Remember Insulin?
Insulin is this type of hormone (i.e. is it a lipid-soluble steroid hormone, or non-lipid-soluble peptide hormone?)
PEPTIDE HORMONE
(thus it needs a receptor to enter into most cells)
A person who has Type I DM is unable to produce the following hormone in their body
INSULIN
Are people who have Type II Diabetes Mellitus (DM) insulin dependent (i.e. not able to produce any insulin in their bodies) or insulin resistant (i.e. having impaired or insufficient - but not absent - production of insulin in their bodies)?
INSULIN RESISTANT
TRUE OR FALSE: Since a person who has Type I or Type II DM can get go on to get pregnant, the term "Gestational Diabetes" is best reserved for someone who FIRST experiences an onset of DM during pregnancy and not before
TRUE
What is the common effect of the following?
*Ingesting carbohydrates
*Raising of blood estrogen levels
*Taking an anti-inflammatory med (such as prednisone) that raises cortisol levels
*Stress, releasing catecholamines (such as epinephrine)
RAISE BLOOD GLUCOSE LEVELS
What is the name of the chemical ion that insulin "chases" into cells, thereby lowering the lab values of this chemical ion in the blood serum?
POTASSIUM (K+)
Type I DM, a disease that is mainly genetic in origin, comes from the destruction of Beta cells in the "islets of Langerhans" in this organ
PANCREAS
Which of the following risk factors for TypeII DM is the most central/prevalent in the onset of this disease?
Obesity
Aging
Sedentary life style
Exposure to Agent Orange
OBESITY
TRUE OR FALSE: Screening for gestational diabetes is recommended for all people over 40 years old who become pregnant
FALSE
It is recommended for all people over _25_ who become pregnant
(so while screening all over 40 years old is technically true, it is not the BEST answer in this case)
TRUE OR FALSE: The vast majority of people who develop DM during pregnancy return to normal blood glucose control after childbirth
TRUE
In lecture, Tom put the figure at over 90%, the handout says over 97%
This hormone could be described as doing the "opposite" of what insulin does. It is not as strong as insulin, so when insulin is released (or injected), it acts to inhibit this hormone from being released from the pancreas.
GLUCAGON
which raises glucose levels in the blood: (1) in the liver it causes glycogen, stored glucose, to break up and become available in the serum, a process called "glycogen-o-lysis"; (2) it synthesizes new glucose out of the body's stored fats and proteins, a process called "gluco-neo-genesis"
Compared to Type II DM, is the onset of Type I DM very slow or very fast?
VERY FAST
(vs. Type II which has an onset that is often so slow that it can be described as "insideous")
TRUE OR FALSE: In Type II DM, at least initially one does not usually see the disease process that is common in Type I DM: the process that begins with Lypolysis, leading to both Weight Loss and the release of Free Fatty Acids.
TRUE
Name AT LEAST FOUR risk factors for a pregnant person developing gestational diabetes
OBESITY, being OVER 40, FAMILY HISTORY of TypeII DM, HYPERTENSION, history of having a BABY OVER NINE POUNDS, history of PREVIOUS GESTATIONAL DIABETES
This is the name of a "pre-Diabetes" SYNDROME of chronic inflammation beginning in the adipose tissue that is characterized by a group of metabolic risk factors in one person, including: abdominal obesity, atherogenic dyslipidemia, hypertension, elevated fasting glucose, prothrombic state, proinflammatory state, and vascular disease.
METABOLIC SYNDROME
What is the major reason why a greater percentage of the US population has DM (diabetes mellitus) today compared to 150 years ago?
Because of the lack of any ability to treat patients who had diabetes 150 years ago, especially before the discovery of insulin, could not process proteins and fats, and would go comatose. So "everyone who had DM back then simply died fairly quickly."
These are the "three P's" that are signs and symptoms that reflect manifestations of TypeI Diabetes Mellitus
POLYPHAGIA (eating all one can, especially carbs)
POLYDIPSIA (insatiable thirst)
POLYURIA (producing a lot of urine)
For a patient with TypeII DM, prolonged hyperglycemia (high blood glucose) leads to TWO DIFFERENT "vicious cycles" that if untreated make the disease progressively worse and worse.
Describe BOTH these cycles
(1) It causes POST-RECEPTOR DEFICIT, leading to greater insulin resistance in tissues, leading to more prolonged hyperglycemia...
(2) It causes impaired BETA-CELLS in pancreas, leading to greater insulin deficiency, leading to more prolonged hyperglycemia...
List AT LEAST THREE potential complications to the Fetus/Newborn of a person who has uncontrolled gestational diabetes
MISCARRIAGE and STILL BIRTH
MACROSOMIA (large baby)
IUGR (Inter-Uterine Growth Restriction)
IRDS (Infant Respiratory Distress Syndrome)
NEONATAL HYPOGLYCEMIA (child with low blood sugar)
Greater risk for obestiy + TYPE 2 DM later in life
LIST AT LEAST THREE other potential causes for DM, beyond Type I, Type II,
and Gestational Diabetes
DISEASE/INJURY of PANCREAS, e.g. Pancreatitis
DISEASE/INJURY of ADRENAL GLANDS
RENAL/KIDNEY FAILURE
GROWTH HORMONE DISTURBANCE (e.g. Gigantism)
Select GENETIC DISEASES (e.g. Downs Syndrome)
Which of the following types of cells need insulin in order to absorb glucose (pick two only):
brain cells
fat cells
nerve cells
kidney cells
muscle cells
FAT CELLS
and
MUSCLE CELLS
Name THREE elements of the treatment for TypeI Diabetes Mellitus
Injection of INSULIN (oral agents are NOT effective)
Consistency of DIET and EXERCISE
Reduction of STRESS
In TypeII DM, untreated ExtraCellular Volume deficit that goes on over a long time leaves a person severely dehydrated. In addition to decreased blood perfusion that can lead to Acute Renal Failure and other complications (as with TypeIDM), it can lead to this OTHER major complication (not common to TypeIDM) that Tom abbreviates with the initials "HHS." Explain what HHS is
HYPERGLYCEMIC (super high blood glucose)
HYPEROSMOLAR (blood becomes too thick)
STATE
In this state, the person is not yet metabolically acidotic, so this is not yet DKA. Characterized by extreme thirst, frequent urination, and confusion. Eventually, if the pancreas gets involved, over time can still lead to DKA. TypeI DM cannot go into HHS, for they would be acidotic before that state.
List AT LEAST THREE potential complications to the Pregnant Mother who has uncontrolled gestational diabetes
HYPERGLYCEMIA
MATERNAL INFECTIONS
DIABETIC KETO-ACIDOSIS (DKA)
HYDRAMNIOS (too much amniotic fluid)
Pre-Eclampsia and ECLAMPSIA (life threatening high BP, seizure, death)
Due to so much glucose in the urine in a patient with poorly maintained DM, the body starts pulling water into the urine to try to dilute it, causing a deficit in Extra-Cellular Volume [especially blood serum fluid] that leads to decreased blood perfusion throughout the body. Name at least TWO complications that result from decreased perfusion
ACUTE RENAL FAILURE
HYPOKALEMIA (low blood Potassium)
Increased risk for THROMBOEMBOLISM
(recall Virchow's triad)