all tissues, RBCs, brain
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GLUT 2 location
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B cells of pancreas
liver kidney |
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GLUT 3 location
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Brain
Kidney Placenta |
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GLUT 4 location
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Muscle, adipose
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GLUT 5 location
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Gut
Kidney |
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Transporters in brain?
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GLUT1, 3
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Transporters in kidney?
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GLUT2, 3, 5
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GLUT 1 function
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Basal uptake of glucose transport across BBB
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GLUT 2 function
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Regulation of insulin release
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GLUT 3 function
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Uptake into neurons
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GLUT 4 function
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Insulin mediated glucose uptake
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GLUT 5 function
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Absorption of fructose
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In the liver, glucose is stored as ____ then converted to ____, ___, then___
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glycogen
FAs, VLDL, adipose |
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Insulin in the liver inhibits?
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glycogenolysis, gluconeogenesis, and conversion of FAs to ketones
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Insulin in skeletal muscle stimulates?
inhibits? |
stimulates: storage as glycogen, storage of AAs as protein
inhibits: protein degradation to AAs |
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Insulin in adipose tissue stimulates?
inhibits? |
stimulates: storage of FAs as TGs
inhibits: conversion of TGs to FAs |
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Insulin is now a human, recombinant form from ___ or ___
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E. coli (Humulin)
Yeast (Novolin) |
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Name the ultra short acting insulins
onset peak duration |
Lispro
Aspart Glulisine 15 min 1-2 hrs 4 hrs |
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Name the short acting insulins
O P D |
Regular
30 min-1 hr 2-4 hr 5-7 hr |
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Name the intermediate acting insulin
O P D |
NPH
1-3 hrs 6-14 hrs 18-24 hrs |
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Name the longer acting insulins
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Lente
Ultralente PZI (Zn, no longer avail) |
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Name the long/ultra long acting insulins
O P D |
Glargine
Detemir 2-4 hr No peak ~24 (Detemir 22-23) |
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Which insulin has switched AAs at 28 and 28 and clipped off 30?
Normal 28=Pro, 29=Lys, 30=Thr ? 28=Lys, 29= Pro |
Lispro
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Which Insulin has a ASP at B28 instead of a proline and has clipped 29 and 30>
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Aspart
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Which insulin has added back B31 and 32 Args from before the C peptide cut?
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Glargine
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Which insulin has a LYS at B3 instead of ASN and GLU at B29 instead of LYS?
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Glulisine
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Which insulin has a 14 chain FA attached to the LYS at B29?
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Detemir
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Which novel form of insulin delivery is in phase 3 trials in Canada?
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sublingual
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Name the 6 indications for insulin
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1. Type 1 patients
2. Pregnant Type 2 pts or Gestational 3. Uncontrolled Type 2 4. Diabetic ketoacidosis 5. Hyperglycemic hyperosmolar nonketotic coma 6. hyerpkalemia |
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Name drugs that decrease hypoglycemic effect of insulin (ie increase risk of hyperglycemia)
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Oral contraceptives
Corticosteroids Dobutamine Epinepherine Niacin Smoking Thiazides Thyroid hormone |
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Name drugs that increase hypoglycemic effect of insulin (ie increase risk for hypoglycemia)
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Alcohol
Alpha blockers Beta blockers Anabolic Steroids MAOis |
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Insulin allergy is Ig__ mediated while immune insulin resistance is Ig__
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IgE
IgG |
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Goals of insulin therapy
1. maintain BG in range to prevent __ 2. prevent long-term ___vascular problems 3.minimize __ |
hyperglycemia
microvascular hypoglycemia |
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ADA's standard of care guidelines
Fasting Glucose Non-Diabetic Goal Action Suggested |
<110
80-120 <80 or >140 |
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ADA's standard of care guidelines
Post Prandial plasma Glucose Non-Diabetic Goal Action Suggested |
<120
100-140 <100 or >160 |
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ADA's standard of care guidelines
A1c Non-Diabetic Goal Action Suggested |
4-6
<7 >8 |
