Chem ppt flashcards, Unit 4



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Chem PPT Flashcards, Unit 4

Diabetes Mellitus is a group of metabolic disorders of ___ metabolism

Carbohydrate

Diabetes Mellitus can cause the following life-threatening episodes:

Ketoacidosis and hyperosmolar coma

Complications of DM includes:

Retinopathy, nephropathy, neuropathy and atherosclerosis

Diabetes was first classified as Juvenile vs. adult onset, then insulin dependent vs. non-insulin dependent and finally:

Type 1 and type 2

Two other types of DM include:

Gestational and other types

Type 1 DM accounts for __% - __%

5 - 10

Type 1 DM presents with:

polyuria, polydipsia, and rapid weight loss

In type 2 DM, insulin deficiency is caused by: loss of pancreatic islet β-cells

loss of pancreatic islet β-cells

Type 2 DM accounts for __%:

90%

Are patients with type 2 DM dependent on insulin?

No.

What is the mechanism for type 2 DM?

Insulin resistance

How is type 2 DM usually treated?

dietary manipulation, oral hypoglycemic agents, or insulin to control hyperglycemia

Usually occurs in people over:

40

Other causes of DM can include:

Genetic defects of β-cell function, Genetic defects in insulin action Exocrine pancreas disease, Endocrinopathies (Cushing syndrome, acromegaly, glucagonoma)Hormones or drugs that induce β-cell dysfunction (dilantin, pentamidine) or impair insulin action (glucocorticoids, thiazides, β-adrenergics), Infection, Uncommon forms of immune-mediated diabetes, Other genetic conditions (Down syndrome, Klinefelter syndrome, porphyria)

Gestational DM is defined as:

carbohydrate intolerance of variable severity with onset or first recognition during pregnancy

Incidence is between __% and __%

6 - 8

Impaired glucose tolerance is defined as:

people with intermediate glucose levels (140 to 199 mg/dL or 7.8 to 11.1 mmol/L

Rare complications of IGT are:

Microvascular disease and renal and retinal

There is an increased prevalence of :

CVD

Hormone that decreases blood glucose

Insulin

Counter-regulatory hormones that increase blood glucose concentrations

Glucagon, epinephrine, cortisol, growth hormone


Insulin is produced by the _______ of the islets of Langerhans of the _____.

B-cells, pancreas

Insulin is an _______ hormone that stimulates uptake of glucose into fat and muscle.

Anabolic

Insulin promotes the conversion of glucose to glycogen or fat for storage.

True


Insulin inhibits glucose production by the liver.

True

Insulin stimulates protein synthesis and inhibits protein breakdown.

True

______ is the major storage form of insulin and has approximately 10% of insulin potency.

Proinsulin

Glucose transport is modulated by what two families of proteins?

Sodium dependent glucose transporter, and facilitative glucose transporters

_____ promotes the uptake of glucose and galactose from the lumen of the small bowel and their reabsorption from urine in the kidney.

Sodium dependent glucose transport

_____ is located on the surface of all cells, and are designated GLUT1 to GLUT14.

Facilitative glucose transporters

What does IGF stand for?

Insulin-like growth factors

_____ were previously referred to as non-suppressible insulin-like activity or somatomedin.

IGF

IGF exhibit metabolic and growth-promoting effects similar to those of insulin.

True

_____ was previously known as somatomedin C, mediates growth hormone action, and regulates cell growth and differentiation.

IGF-1

Synthesis of IGF-1 occurs primarily in the ______.

Liver

Exogenous administration of IGF-1 produces _______.

Hypoglycemia

Deficiency of IGF-1 causes ________.

Dwarfism

The physiological role of IGF-2 is unknown.

True

Glucagon, epinephrine, and growth hormone have actions ______ to those of insulin.

Opposite

Where is glucagon secreted?

Alpha cells of the pancreas

What is the major target organ for glucagon?

Liver

Glucagon stimulates the production of glucose in the liver by _______ and ________ and enhances ketogenesis in the liver.

Glyconeogenesis and gluconeogenesis

The minor target organ for glucagon is ___________, where the hormone increases lipolysis.

Adipose tissue

Increased secretion of glucagon is primarily regulated by low concentrations of _____ ______. High concentration is regulated by decreased secretion.

Plasma glucose

______, ______, and ______induce glucagon release.

Stress, exercise, and amino acids


Insulin inhibits glucagon release from the pancreas and decreases glucagon gene expression, thereby attenuating its biosynthesis.

True

Increased glucagon concentrations are believed to contribute to the hyperglycemia and ketosis of diabetes.

True


Epinephrine is a ______ secreted by the adrenal medulla.

Catecholamine


Epinephrine stimulates glucose production via gluconeogenesis and glycogenolysis, and _______ glucose use, thereby _______ blood glucose concentrations.

Decreases, increasing

Epinephrine also ______ glucagon secretion and ______insulin secretion by the pancreas.

Stimulates, inhibits

_________ has a key role in glucose counter-regulation when glucagon secretion is impaired

epinephrine

Phyisical or emotion stress _______ epinephrine production, releasing glucose for energy.

increases

What are tumors of the adrenal medulla also known as?

pheochromocytomas

What is a polypeptide hormone secreted by the anterior pitutiary gland?

Growth hormone

What is the anterior pituitary also known as?

Adenohypophysis

What is the most abundant hormone produced by the adenohypophysis?

Growth hormone

During daytime hours, plasma concentrations are ____.

Low

In the evening hours, adults and children show a marked _____ 90 minutes after the onset of sleep.

Rise

Growth hormone stimulate _______, enhances _____, and antagonizes insulin-stimulated glucose uptake.

Gluconeogenesis, lipolysis

What is the major glucocorticoid synthesized from cholesterol in the zona fasciculata and reticularis of the adrenal cortex?

Cortisol

Cortisol is secreted in response to _____.

ACTH

Cortisol stimulates _______and ________ the breakdown of protein and fat.

Gluconeogenesis, increases

Patients with Cushing Syndrome have _______ level or cortisol due to tumor or hyperplasia of the adrenal cortex and may become _____glycemic.

Increases, hyper

What hormone is secreted by the thyroid gland and is not directly involved in glucose homeostasis?

Thyroxine

Thyroxine stimulates _______ and increases the rates of gastric emptying and intestinal glucose absorption.

Glyconeogenesis

Patients usually have a normal fasting plasma glucose concentration despite factors that may produce glucose intolerance in thyrotoxic individuals.

True

What is also known as growth hormone inhibiting hormone?

Somatostatin

Where is somatostatin found?

Gastrointestinal tract, hypothalamus, and Delta cells of the pancreatic islets

Somatostatin inhibits secretion of ________ and _______ by the pancreas, thus modulating the reciprocal relationship between the two hormones.

Glucagon, insulin

What are the primary clinical applications for insulin for the evaluation of patients with fasting hypoglycemia?

Immunoassays, isotope dilution mass spectrometry assay, immunoreactive insulin assays

What does IDMS stand for?

Isotope Dilution Mass Spectrometry

What is usually in patients with benign or malignant b-cell tumors of the pancreas?

Proinsulin

What is primarily used to evaluate fasting hypoglycemia and monitor patients response to pancreatic surgery?

C-peptide

Measurement of urine C-peptide is useful when continuous assessment of ______ is desired.

B-cell

Very high concentrations of glucagon are seen in patients with α-cell tumors of the pancreas called

Glucagonomas

What is low glucagon associated with?

Chronic Pancreatitis

What are the names of type1 Diabetes Mellitus?

Type 1A (Immune medicated diabetes)

Type 1B (Idiopathic diabetes)



Autoimmune process where there is 80% to 90% reduction in the volume of β-cells to induce symptomatic type I diabetes

Type 1A

β-cells destruction is due to chromosomal abnormality or an unknown cause rather than any autoimmune process

Type 1B

What are the most practical markers of beta cell autoimmunity our circulating antibodies which have been detected in the serum years before the onset of hyperglycemia:

Islet Cell Antibodies (ICA)

Insulin Autoantibodies (IAA)

Antibodies to the 65 kDa isoform of glutamic acid decarboxylase

Insulinoma-associated antigens (IA-2A and IA-2βA)

Zinc Transporter (ZnT8)


What are the most important determinants for risk of type I diabetes?

The human leukocyte antigen (HLA)-DQ and –DR genetics factors

What decreased ability of insulin to act on peripheral tissue and also known as syndrome X or the metabolic syndrome?

Insulin Resistance

Inability of the pancreas to produce sufficient insulin to compensate for the insulin resistance

B-cell dysfunction

Chronic complications in diabetes mellitus includes:

Diabetes-specific microvascular pathology in the retina, renal glomeruli, and peripheral nerves produces retinopathy, nephropathy, and neuropathy

Diabetes is the most frequent cause of?

Blindness

What disease is the leading cause of diabetes?

End stage renal disease

What is the major cause of mortality in diabetes?

Myocardial Infarction

Portable meters for measurement of blood glucose concentrations are used in three major settings:

1. In acute and chronic care facilities (at the

patient's bedside and in clinics or hospitals)

2. In physician’s offices

3. By patients at home, work, and school (self-

monitoring of blood glucose - SMBG)


What is blood glucose monitoring called based on enzymes, electrodes, or fluorescence implanted subcutaneously?

Implanted sensors

Applies low-level electric current to the skin

Minimally invasive monitoring

Spectroscopic measurement of light absorption from subcutaneous tissue

Noninvasive monitoring

The primary substrates for ketone body formation are?

free fatty acids from adipose stores.


What are the 3 kinds of ketone bodies?

Acetone

β-hydroxybutyrate

Acetoacetate


What is Ketonemia

Increased concentration of ketones in the blood

What is Ketonuria

Increased excretion of ketones in the urine

Ketonemia and Ketonuria are seen in what two instances?

Decreased glucose availability

Decreased carbohydrate use



What might cause a decrease in glucose availability?

Starvation or severe vomiting

What might cause a decrease in carbohydrate use?

Diabetes mellitus

Glycogen storage disease (von Gierke disease)

Alkalosis


What are two specimens used to measure ketones?

Blood

Urine


Why are ketones routinely measured in patients with DM?

To monitor diabetic ketoacidosis

Which ketone body does Gerhardt’s ferric chloride test test for?

Acetoacetate

True or false

Acetest is a tablet that turns purple when certain ketones react to it.



True

Acetest tablets contain a mixture of glycine, sodium nitroprusside, disodium phosphate and lactose. Which of these causes the important chemical reaction when in contact with certain ketone bodies?

Nitroprusside

In an acetest tablet, what role does lactose play?

Enhances the color

In an acetest tablet, what role does disodium phosphate play?

Provides optimum pH for the reaction.



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