What is insulin synthesized as?
What is a single amino acid chain, 51 AA long
What is the amino terminus of the proinsulin chain called?
What is the middle of the proinsulin chain called?
What is the carboxy-terminal amino acid part of the proinsulin chain?
What chains make up insulin?
A and B
When beta cells are induced to secrete what do they secrete?
insulin (A-B chains) and C-peptide simultaneously
Which part of the proinsulin chain is proteolytically cleaved post-translationally to make insulin?
What is the ratio of C:peptide to insulin?
Which is metabolized faster C peptide or insulin?
If blood is left in a test tube what can occur?
How fast does glycolysis reduce glucose in a test tube?
5-10mg/dL/hour depending on temp and WBC
what do you need to add to the test tube to stop glycolysis for 24hrs?
What process involves a Schiff base undergoing Amadori rearrangement?
glycosylated hb (HbA1c)
What type of reaction is glycosylation of Hb?
If the RBC has a shortened lifespan what happens to HbA1c?
What is the time frame that HbA1c measures?
What is the % of norm HbA1c?
What is the % of well controlled DM HbA1c?
Which hormone in preg has anti-insulin effects similar to GH and causes glc intol in preg?
What are the 2 phenomena that show sxs of hypoglycemia?
Neurologic: brain needs glc, get altered MS
Adrenergic: sweat, palpitations, tachy, nervous
Which type of responses do you see in fasting hypoglycemia?
slow, gradual onset altered MS
Which type of response is seen in reactive hypoglycemia?
What does insulin, sufonylurea, alcohol and quinine cause?
What type of hypoglycemia is caused by prolonged fast or exercise?
What type of hypoglycemia is caused by prolif of islet beta cells, sarcomas, inherited metabolic defects, and end stage liver dz?
What is the term used when you have hypoglycemia sxs, plasma glc<45 mg/dL, and resolution of sxs when given glc?
What is the entity when the insulin: glc ratio >189 mg/dL?
What type of hypoglycemia is caused by hereditary fructose intol, galactosemia, post-vagotomy (dumping synd)?
What is the dx for gestational DM with the 50g OGTT?
What is the dx for gestational DM with the 100g (75g) OGTT fasting?
What is the dx for gestational DM with the 100g (75g) OGTT 1hr?
What is the dx for gestational DM with the 100g (75g) OGTT 2hr?
What is the dx for gestational DM with the 100g OGTT 3hr (75g OGTT doesn't have)?
What is the fasting plasma glc for impaired glc tolerance?
What is the 75g OGTT with 2h plasma glc for impaired glc tolerance?
What is considered to be pre diabetes?
What is the best screening test to dx DM?
fasting plasma glc
What is the fasting plasma glc to dx DM?
>= 126 mg/dL
What is the 75g OGTT with 2h plasma glc that is dx of DM?
>= 200 mg/dL
What type of DM does DKA occur most often?
What occurs in insulin-deficient pts after some sort of provocation like infxn, trauma or not taking their insulin?
What are the early sxs of DKA?
What is the altered breathing pattern seen in late DKA?
What happens if you don't tx DKA?
altered MS, coma then death
What 3 things do you need to dx DKA?
What dx can sometimes be made on the clinical sxs and urine dipstick findings of glycosuria and ketonuria?
What technique measures the serum ketones acetoacetic acid and acetone but NOT beta-hydroxybutyrate?
Why do you get an apparent initial increase in ketones when you tx DKA?
because more betahydroxybutyrate is being broken down to acetoacetic acid and acetone as the total serum ketones decrease
What is the intial level of glucose in DKA?
Are pH, bicarb and sodium up or down in DKA?
decreased and there is an anion gap
What is increased in DKA due to severe vol depletion resulting in prerenal azotemia?
Why is K tricky in DKA?
initially increased, then transcellular shifts and urinary loss and insulin admin, total K down, get profound HYPOkalemia
What is crucial to give DKA patients when you treat them?
What type of DM do you see hyperglycemic hyperosmolar nonketotic coma?
What presents with altered MS, profound hyperglycemia, hyperosmolarity, dehydration and norm pH?
What are common features of HHNC?
seizures and localizing neurologic deficits like hemiplegia
What is the mortality rate of HHNC?
What is the glc level of HHNC?
What is the osmolarity of HHNC?
Are pH, HCO3, Na, and K norm in HHNC?
Where does A1c get added?
glucose added to N-term valine in beta chain
In pts who don't have HbA (ie sickle cell) how do you monitor diabetic control?
What is the most sensitive early lab marker of diabetic nephropathy?
microalbuminuria, measure T2DM q yr and T1DM q yr after 5y
Which type of DM has anti-islet autoAb?
What type of DM has HLA-DR3 and DR4?
What syndrome is DM2 frequently a part of?
What is the syndrome that has insulin resistance, dyslipidemia, dysglycemia, non alcoholic fatty liver?
What type of infants have inc risk of neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, and higher risk for RDS?
babies of moms with gestational DM
how do you confirm hypoglycemia?
72h fast w periodic glc measurement
How do you determine specific cause of hyperinsulinemia?
C-peptide (marker for endogenous insulin)
If C-peptide is low or absent in pt with hyperinsulin what is cause?
exogeneous hyperinsulinism: insulin injection
What syndrome do you see insulinomas in?
Wermer synd (MEN I): 3 Ps: pituitary, parathyroid, pancreas
What are the 2 fast acting anti-insulin hormones?
Glucagon and epinephrine
What are the 2 slow acting anti-insulin hormones?
cortisol and GH