Physio Integration

Front 1

DM I or II with increased insulin/C peptide

Back 1

DM II

Front 2

what are clinical finding that are consistant with DM II

Back 2

increased inhilin
increased glucose in plasma
NO ketones

Front 3

hwo can hyperinsulinemia be confirmed

Back 3

C peptide assay (longer 1/2 life than insulin)

Front 4

are ketones associated with DM II

Back 4

nope, we have SOME insulin, just enough to inhibit lipolysis and ketone formation

Front 5

what does untreated DM I look like

Back 5

high ketones
high FFA
lw insulin

Front 6

what is the problem

eat drink pee LOTS
increased FFA
low Na/K
HIGH glucagon
C peptide is low
Ketones high
glucose high

Back 6

DM I

Front 7

how does an insulin deficit affect plasma and urine glucose levels in DM I

Back 7

Plasma: increased becuase less GLUT 4 to take glucose into cells, gluconeogenesis als increases plasma glucose levels bc glucagon levels are high

Urine: LOTS of glucse, exceed reabs capacity, so Glucose is lost in urine as acts as osmotic gradient to pull out Na/K and water. Pee LOTS, low Na/K

Front 8

what happens to plasma FFA in DM I

Back 8

increased

**no insulin means hormone sensitive lipase goes unregulated. TONS of lipolysis releasing FFA. this is enhanced by glucagon

**the presense of insulin inhibits lipolysis

Front 9

how does lack of insulin in DM I affect plasma glucagn

Back 9

HIGH!

no insulin so no inhibitin on glucagon

**increased lipolysis and gluconeogenesis

Front 10

what happens to ketoens in the plasma nad urine in DM I. this is a result of lack of insulin

Back 10

increased FFA

**these are then converted to Ketone bodies (acetoacrtic acid and hydroxybutryic acid)

**filtered by kidney adn appear in urine

Front 11

why are ketones present in the plasma and urine in DM I

Back 11

there is MASSIVE lipolysis bc of lack in insulin and high glucagn. teh FFA released are converted t ketne bodies that are in plasma and urine

**insulin normally wuld inhibit hormone sensitive lipase form going lipolysis crazy but in DM I we dont have insulin to stop HSL

Front 12

what happens to C peptice in DM I

Back 12

decreased, C peptide is a reflectin f plasma levels. in DM I its low

Front 13

wht happens to BP in DM I

Back 13

decreased and decreases more when you stand

**low BP is secondary to fluid loss (osmotic diuresis from glucose in urine)
**decrease in ECF, means as you stand decreased venous return to heart, decreased CO and decreased arterial pressure

Front 14

if yu exercise what happens t FFA with and withut insulin injectins

Back 14

withut: increase FFA levels

With insuiln: FFA levels are low

Front 15

what happens to plasma glocose in exercise with and withouth insulin

Back 15

Without InsulinL decreases

With Insulin: decreases more

Front 16

what happens to insulin levels during exercise, what happens if we add insulin

Back 16

w/o insulin: decreases

with insulin: not as much of a decrease

Front 17

what decreases insulin release in exercise

Back 17

catecholamines

**greater intensity of exercise greater drop in insulin, more lipolysis

Front 18

why do we need to account for exersice wehn dosing insulin for DM I

Back 18

exercise decreases insulin levels so we would need to give them a little more

Front 19

why do we see a decrease in glucose with exercise, why is there an even greater driop when we exercise with insulin given

Back 19

exercise increases glucose uptake into the mm

with insulin more glucose is taken up int the tissues and glucose levels drop further

**increased demands for glucose in exercising mm

Front 20

why do plasma FFA increase in exercise and decrease with exercise and insulin

Back 20

w/o insulin and exersice: increased FFA bc lipolysis is stim

w/insulin the FFA is low bc insulin is antilipolytic

Front 21

how is plasma glucose constant throughot exercise with and w/o glucose infusion

Back 21

gucose utilization is the sme as hepatic glucose production

**countergegulatoy hormones on glycogenolysis nad gluconeogenesis

**even with extra insulin added the hypoglycemia is stronger than the insuin so glucagon is stil released to make sure we have hepatic glocose production

Front 22

how does the rate of glucose produciton and utilization during exercise compare for men and women

Back 22

men have higher rates of hepatic glucose production and tissue utilization

**males make and use more glucose during exercise

Front 23

who has a greater EPI respons to exercise men or women

Back 23

men

*8the NE response was hte same

Front 24

what is the effect of exercise on catecholamine release in men and women

Back 24

NE: same for both

EPI: more released in men than women

Front 25

how do levels of glucagon release during exercise vary among men nad women

Back 25

same

**men did have a higher increment from rest to exercise

Front 26

what happened to the cortisol response in men and women in response to exercise

Back 26

same increase and hten a decrease

Front 27

so men use more glucose in exercise than women, what hormone mirrors this result

Back 27

men also have increased EPI release

**the larger increment in glucagon can also accoudn for the higher amt of glucose men use

Front 28

what are the 2 possible explainations for increased glucose use in men during exercise as compared to women

Back 28

1. men also have icnreased EPI release

2. Men have increased glucagon increment

**same NE, cortisol, (gucagon),