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66 Cards in this Set
- Front
- Back
What are the three primary cells that make up the Islet’s of Langerhans and what hormones/proteins do they secrete?
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1. Alpha Cells - Glucagon (15-20% of cells)
2. Beta Cells - Insulin/Amylin (60-80% of cells) 3. Delta cells - Somatostatin (3-10% of cells) |
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In addition to the rise in blood glucose, what other four events stimulate the release of insulin?
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1. Amino Acid
2. Fatty Acid 3. Gastrointestinal Hormones 4. Parasympathetic of Vagal Action |
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Describe the normal response of blood levels of glucose, insulin, and glucagon to an oral glucose tolerance test (OGTT).
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Explain the 1st step that occur in the beta cell release of insulin.
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Glucose transported into beta cell by facilitated diffusion through a glucose transport protein-2 (GLUT2);
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Explain the 2nd step that occur in the beta cell release of insulin.
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Entrance of glucose activates production of ATP, which closes potassium channels (K+ channels), thus depolarizing the cell
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Explain the 3rd step that occur in the beta cell release of insulin.
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Deporization of cell opens voltage-gated calcium channels, and Ca++ enters the cell;
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Explain the 4th step that occur in the beta cell release of insulin.
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Entrance of Ca++ triggers exocytosis of insulin-containing secretory granules.
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Besides glucose, what other nutrients will stimulate insulin release by beta cells?
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1. Fats (fatty acids);
2. Proteins (amino acids) |
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What are the three target cells (i.e., tissues) of insulin and what are the actions of insulin at each tissue?
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1. Liver; Glucose->Glycogen
2. Liver/Fat cells ; Glucose->Fatty Acids->Fat 3. Muscle; AminoAcids->Protein Glucose->Glycogen |
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Why is Insulin called an “anabolic hormone”?
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Anabolic Hormone in general:
stimulate growth, mineralization of bone, growth of muscle mass Insulin causes synthesis/formation of: -glycogen (from glucose) -triglycerides (from glucose) -protein (from amino acids) |
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What are the cellular action of insulin at the target cell?
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Insulin @ Receptor -> up regulate Glucose Transport Protein-4 (GLUT4)
Up regulation GLUT4 -> Entrance of glucose |
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In the “Fed State”, what factors inhibit the release of glucagon from the alpha cells?
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1. Insulin / Amylin (beta cells) secretion
2. Entrance of glucose into the alpha cells |
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In the “Fasting State”, what two factors allow for the release of glucagon from the alpha cell?
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1. little to no release of insulin and amylin by the beta cells
2. Removal of the inhibitory effect that glucose entry into the alpha cells has |
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What effect does Glucagon have on the liver’s glycogen (what is the term for this)?
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Glycogenolysis:
Liver converts Glycogen -> Glucose |
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What effect does Glucagon have on the liver in terms of its handling of Amino Acids (what is the term for this)?
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Gluconeogenesis:
Liver converts Amino Acids -> Glucose |
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What effect does Glucagon have on fat cells (what is the term for this)?
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Lipolysis:
Fat cells: Triglycerides -> Fatty acids Ketogenesis: Liver: Fatty acids -> Ketones |
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What effect does Glucagon have on blood levels of Ketones?
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Liver releases ketones into the blood and therefore, increase blood levels of ketones
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What effect does Glucagon have on blood sugar?
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Increases blood glucose
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What are the three types of diabetes studied in this course?
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1. Type 1 DM
2. Type 2 DM 3. Gestational Diabetes (Type 3) |
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Which one is identified with autoimmune destruction of the beta cells?
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Type 1 DM
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Which type of diabetes goes with Insulin insensitivity?
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Type 2 DM
also: Gestational Diabetes (called Type 3) during pregnancy |
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Which type of diabetes goes with Pregnancy?
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Gestational Diabetes (considered type 2 b/c assoc. with insulin resistance during pregnancy)
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What are the terms “childhood diabetes” misnomers?
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Type 1 DM occurs in middle age or elderly
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What are the terms “adult onset diabetes" misnomers?
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Type 2 DM can occur in adolescents
(obesity) |
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What are the terms “insulin independent diabetes” misnomers?
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Insulin:
-treatment in the latter states of Type 2 DM |
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What is the usual age range for the onset of type 1 diabetes?
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Childhood / Adolescence
peak onset: early adolescents |
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When considering the time line of type 1 diabetes, what is meant by “silent Beta cell loss”?
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No symptoms until Symptomatic onset
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In type 1 diabetes, by the time symptoms are demonstrated, what percentage of functional islet cell loss has occurred?
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<20%
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In type 1 diabetes, what two conditions cause diuresis?
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High blood glucose
Ketone levels **These spill over into the urine, taking water and solutes along with them in the a process known as osmotic diuresis |
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What do the terms polyuria mean?
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Excessive Urination
(caused by Osmotic diuresis) |
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What do the terms polydipsia mean?
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Excessive Thirst
(Polyuria causes dehydration) |
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In type 1 diabetes, what four symptoms are caused by Ketoacidosis?
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1. Abdominal pains
2. Vomiting 3. Mental Confusion 4. Hyperventilation |
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What are the three characteristics of type 2 diabetes?
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1. Insulin Resistance
2. Relative Insulin deficiency 3. Hyperglycemia |
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What does insulin resistance mean?
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Higher than normal levels of insulin are needed to control blood glucose levels
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What does relative insulin deficiency mean?
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The beta cells become "exhausted" and cant produce sufficient amts of insulin to control blood sugar levels
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What causes hyperglycemia?
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-insulin resistance
-insulin deficiency (from chronic high blood glucose levels) |
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What are the two metabolic defects that characterize type 2 diabetes?
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Genetic Component
1. Derangement of beta-cell secretion of insulin (relative insulin deficiency) Environmental Component 2. Inability of peripheral tissues to respond to insulin (insulin resistance) |
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What would be normal prediabetic and diabetic readings for a FASTING plasma glucose test?
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Pre-Diabetic = 110-126
Diabetic = >126 |
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What would be normal prediabetic and diabetic readings for an OGTT (oral glucose tolerance test)?
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Pre-Diabetic = 140-200
Diabetic = >200 |
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It is said that fasting plasma glucose test and the oral glucose tolerance test gives you a “snap shot” of a persons blood glucose whereas a glycated hemoglobin (glycosylated) hemoglobin (HbA1c) gives a clinician a “bigger pictures” of a patient’s blood glucose levels. Explain.
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Average plasma glucose level (60-90 days)
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What percent levels of HbA1c could be considered:
-Healthy -“at risk” developing type 2 diabetes -diagnosis for diabetes? |
≤ 5.6%: Good / healthy range
5.7 – 6.5%: At risk >6.5%: Diabetes diagnoses |
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Identify the name given to areas of the body for major diabetic complications:
eyes |
Retinopathy
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Identify the name given to areas of the body for major diabetic complications:
brain and cerebral circulation |
Cerebrovascular Disease
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Identify the name given to areas of the body for major diabetic complications:
kidney |
Nephropathy
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Identify the name given to areas of the body for major diabetic complications:
heart and coronary circulation |
Coronary Heart Disease (CHD)
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Identify the name given to areas of the body for major diabetic complications:
lower limbs |
Peripheral Vascular Disease (PVD)
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Identify the name given to areas of the body for major diabetic complications:
peripheral nervous system |
Neuropathy
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Identify the name given to areas of the body for major diabetic complications:
diabetic foot |
Ulceration and amputation
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How can the complications from eyes, brain, heart, kidney, lower limbs, peripheral nervous system, and diabetic foot be controlled or prevented?
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Control Hyperglycemia
(medications / lifestyle) |
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In general, what is a diabetogenic hormones?
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Hormones that block/suppress the action of insulin
(therefore cannot stimulate uptake of glucose) |
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Where are the diabetogenic hormones produced during pregnancy?
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placenta
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In gestational diabetes, what trimester do symptoms begin to appear?
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3rd trimester
(Glucose levels are Elevated and diabetic symptoms begin to appear) |
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factors that increase risk of Gestational Diabetes?
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-family hist of diabetes
-obesity -abnormal birth (large baby, stillbirth, prev. birth defects) -age >25 |
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Differentiate the foods with a high glycemic index (GI) in terms of speed at which glucose is released into the blood and insulin demand
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Processed Foods / simple carbs:
-break down quickly during digestion -Release glucose rapidly into the bloodstream -spike in Insulin follows |
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What types (low or high glycemic index) should a type 2 diabetic consume to help control his/her blood sugar level?
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-Low GI (glycemic index) = lower insulin demand
-Improved long-term blood glucose |
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Differentiate foods with a low glycemic index (GI) in terms of speed at which glucose is released into the blood and insulin demand
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Complex carbs, protein, etc:
-break down more slowly -releasing glucose gradually into the bloodstream -no rapid spike in Insulin |
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Glucose Levels for: Diabetic
HbA1C, Fasting Plasma Glucose, OGTT |
HbA1C: >6.5%
Fasting: >126 OGTT: >200 |
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Glucose Levels for: Prediabetic
HbA1C, Fasting Plasma Glucose, OGTT |
HbA1C: 5.7-6.4%
Fasting: 100-125 OGTT: 140-199 |
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Glucose Levels for: Normal
HbA1C, Fasting Plasma Glucose, OGTT |
HbA1C: <5.6%
Fasting: <99 OGTT: <139 |
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What is the glycemic index (GI) measuring?
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the effects of carbohydrates on blood sugar levels
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What are the 2 reference foods for glycemic values?
What are their GIs? |
white bread: 100
glucose: 140 |
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Examples of Low GI foods
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fruit/veggies, legumes/pulses, whole GRAINs, meat, eggs, milk, nuts, fructose, low carb foods
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Examples of Medium GI foods
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whole wheat products, basmati rice, sweet potato, sucrose
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Examples of HIGH GI foods
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baked potate, watermelon, white bread, most white rices, corn flakes, extruded breakfast cereal, glucose
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what does gestational diabetes put the mother at risk for?
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Later in life: Type2 DM
(especially if overweight before pregnancy) |
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what does gestational diabetes put the baby at risk for?
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high birth weight
childhood and adulthood obesity |