Phar 471 - Diabetes

Front 1

What is the cause of Type 1 Diabetes?

Back 1

A consequence of an inability of the pancreas to produce insulin

Front 2

What is the cause of Type 2 Diabetes?

Back 2

A consequence of tissues (like skeletal muscle, adipose tissue and liver) not responding to Insulin (properly)

Front 3

What is the most important controller of insulin secretion?

Back 3

Glucose

Front 4

What is the mechanism of Insulin secretion from β cells?

Back 4

1) Glucose is converted into ATP from mitochondria

2) The ATP closes the K+ channel eliciting depoloarization if the membrane

3) Ca2+ enters the cell

4) Ca2+ stimulates the exocytosis of secretory granules containing Insulin

Front 5

"Glucose is able to increase insulin secretion in the absence of any other stimulatory agent" True or False?

Back 5

TRUE

Front 6

What are examples of substances that can trigger secretion of Insulin?

Back 6

1) Glucose

2) Fatty Acids

3) Amino Acids

4) Sulphonylurea drugs (e.g. Tolbutamide, Glyburide)

Front 7

What are examples of substances that can enhance secretion of Insulin?

Back 7

Glucagon Like Peptide (GLP)

Front 8

What are examples of substances that can inhibit secretion of Insulin?

Back 8

Catecholamines

Front 9

What is the precursor to Insulin?

Back 9

Proinsulin

Front 10

How do you convert Proinsulin to Insulin?

Back 10

C-peptide (a 31 amino acid peptide that bridges the insulin A and B) is removed

[Note: Lys/Arg and Arg/Arg]

Front 11

What is the structure of Insulin?

Back 11

Consists of 51 amino acids in 2 chains;

(A) chain with 21 amino acids and

(B) chain with 30 amino acids.

Where both Chains are linked by disulfide bonds

Front 12

What are the clinical manifestations of Diabetes?

Back 12

Polyuria, Polydypsia and Polyphagia

Front 13

What are the effects of Insulin?

Back 13

1) Promotes Glycogen Synthesis in the Liver/Muscle

2) Promotes Lipid formation in the Adipocytes

3) Promotes Amino Acid Uptake and Protein Synthesis

4) Promotes Glucose Uptake of cells

Front 14

What are the Net Effects of Insulin?

Back 14

1) Decreased Blood Glucose

2) Decreased Blood Triglycerides and Cholesterol

3) Decreased Blood Free Fatty Acids

4) Decreased Blood Amino Acids

Front 15

What is the transporter for Glucose uptake by Muscle and Adipose Tissues?

Back 15

GLUT4

Front 16

"Skeletal muscle accounts for ______ of the glucose uptake"

Back 16

80-85%

Front 17

"Adipocytes accounts for _______ of the glucose uptake"

Back 17

4-5%

Front 18

What can happen to glucose after entry into the cell?

Back 18

1) Oxidative breakdown to produce energy

2) Conversion to Glycogen for Storage in the Liver and Muscle

3) Conversion to Fats for storage in Adipocytes

Front 19

How does Insulin lower plasma Triglyceride levels?

Back 19

Multiple mechanisms include an increase in Glucose uptake (which is then esterified to Triglyceride) or inhibition of Lipolysis (which prevents breakdown of TGs to Fas)

Front 20

"Insulin inhibits protein degradation" True or False?

Back 20

TRUE

Front 21

In the absence of Insulin; which amino acid is broken down to Glucose in the Liver?

Back 21

Alanine

Front 22

In the absence of Insulin; which amino acid is broken down to Glucose in the Kidney?

Back 22

Glutamine

Front 23

What is the definition of Diabetes Mellitus?

Back 23

A metabolic disorder characterized by the presence of Hyperglycemia due to defective insulin secretion, defective insulin action or both

Front 24

What is Gestational Diabetes?

Back 24

Glucose intolerance during pregnancy.

Blood sugar returns to normal after delivery; However these women face a lifelong risk of developing T2DM

(20-50% chance in the next 5-10yrs)

Front 25

What is Secondary Diabetes?

Back 25

Hyperglycaemia occurring in relation to other disease states (e.g. pancreatic disorders like carcinoma of the pancreas) and drug induced conditions (e.g. Glucocorticoids)

Front 26

What are tests that can be used to diagnose Diabetes?

Back 26

1) Fasting Plasma Glucose

2) Casual Blood Glucose

3) Glycated Hemoglobin Levels (HbA1c)

4) Oral Glucose Tolerance Test (OGTT)

Front 27

What is Fasting Plasma Glucose indicative of?

Back 27

Mainly reflects Hepatic gluconeogenesis and Basal Metabolic Needs

Front 28

What are the test results of FPG?

Back 28

Normal: 3.8 - 6.0 mmol/L

Impaired Fasting Glucose: 6.1 - 6.9 mmol/L

Diabetes: >7.0 mmol/L

Front 29

What is Casual Blood Glucose indicative of?

Back 29

Reflects dietary intake

Front 30

What are the test results of Casual Blood Glucose?

Back 30

Normal: <7.8 mmol/L

Diabetes: >11.1 mmol/L

Front 31

What is HbA1C indicative of?

Back 31

Measures the amount of glucose that binds to hemoglobin

Front 32

"1% change of HbA1C reflects ______mM change in mean blood glucose"

Back 32

1.4 - 1.9

Front 33

What are the test results of HbA1C?

Back 33

Normal: 4-6%

Pre-Diabetes: 6-6.5%

Diabetes: >6.5%

Front 34

What is OGTT indicative of?

Back 34

Measure the body's ability to breakdown Carbohydrates

Front 35

How is an OGTT performed?

Back 35

Overnight fast of 8-14 hours (during which can be drunk)

A standard dose of 75g of Glucose is given as a drink and blood is drawn at 1 and 2 hours post ingestion to measure blood glucose.

Front 36

What are the test results of OGTT?

Back 36

Normal: <7.8 mmol/L

Impaired Glucose Tolerance: 7.8 - 11.0 mmol/L

Diabetes: >11.1 mmol/L

Front 37

What are the requirements for a diagnosis of Diabetes (Any ONE of these)?

Back 37

1) Symptoms of Diabetes + Random Casual BG >11.1 mmol/L

2) Fasting Plasma Glucose >7 mmol/L

3) OGTT result after 2 hours is >11.1 mmol/L

4) An A1C >6.5%

Front 38

"A confirmatory test for Diabetes can be done on the same day as the original" True or False?

Back 38

False; It must be done on another day

Front 39

What percentage of diabetes are Type 1 and Type 2?

Back 39

10% are Type 1 Diabetics.

90% are Type 2 Diabetics

Front 40

What are the common ages for Type 1 and Type 2 Diabetes?

Back 40

<30% (common in youth) in Type 1 Diabetics.

>20 (more frequent in adults) in Type 2 Diabetics

Front 41

What is the onset of Type 1 and Type 2 Diabetes?

Back 41

Sudden Onset in Type 1 Diabetics.

Gradual onset in Type 2 Diabetics

Front 42

What are the nutritional statuses for Type 1 and Type 2 Diabetes?

Back 42

Most Type 1 Diabetics are Malnourished (usually thin).

Majority of Type 2 Diabetics are Overweight.

Front 43

How prone to Ketosis are Type 1 and Type 2 Diabetes?

Back 43

Type 1 Diabetics are prone to Ketosis (unless diet and insulin are coordinated).

Type 2 Diabetics are resistant to Ketosis.

Front 44

What proportion of Type 1 and Type 2 Diabetic patients require Insulin?

Back 44

100% of Type 1 Diabetics require Insulin.

<30% of Type 2 Diabetics require Insulin.

Front 45

What proportion of Type 1 and Type 2 Diabetic patients require Dietary Modification?

Back 45

Dietary modification is mandatory in Type 1 Diabetics.

Dietary modification controls 30-50% of cases of Type 2 Diabetics.

Front 46

How do β cells compare in Type 1 and Type 2 Diabetes?

Back 46

There are no β cells in Type 1 Diabetics (complete islet cell loss).

Variable β cells in Type 2 Diabetics.

Front 47

How do Isclet Cell Abs compare in Type 1 and Type 2 Diabetes?

Back 47

Islet Cell Abs are present in Type 1 Diabetes.

Islet Cell Abs are NOT present in Type 2 Diabetes.

Front 48

How relevant is Family History in Type 1 and Type 2 Diabetes?

Back 48

Only 10% Positive family history in Type 1 Diabetics.

Only 30% Positive family history in Type 2 Diabetics.

Front 49

What is the concordance with Identical Twins for Type 1 and Type 2 Diabetes?

Back 49

50% concordance in identical twins with Type 1 Diabetics.

60-80% concordance in identical twins with Type 2 Diabetics.

Front 50

What is a common easy to detect symptom of Ketoacidosis?

Back 50

Smell of Acetone on Breath

Front 51

What are the early symptoms of Type 1 Diabetes?

Back 51

1) Fatigue

2) Weight Loss

3) Polyuria/Nocturia

4) Polydipsia/Thirst

5) Polyphagia/Increased Appetite

6) Pruritis

7) Impotence

8) Infections (UTI, Oral/Vaginal Candidiasis)

9) Ketoacidosis

Front 52

What are the early symptoms of Type 2 Diabetes?

Back 52

1) Fatigue

2) Impotence

3) Perhaps Type 1 Syndromes

Front 53

What are the Long Term Late Manifestations of Diabetes (Both Type 1 and Type 2)?

Back 53

1) Ocular (Retinopathy): Bleeding/Visual Disturbances/Cataracts/Glaucoma

2) Renal (Proteinuria): >500mg in 24 hours

3) Atherosclerotic Arterial Disease: (2-4 times increased risk of stroke)

4) Neuropathy: Peripheral Nerve Dysfunction (Loss of touch/vibration/temp) may lead to ulcers or gangrene. Also erectile dysfunction.

5) Hypertension

Front 54

"Retinopathy is the most common microvascular complication of Diabetes and is the leading cause of blindness In North America" True or False?

Back 54

TRUE

Front 55

What is the major cause of death in diabetic patients?

Back 55

Cardiovascular Disease

Front 56

"When insulin was introduced to treat T2DM the number of deaths from CV disease and Diabetic Coma both decreased" True or False?

Back 56

False: Coma decreases by CV disease increased and then plateus

Front 57

What coutries have the highest incidence of T1DM in the world?

Back 57

Finland and Canada

Front 58

"80-90% of patients with T2DM have insulin resistance" True or False?

Back 58

TRUE

Front 59

What aspect of Insulin release is lost in T2DM?

Back 59

The rapid 1st phase insulin release is lost;

The 2nd phase is still present.

So this is why they are more susceptible to post prandial hyperglycaemia.

Front 60

How does Insulin resistance progress with the T2DM?

Back 60

Generally becomes more significant as the disease progresses with time

Front 61

What race of people have the highest rates of T2DM in age 45-54 populations?

Back 61

Pima Indians