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BSI 2 LEC 52: Endocrine 6; Diabetes
Terms in this set (35)
______ ________ is a condition of impaired metabolism which affects the body's utilization of carbohydrates, fats and proteins.
T or F? Diabetes mellitus is caused by either a lack of insulin (type I) or decrease sensitivity to insulin (type II)
What is the upper limit of fasting blood glucose level measured first thing before breakfast?
T or F? In an oral glucose tolerance test (OGTT), a normal person glucose increases rapidly and returns to normal within 2 hours. In a diabetic, glucose increases much greater and declines after 2 hours.
False, in a diabetic, glucose levels declines after 4-6 hours.
In type 1, as insulin is processed from proform to functional hormone, _____ __-______ is released and a good measure for insulin production.
In type 1 diabetics, high levels of ketones bodies are formed and some are converted into ______ which has a characteristic odor.
Acetone. Ketone bodies can also be detected in the urine and if quantified can indicate the severity of the condition.
Apart from failing the OGTT, what else could be measured?
Levels of antibodies against Glutamic Acid Decarboxylase (GAD), Islet cells (ICA), and insulin itself (IAA).
What are some reasons type 1 diabetes are explained?
Damage or destruction of pancreatic beta cells.
1. Predisposition via genetics
2. Viral infection (Rubella, similar antigens like MS)
3. Autoimmune response
The combination of dehydration due to osmotic diuresis and the production of significant quantities of ketones due to ↑FFA metabolism result in _____ ______, (ketosis), and possibly death if not treated appropriately.
Onset of Type I diabetes often occurs at ~ 14 years and is therefore frequently called Juvenile diabetes mellitus: it can develop very rapidly usually _____ to ______.
What are the 3 major consequences of Juvenile diabetes mellitus?
1. Increase blood glucose (high as 1200%!)
2. Increase utilization of FAs, metabolic acidosis
3. Decrease body protein; protein catabolism, wasting and death in a few weeks.
What events can happen with extremely elevated blood glucose levels?
1. Transporters in kidneys overwhelmed, glucose appears in the urine.
2. Diuresis due to increasing osmolarity of urine
3. Cellular dehydration, increase thirst
4. Peripheral ischemia, gangrene, and possible amputation
5. Nerve damage, peripheral neuropathy and ANS dysfunction (impaired cardiovascular reflexes, bladder control, and perception)
What events can happen with increase utilization of FAs?
1. More ketone body production than utilized
2. Metabolic acidosis (enhanced dehydration)
3. Diabetic coma or death
How does the body attempt to compensate for metabolic acidosis?
"Blowing off" CO2, while kidneys conserve and synthesize HCO3.
Type II diabetes is often associated with ________ as "feedback" from unresponsive tissues stimulate the secretion of more and more insulin in an attempt to maintain homeostasis as insulin resistance develops.
Metabolic syndrome includes _____, ______ ______, ____ _______, and ____________,
obesity, fasting hyperglycemia, lipid abnormalities, (↑blood triglycerides/↓HDLP), and hypertension.
T or F? In type 2 diabetes, quite often if obesity is reversed, (~85% of Type 2 sufferers are obese), then the condition is resolved!
Local inflammation may also be very important as TNF released from hypertrophic adipocytes and local macrophages is thought to block the effects of Peroxisome Proliferator-Activated Receptor Gamma, (PPAR-gamma) which affects an _____ ___ ____.
adipose transcription factor that decreases resistance to insulin. (May also cause Bete-cell proliferation in high-fat diets.
What are the other possible causes of insulin resistance?
Polycystic Ovary Disease
Autoimmune destruction of insulin receptors
Insulin receptor mutation
Genetic based obesity (Melanocortin receptor mutation)
Hemochromatosis (genetic condition, iron accumulation)
T or F? Type 2 diabetes could eventually become type 1 diabetes.
________ appears to be central in Metabolic Syndrome and therefore the development of Type 2 diabetes.
Regular insulin has a duration of action of ______
Most insulin is produced by _______ _____ ________, which is identical to human.
Recombinant DNA techonology.
What is the initial treatment of type 2 diabetes?
Initially advised to undergo lifestyle changes, (diet and exercise), which may reverse the insulin resistance.
In type 2 diabetes, if excercise fails, what is recommended?
Drugs that increase sensitivity to insulin or increase release are used. If this fail insulin must be administered.
________ is secreted by adipose tissue and the placenta and appears to suppress the metabolic disruption and development of NAFLD; when combined with Leptin it completely abolished insulin resistance in mice.
__________ activate nuclear PPAR-gamma receptors, (see previously), and affect transcription which in turn decreases insulin resistance.
_______ is currently a drug of choice for Type 2 treatment as it helps prevent CV complications by decreasing gluconeogenesis in the liver, increasing insulin sensitivity and increasing peripheral glucose uptake.
_______ is used to treat type 2 diabetes, it increases insulin release.
________ is often caused by an adenoma of an islet: ~ 10 -15% of these are malignant and occasionally metastasize throughout the body producing huge quantities of insulin: some sufferers requiring > 1 Kg glucose daily to prevent hypoglycemia!
Extreme __________ can reduce blood glucose to levels that depress brain function and Insulin Shock Syndrome may occur.
How does clinicians monitor blood sugar long-term?
They use a measurement called HbA1c level.
What is ideal percentage for diabetics to maintain their A1c at or below?
7%. This translates to actual blood sugar levels rarely reaching 150mg%.
[glucose]blood < 50-70mg% causes ______, _____, and even ______
hyperexcitability, nervousness, and even hallucinations.
[glucose]blood < 20-50mg% causes _____ ______ and ____ ____ ____.
clonic seizures and loss of consciousness → coma