Anatomy/
Physiology
Physiology
Proinsulin is cleaved into mature insulin and ___________ by proteases in secretory granules.
C-peptide
T1DM involves which immune system (innate or acquired)?
Both innate and acquired immune system (direct T-cell attack and auto-antibodies).
This medication takes longer to become effective because it works at the level of transcription.
Thiazolidinediones (PPAR-gamma)
Neutral protamine hagedorn (NPH) is a __________ (rapid/short/intermediate/long)-acting insulin
Intermediate (peak at 4-10 hours)
Diabetic complications are mostly due to __________ (pathophysiologic process).
Nonenzymatic glycation (production of advanced glycation end products)
This insulin-dependent glucose transporter is found in the striated muscle and adipose tissue.
GLUT-4
This type of breathing is found in DKA but NOT HHS
Kussmaul breathing (rapid deep breathing to blow off acid).
Your patient wants to start Semaglutide. You tell her _______ is a severe adverse effect of this drug.
Pancreatitis
Two insulins useful for the management of Type 1 diabetes (one for baseline control, and one for post-prandial control)
Insulin glargine (long-acting) and insulin lispro (rapid-acting)
Increased lipolysis in diabetes can cause these two clinical findings _________________.
Eruptive xanthomatosis, lipemia retinalis
What two haplotypes are associated with 90% of T1 diabetes, compared to 40% of the general population?
HLA-DR3 and HLA-DR4
Ketogenesis produces ____ and _____ in DKA.
Acetoacetate and beta-hydroxybutyric acid
This class of antidiabetic drugs is renoprotective.
SGLT-2 inhibitors:
inhibits SGLT-2 inhibitors → increased Na delivery to macula densa → decreased renin production & hyperfiltration
What are the cutoff levels for random blood glucose, fasting blood glucose, and HbA1c for diabetes diagnosis?
-Random blood glucose ≥200 mg/dL (1x for symptomatic pts, or 2x consecutively for asymptomatic pts)
-Fasting plasma glucose ≥126 mg/dL
-HbA1c ≥ 6.5%
The first step of HHS management is administration of ______________ (2 things).
IV normal saline and IV insulin.
When insulin binds to its receptor, _________________ is activated and auto-phosphorylates the β-subunits of the receptor.
Tyrosine kinase
A major complication of HHS is dehydration, which can be seen clinically by _____________________ (symptoms).
Decreased JVP, orthostasis (postural hypotension / postural tachycardia), increased resting HR; skin tenting, dry mucous membranes.
These 2 diabetic medications may not be helpful in patients with metabolic syndrome due to their effects on weight.
Thiazolidinediones, sulfonylureas (weight gain)
Check HbA1c at least ____ times per year for patients meeting treatment goals, and at least _______ for patients not meeting goals.
2x/year for patients meeting goals (every 6 months)
4x/year for patients not meeting goals (every 3 months)
Increased levels of _______ lead to demyelination of peripheral nerves.
Sorbitol (causes osmosis leading to glove and stocking polyneuropathy).
The equation for corrected serum Na is _______.
Serum Na = [1.65 x (glucose - 100)] / 100 + measured Na
The autoantibodies in T1DM are __________.
Anti-glutamic acid decarboxylase antibodies (GAD).
Metformin acts increases insulin sensitivity in these 3 ways:
(1) Inhibits mGPD → inhibit hepatic gluconeogenesis.
(2) Activates AMPK → decrease gluconeogenesis.
(3) Increases glycolysis and increases peripheral glucose uptake.
Physical exercise is encouraged for type 2 diabetics because it causes ________________ in peripheral target tissues, reducing blood glucose and increasing insulin sensitivity
Increased GLUT-4 receptor expression
The 3 primary electrolyte abnormalities seen in refeeding syndrome are:
Decreased serum PO4 (primary bioindicator), K+, and Mg
These predispose to arrhythmias, tetany, CNS symptoms, and rhabdomyolysis