Pathophys Final Exam - Insulin, Glucagon, And Dm

Front 1

What 3 hormones does the pancreas secrete?

Back 1

insulin
glucagon
somatostatin

Front 2

What are the two types of tissue in the pancreas?

Back 2

1. Acini cells
2. Islets of Langerhans

Front 3

What do acini cells do?

Back 3

Secrete digestive juices into the duodenum

Front 4

What do the Islets of Langerhans do?

Back 4

Secrete insulin and glucagon into the blood

Front 5

What are the 4 types of islet cells in the pancreas?

Back 5

1. Alpha cells secrete glucagon
2. Beta cells (Largest # of islet cells) secrete insulin
3. Delta cells secrete somatostatin
4. PP cells that secrete pancreatic polypeptide - unknown function

Front 6

Normal glucose physiology incorporates the balance of ...

Back 6

food sources of glucose and the utilization of glucose (maintenance of normal blood sugar levels)

Front 7

Normal glucose range

Back 7

90 - 140 mg/dL

Front 8

Glucogenesis is

Back 8

the storage of glucose as glycogen in liver and muscle

Front 9

Lipogenesis is

Back 9

the storage of TG as fat (adipose tissue)

Front 10

Gluconeogenesis is

Back 10

the formation of glucose from non-carbohydrate sources such as lactate, pyruvate, amino acids, and glycerol

Front 11

In the endoplasmic reticulum, preproinsulin is cleaved into _____

Back 11

proinsulin

Front 12

Proinsulin is cleaved in the gogi apparatus to ____

Back 12

insulin which is then stored in the golgi apparatus

Front 13

Insulin circulates ____ in the blood

Back 13

unbound

Front 14

1/2 life of insulin is

Back 14

6 minutes

Front 15

insulin is cleared from the plasma within

Back 15

10 - 15 minutes

Front 16

The enzyme that is responsible for the breakdown of insulin is

Back 16

insulinase

Front 17

The insulin receptor on the cell contains two ___ subunits and two ____ subunits

Back 17

Alpha (outside cell) and
Beta ( inside cell)

Front 18

When insulin binds the alpha subunit, a conformational change occurs in the beta subunit causing

Back 18

phosphorylation of tyrosine kinase, leading to several enzyme reactions

Front 19

Insulin binding to the cell causes

Back 19

increased uptake of glucose into the cell

Front 20

When glucose is transported into a muscle cell and not used, it is stored as

Back 20

glycogen

Front 21

The enzyme that is responsible for the breakdown of insulin is

Back 21

insulinase

Front 22

The insulin receptor on the cell contains two ___ subunits and two ____ subunits

Back 22

Alpha (outside cell) and
Beta ( inside cell)

Front 23

When insulin binds the alpha subunit, a conformational change occurs in the beta subunit causing

Back 23

phosphorylation of tyrosine kinase, leading to several enzyme reactions

Front 24

Insulin binding to the cell causes

Back 24

increased uptake of glucose into the cell

Front 25

When glucose is transported into a muscle cell and not used, it is stored as

Back 25

glycogen

Front 26

When glucose is taken into the liver it is stored as

Back 26

glycogen

Front 27

Insulin promotes the formation of fatty acids from carbohydrates, which are stored in

Back 27

adipose tissue

Front 28

Excess fatty acid production leads to the formation of

Back 28

triglycerides (TG)

Front 29

True or False: The brain and neural tissue can store glucose

Back 29

FALSE

Front 30

When insulin is deficient, ___ are broken down

Back 30

triglycerides (via lipolysis)

Front 31

When glucose is taken into the liver it is stored as

Back 31

glycogen

Front 32

Insulin promotes the formation of fatty acids from carbohydrates, which are stored in

Back 32

adipose tissue

Front 33

Excess fatty acid production leads to the formation of

Back 33

triglycerides (TG)

Front 34

True or False: The brain and neural tissue can store glucose

Back 34

FALSE

Front 35

When insulin is deficient, ___ are broken down

Back 35

triglycerides (via lipolysis)

Front 36

Fatty acids are converted by the liver to

Back 36

phospholipids and cholesterol

Front 37

The breakdown of fatty acids produces

Back 37

acetoacetic acid

Front 38

Acetoacetic acid is broke down in to the ketone bodies

Back 38

acetone and bbeta hydroxy butyric acid

Front 39

Insulin makes the cell more permeable to

Back 39

amino acid transport

Front 40

Insulin favors the formation of ____ and _____.

Back 40

new proteins ; muscle growth

Front 41

Insulin increases activity of the

Back 41

Na-K-ATPase pump, driving potassium into the cell

Front 42

Increased plasma glucose causes

Back 42

Insulin release

Front 43

Insulin release is biphasic. The first phase occurs in ____.

Back 43

3-5 minutes

Front 44

Insulin release is biphasic. The second phase occurs in ___ and lasts ___.

Back 44

15 minutes; 2hours

Front 45

Factors other than increased plasma glucose that cause insulin secretion are:

Back 45

Increased levels of the following
1. amino acid presence
2. Gastrin
3. secretin
4. CCK
5. Gastric Inhibitory Peptide
6. Growth Hormone
7. Cortisol
8. Estrogen
9. Progesterone
10. Glucagon

Front 46

Epinephrine causes increased plasma glucose by what mechanism?

Back 46

Stimulation of the Beta-2 receptor in liver and adipose tissue when the SNS is stimulated

Front 47

Glucagon is secreted by

Back 47

alpha cells of the pancreas

Front 48

Glucagon induces

Back 48

1. the breakdown of glycogen into glucose
2. frees fatty acids and inhibits TG storage
3. increases blood flow through the kidney
4. inotropy (+)

Front 49

Glucagon inhibits

Back 49

gastric acid secretion

Front 50

Glycogen release is inhibited by

Back 50

rise in plasma glucose

Front 51

Somatostatin inhibits

Back 51

glucagon and insulin secretion

Front 52

Diabetes Mellitus is defined by

Back 52

1. Fasting plasma glucose > 125mg/dl
2. Random plasma glucose > 200mg/dl

Front 53

Causes of increased incidence of DM are

Back 53

1. Obesity
2. sedentary lifestyle
3. rise in elderly population

Front 54

Type I DM is aka

Back 54

Insulin dependent or juvenile onset

Front 55

Type I DM is caused by

Back 55

lack of insulin secretion

Front 56

Type I DM is thought to be

Back 56

Autoimmune or viral related
Possibly familial
Other immune disorders often present

Front 57

Type I DM onset is often ____ and occurs around the age of ___.

Back 57

rapid or abrupt; 14

Front 58

Symptoms of Type I DM include

Back 58

1. Fatigue
2. Weight loss
3. polyuria
4. polydipsia
5. intravascular dehydration
6. ketoacidosis

Front 59

Ketoacidosis represents

Back 59

SEVERE insulin deficiency

Front 60

Pancreatic transplants are showing promise for which type of DM patients?

Back 60

Type I

Front 61

Type II DM is aka

Back 61

Non-Insulin dependent DM

Front 62

Type II DM is caused by

Back 62

insulin resistance (decreased responsiveness of cell to insulin)

Front 63

Causes of Type II DM

Back 63

1. Age (often after 30)
2. Obesity (especially childhood)

*Onset is usually gradual

Front 64

Type II initially presents as

Back 64

Hyperinsulinemia

Front 65

Hyperinsulinemia results from

Back 65

chronic hyperglycemia

Front 66

Hyperinsulinemia causes the pancreas to

Back 66

burn out and lose the ability to produce insulin

Front 67

Type II DM is associated with

Back 67

Metabolic Syndrome

Front 68

Metabolic Syndrome includes

Back 68

1.Obesity (belly fat)
2. Hyperglycemia (FBS > 110)
3. Increased TG, LDL
4. Decreased HDL
5. hypertension

Front 69

Other causes of insulin resistance

Back 69

1. Polycystic ovarian disease
2. gluccocorticoids (Cushings)
3. Steroid administration
4. Growth Hormone excess (Acromegaly)

Front 70

In insulin deficiency, the body's utilization of fat for energy causes

Back 70

increased TG and lipid levels

Front 71

Increased TG and circulating lipids secondary to insulin deficiency causes

Back 71

angiogenic and atherosclerotic changes

Front 72

Insulin deficiency can lead to depletion of protein stores resulting in

Back 72

muscle wasting and muscle fatigue

Front 73

Polyphagia results from

Back 73

muscle wasting caused by insulin deficiency

Front 74

Polyphagia is

Back 74

increased appetite

Front 75

Hgb A1C is

Back 75

glycosylated hemoglobin which results from chronic protein metabolism secondary to insulin deficiency

Front 76

Glucosuria is

Back 76

glucose in the urine

Front 77

The concentration at which glucose will spill over into the urine is

Back 77

180-200mg/dl

Front 78

Glucosuria can lead to polyuria because

Back 78

when glucose spills into the urine, it takes water with it (hyperosmolar)

Front 79

Long term complications of DM include

Back 79

1. Thrombotic lesions
2. Heart disease
3. HTN
4. Blindness (25x more) - retinopathy
5. Neuropathy (50% of all DM pts)
6. Vagal denervation
7. Orthostatic hypotension
8. Painless myocardial ischemia
9. ESRD
10. Stroke
11. CAD
12. Athersclerosis

Front 80

Vagal denervation secondary to diabetic neuropathy manifests as

Back 80

Tachycardia
dysrythmias
loss of HR variability seen with deep breathing

Front 81

Orthostatic hypotension secondary to autonomic neuropathy results from

Back 81

dysfunctional sympathetic nervous system that loses vasoconstrictive ability

Front 82

What type of induction is often preffered for DM patients?

Back 82

RSI

Front 83

Why RSI for DM patients?

Back 83

Autonomic neuropathy can cause delayed gastric emptying (increased risk of aspiration)

Front 84

What helps determine aspiration risk in DM patients?

Back 84

1. How long DM has existed
2. IDDM vs NIDDM
3. Autonomic neuropathy symptoms (i.e. orthostatic hypotension, vagal denervation)

Front 85

For RSI in the DM patient with ESRD, what would you use for muscle relaxant?

Back 85

Depending on K+ level, may need to use roc instead of succs. perform thorough airway assessment