Patho Exam 4 2/3 - Diabetes

Front 1

What are the three primary cells that make up the Islet’s of Langerhans and what hormones/proteins do they secrete?

Back 1

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)

Front 2

In addition to the rise in blood glucose, what other four events stimulate the release of insulin?

Back 2

1. Amino Acid
2. Fatty Acid
3. Gastrointestinal Hormones
4. Parasympathetic of Vagal Action

Front 3

Describe the normal response of blood levels of glucose, insulin, and glucagon to an oral glucose tolerance test (OGTT).

Back 3

Front 4

Explain the 1st step that occur in the beta cell release of insulin.

Back 4

Glucose transported into beta cell by facilitated diffusion through a glucose transport protein-2 (GLUT2);

Front 5

Explain the 2nd step that occur in the beta cell release of insulin.

Back 5

Entrance of glucose activates production of ATP, which closes potassium channels (K+ channels), thus depolarizing the cell


Front 6

Explain the 3rd step that occur in the beta cell release of insulin.

Back 6

Deporization of cell opens voltage-gated calcium channels, and Ca++ enters the cell;


Front 7

Explain the 4th step that occur in the beta cell release of insulin.

Back 7

Entrance of Ca++ triggers exocytosis of insulin-containing secretory granules.

Front 8

Besides glucose, what other nutrients will stimulate insulin release by beta cells?

Back 8

1. Fats (fatty acids);
2. Proteins (amino acids)

Front 9

What are the three target cells (i.e., tissues) of insulin and what are the actions of insulin at each tissue?

Back 9

1. Liver; Glucose->Glycogen

2. Liver/Fat cells ; Glucose->Fatty Acids->Fat

3. Muscle;
AminoAcids->Protein
Glucose->Glycogen

Front 10

Why is Insulin called an “anabolic hormone”?

Back 10

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)

Front 11

What are the cellular action of insulin at the target cell?

Back 11

Insulin @ Receptor -> up regulate Glucose Transport Protein-4 (GLUT4)

Up regulation GLUT4 -> Entrance of glucose

Front 12

In the “Fed State”, what factors inhibit the release of glucagon from the alpha cells?

Back 12

1. Insulin / Amylin (beta cells) secretion
2. Entrance of glucose into the alpha cells

Front 13

In the “Fasting State”, what two factors allow for the release of glucagon from the alpha cell?

Back 13

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

Front 14

What effect does Glucagon have on the liver’s glycogen (what is the term for this)?

Back 14

Glycogenolysis:
Liver converts Glycogen -> Glucose

Front 15

What effect does Glucagon have on the liver in terms of its handling of Amino Acids (what is the term for this)?

Back 15

Gluconeogenesis:
Liver converts Amino Acids -> Glucose


Front 16

What effect does Glucagon have on fat cells (what is the term for this)?

Back 16

Lipolysis:
Fat cells: Triglycerides -> Fatty acids

Ketogenesis:
Liver: Fatty acids -> Ketones

Front 17

What effect does Glucagon have on blood levels of Ketones?

Back 17

Liver releases ketones into the blood and therefore, increase blood levels of ketones

Front 18

What effect does Glucagon have on blood sugar?

Back 18

Increases blood glucose

Front 19

What are the three types of diabetes studied in this course?

Back 19

1. Type 1 DM
2. Type 2 DM
3. Gestational Diabetes (Type 3)

Front 20

Which one is identified with autoimmune destruction of the beta cells?

Back 20

Type 1 DM

Front 21

Which type of diabetes goes with Insulin insensitivity?

Back 21

Type 2 DM


also: Gestational Diabetes (called Type 3) during pregnancy

Front 22

Which type of diabetes goes with Pregnancy?

Back 22

Gestational Diabetes (considered type 2 b/c assoc. with insulin resistance during pregnancy)

Front 23

What are the terms “childhood diabetes” misnomers?

Back 23

Type 1 DM occurs in middle age or elderly

Front 24

What are the terms “adult onset diabetes" misnomers?

Back 24

Type 2 DM can occur in adolescents
(obesity)

Front 25

What are the terms “insulin independent diabetes” misnomers?

Back 25

Insulin:
-treatment in the latter states of Type 2 DM

Front 26

What is the usual age range for the onset of type 1 diabetes?

Back 26

Childhood / Adolescence
peak onset: early adolescents

Front 27

When considering the time line of type 1 diabetes, what is meant by “silent Beta cell loss”?

Back 27

No symptoms until Symptomatic onset

Front 28

In type 1 diabetes, by the time symptoms are demonstrated, what percentage of functional islet cell loss has occurred?

Back 28

<20%

Front 29

In type 1 diabetes, what two conditions cause diuresis?

Back 29

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

Front 30

What do the terms polyuria mean?

Back 30

Excessive Urination

(caused by Osmotic diuresis)

Front 31

What do the terms polydipsia mean?

Back 31

Excessive Thirst

(Polyuria causes dehydration)

Front 32

In type 1 diabetes, what four symptoms are caused by Ketoacidosis?

Back 32

1. Abdominal pains
2. Vomiting
3. Mental Confusion
4. Hyperventilation

Front 33

What are the three characteristics of type 2 diabetes?

Back 33

1. Insulin Resistance
2. Relative Insulin deficiency
3. Hyperglycemia

Front 34

What does insulin resistance mean?

Back 34

Higher than normal levels of insulin are needed to control blood glucose levels

Front 35

What does relative insulin deficiency mean?

Back 35

The beta cells become "exhausted" and cant produce sufficient amts of insulin to control blood sugar levels

Front 36

What causes hyperglycemia?

Back 36

-insulin resistance
-insulin deficiency

(from chronic high blood glucose levels)

Front 37

What are the two metabolic defects that characterize type 2 diabetes?

Back 37

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)

Front 38

What would be normal prediabetic and diabetic readings for a FASTING plasma glucose test?

Back 38

Pre-Diabetic = 110-126
Diabetic = >126

Front 39

What would be normal prediabetic and diabetic readings for an OGTT (oral glucose tolerance test)?

Back 39

Pre-Diabetic = 140-200
Diabetic = >200

Front 40

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.

Back 40

Average plasma glucose level (60-90 days)

Front 41

What percent levels of HbA1c could be considered:
-Healthy
-“at risk” developing type 2 diabetes
-diagnosis for diabetes?

Back 41

≤ 5.6%: Good / healthy range

5.7 – 6.5%: At risk

>6.5%: Diabetes diagnoses

Front 42

Identify the name given to areas of the body for major diabetic complications:
eyes

Back 42

Retinopathy

Front 43

Identify the name given to areas of the body for major diabetic complications:
brain and cerebral circulation

Back 43

Cerebrovascular Disease

Front 44

Identify the name given to areas of the body for major diabetic complications:
kidney

Back 44

Nephropathy

Front 45

Identify the name given to areas of the body for major diabetic complications:
heart and coronary circulation

Back 45

Coronary Heart Disease (CHD)

Front 46

Identify the name given to areas of the body for major diabetic complications:
lower limbs

Back 46

Peripheral Vascular Disease (PVD)

Front 47

Identify the name given to areas of the body for major diabetic complications:
peripheral nervous system

Back 47

Neuropathy

Front 48

Identify the name given to areas of the body for major diabetic complications:
diabetic foot

Back 48

Ulceration and amputation

Front 49

How can the complications from eyes, brain, heart, kidney, lower limbs, peripheral nervous system, and diabetic foot be controlled or prevented?

Back 49

Control Hyperglycemia

(medications / lifestyle)

Front 50

In general, what is a diabetogenic hormones?

Back 50

Hormones that block/suppress the action of insulin

(therefore cannot stimulate uptake of glucose)

Front 51

Where are the diabetogenic hormones produced during pregnancy?

Back 51

placenta

Front 52

In gestational diabetes, what trimester do symptoms begin to appear?

Back 52

3rd trimester

(Glucose levels are Elevated and diabetic symptoms begin to appear)

Front 53

factors that increase risk of Gestational Diabetes?

Back 53

-family hist of diabetes
-obesity
-abnormal birth (large baby, stillbirth, prev. birth defects)
-age >25

Front 54

Differentiate the foods with a high glycemic index (GI) in terms of speed at which glucose is released into the blood and insulin demand

Back 54

Processed Foods / simple carbs:
-break down quickly during digestion
-Release glucose rapidly into the bloodstream
-spike in Insulin follows

Front 55

What types (low or high glycemic index) should a type 2 diabetic consume to help control his/her blood sugar level?

Back 55

-Low GI (glycemic index) = lower insulin demand

-Improved long-term blood glucose

Front 56

Differentiate foods with a low glycemic index (GI) in terms of speed at which glucose is released into the blood and insulin demand

Back 56

Complex carbs, protein, etc:
-break down more slowly
-releasing glucose gradually into the bloodstream
-no rapid spike in Insulin

Front 57

Glucose Levels for: Diabetic

HbA1C, Fasting Plasma Glucose, OGTT

Back 57

HbA1C: >6.5%
Fasting: >126
OGTT: >200

Front 58

Glucose Levels for: Prediabetic

HbA1C, Fasting Plasma Glucose, OGTT

Back 58

HbA1C: 5.7-6.4%
Fasting: 100-125
OGTT: 140-199

Front 59

Glucose Levels for: Normal

HbA1C, Fasting Plasma Glucose, OGTT

Back 59

HbA1C: <5.6%
Fasting: <99
OGTT: <139

Front 60

What is the glycemic index (GI) measuring?

Back 60

the effects of carbohydrates on blood sugar levels

Front 61

What are the 2 reference foods for glycemic values?
What are their GIs?

Back 61

white bread: 100
glucose: 140

Front 62

Examples of Low GI foods

Back 62

fruit/veggies, legumes/pulses, whole GRAINs, meat, eggs, milk, nuts, fructose, low carb foods

Front 63

Examples of Medium GI foods

Back 63

whole wheat products, basmati rice, sweet potato, sucrose

Front 64

Examples of HIGH GI foods

Back 64

baked potate, watermelon, white bread, most white rices, corn flakes, extruded breakfast cereal, glucose

Front 65

what does gestational diabetes put the mother at risk for?

Back 65

Later in life: Type2 DM

(especially if overweight before pregnancy)

Front 66

what does gestational diabetes put the baby at risk for?

Back 66

high birth weight
childhood and adulthood obesity