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61 Cards in this Set
- Front
- Back
What is the cause of Type 1 Diabetes?
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A consequence of an inability of the pancreas to produce insulin
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What is the cause of Type 2 Diabetes?
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A consequence of tissues (like skeletal muscle, adipose tissue and liver) not responding to Insulin (properly)
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What is the most important controller of insulin secretion?
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Glucose
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What is the mechanism of Insulin secretion from β cells?
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1) Glucose is converted into ATP from mitochondria
2) The ATP closes the K+ channel eliciting depoloarization if the membrane 3) Ca2+ enters the cell 4) Ca2+ stimulates the exocytosis of secretory granules containing Insulin |
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"Glucose is able to increase insulin secretion in the absence of any other stimulatory agent" True or False?
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TRUE
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What are examples of substances that can trigger secretion of Insulin?
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1) Glucose
2) Fatty Acids 3) Amino Acids 4) Sulphonylurea drugs (e.g. Tolbutamide, Glyburide) |
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What are examples of substances that can enhance secretion of Insulin?
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Glucagon Like Peptide (GLP)
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What are examples of substances that can inhibit secretion of Insulin?
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Catecholamines
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What is the precursor to Insulin?
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Proinsulin
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How do you convert Proinsulin to Insulin?
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C-peptide (a 31 amino acid peptide that bridges the insulin A and B) is removed
[Note: Lys/Arg and Arg/Arg] |
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What is the structure of Insulin?
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Consists of 51 amino acids in 2 chains;
(A) chain with 21 amino acids and (B) chain with 30 amino acids. Where both Chains are linked by disulfide bonds |
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What are the clinical manifestations of Diabetes?
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Polyuria, Polydypsia and Polyphagia
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What are the effects of Insulin?
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1) Promotes Glycogen Synthesis in the Liver/Muscle
2) Promotes Lipid formation in the Adipocytes 3) Promotes Amino Acid Uptake and Protein Synthesis 4) Promotes Glucose Uptake of cells |
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What are the Net Effects of Insulin?
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1) Decreased Blood Glucose
2) Decreased Blood Triglycerides and Cholesterol 3) Decreased Blood Free Fatty Acids 4) Decreased Blood Amino Acids |
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What is the transporter for Glucose uptake by Muscle and Adipose Tissues?
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GLUT4
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"Skeletal muscle accounts for ______ of the glucose uptake"
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80-85%
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"Adipocytes accounts for _______ of the glucose uptake"
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4-5%
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What can happen to glucose after entry into the cell?
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1) Oxidative breakdown to produce energy
2) Conversion to Glycogen for Storage in the Liver and Muscle 3) Conversion to Fats for storage in Adipocytes |
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How does Insulin lower plasma Triglyceride levels?
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Multiple mechanisms include an increase in Glucose uptake (which is then esterified to Triglyceride) or inhibition of Lipolysis (which prevents breakdown of TGs to Fas)
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"Insulin inhibits protein degradation" True or False?
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TRUE
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In the absence of Insulin; which amino acid is broken down to Glucose in the Liver?
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Alanine
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In the absence of Insulin; which amino acid is broken down to Glucose in the Kidney?
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Glutamine
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What is the definition of Diabetes Mellitus?
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A metabolic disorder characterized by the presence of Hyperglycemia due to defective insulin secretion, defective insulin action or both
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What is Gestational Diabetes?
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Glucose intolerance during pregnancy.
Blood sugar returns to normal after delivery; However these women face a lifelong risk of developing T2DM (20-50% chance in the next 5-10yrs) |
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What is Secondary Diabetes?
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Hyperglycaemia occurring in relation to other disease states (e.g. pancreatic disorders like carcinoma of the pancreas) and drug induced conditions (e.g. Glucocorticoids)
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What are tests that can be used to diagnose Diabetes?
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1) Fasting Plasma Glucose
2) Casual Blood Glucose 3) Glycated Hemoglobin Levels (HbA1c) 4) Oral Glucose Tolerance Test (OGTT) |
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What is Fasting Plasma Glucose indicative of?
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Mainly reflects Hepatic gluconeogenesis and Basal Metabolic Needs
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What are the test results of FPG?
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Normal: 3.8 - 6.0 mmol/L
Impaired Fasting Glucose: 6.1 - 6.9 mmol/L Diabetes: >7.0 mmol/L |
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What is Casual Blood Glucose indicative of?
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Reflects dietary intake
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What are the test results of Casual Blood Glucose?
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Normal: <7.8 mmol/L
Diabetes: >11.1 mmol/L |
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What is HbA1C indicative of?
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Measures the amount of glucose that binds to hemoglobin
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"1% change of HbA1C reflects ______mM change in mean blood glucose"
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1.4 - 1.9
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What are the test results of HbA1C?
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Normal: 4-6%
Pre-Diabetes: 6-6.5% Diabetes: >6.5% |
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What is OGTT indicative of?
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Measure the body's ability to breakdown Carbohydrates
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How is an OGTT performed?
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Overnight fast of 8-14 hours (during which can be drunk)
A standard dose of 75g of Glucose is given as a drink and blood is drawn at 1 and 2 hours post ingestion to measure blood glucose. |
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What are the test results of OGTT?
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Normal: <7.8 mmol/L
Impaired Glucose Tolerance: 7.8 - 11.0 mmol/L Diabetes: >11.1 mmol/L |
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What are the requirements for a diagnosis of Diabetes (Any ONE of these)?
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1) Symptoms of Diabetes + Random Casual BG >11.1 mmol/L
2) Fasting Plasma Glucose >7 mmol/L 3) OGTT result after 2 hours is >11.1 mmol/L 4) An A1C >6.5% |
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"A confirmatory test for Diabetes can be done on the same day as the original" True or False?
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False; It must be done on another day
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What percentage of diabetes are Type 1 and Type 2?
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10% are Type 1 Diabetics.
90% are Type 2 Diabetics |
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What are the common ages for Type 1 and Type 2 Diabetes?
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<30% (common in youth) in Type 1 Diabetics.
>20 (more frequent in adults) in Type 2 Diabetics |
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What is the onset of Type 1 and Type 2 Diabetes?
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Sudden Onset in Type 1 Diabetics.
Gradual onset in Type 2 Diabetics |
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What are the nutritional statuses for Type 1 and Type 2 Diabetes?
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Most Type 1 Diabetics are Malnourished (usually thin).
Majority of Type 2 Diabetics are Overweight. |
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How prone to Ketosis are Type 1 and Type 2 Diabetes?
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Type 1 Diabetics are prone to Ketosis (unless diet and insulin are coordinated).
Type 2 Diabetics are resistant to Ketosis. |
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What proportion of Type 1 and Type 2 Diabetic patients require Insulin?
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100% of Type 1 Diabetics require Insulin.
<30% of Type 2 Diabetics require Insulin. |
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What proportion of Type 1 and Type 2 Diabetic patients require Dietary Modification?
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Dietary modification is mandatory in Type 1 Diabetics.
Dietary modification controls 30-50% of cases of Type 2 Diabetics. |
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How do β cells compare in Type 1 and Type 2 Diabetes?
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There are no β cells in Type 1 Diabetics (complete islet cell loss).
Variable β cells in Type 2 Diabetics. |
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How do Isclet Cell Abs compare in Type 1 and Type 2 Diabetes?
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Islet Cell Abs are present in Type 1 Diabetes.
Islet Cell Abs are NOT present in Type 2 Diabetes. |
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How relevant is Family History in Type 1 and Type 2 Diabetes?
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Only 10% Positive family history in Type 1 Diabetics.
Only 30% Positive family history in Type 2 Diabetics. |
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What is the concordance with Identical Twins for Type 1 and Type 2 Diabetes?
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50% concordance in identical twins with Type 1 Diabetics.
60-80% concordance in identical twins with Type 2 Diabetics. |
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What is a common easy to detect symptom of Ketoacidosis?
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Smell of Acetone on Breath
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What are the early symptoms of Type 1 Diabetes?
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1) Fatigue
2) Weight Loss 3) Polyuria/Nocturia 4) Polydipsia/Thirst 5) Polyphagia/Increased Appetite 6) Pruritis 7) Impotence 8) Infections (UTI, Oral/Vaginal Candidiasis) 9) Ketoacidosis |
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What are the early symptoms of Type 2 Diabetes?
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1) Fatigue
2) Impotence 3) Perhaps Type 1 Syndromes |
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What are the Long Term Late Manifestations of Diabetes (Both Type 1 and Type 2)?
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1) Ocular (Retinopathy): Bleeding/Visual Disturbances/Cataracts/Glaucoma
2) Renal (Proteinuria): >500mg in 24 hours 3) Atherosclerotic Arterial Disease: (2-4 times increased risk of stroke) 4) Neuropathy: Peripheral Nerve Dysfunction (Loss of touch/vibration/temp) may lead to ulcers or gangrene. Also erectile dysfunction. 5) Hypertension |
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"Retinopathy is the most common microvascular complication of Diabetes and is the leading cause of blindness In North America" True or False?
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TRUE
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What is the major cause of death in diabetic patients?
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Cardiovascular Disease
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"When insulin was introduced to treat T2DM the number of deaths from CV disease and Diabetic Coma both decreased" True or False?
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False: Coma decreases by CV disease increased and then plateus
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What coutries have the highest incidence of T1DM in the world?
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Finland and Canada
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"80-90% of patients with T2DM have insulin resistance" True or False?
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TRUE
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What aspect of Insulin release is lost in T2DM?
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The rapid 1st phase insulin release is lost;
The 2nd phase is still present. So this is why they are more susceptible to post prandial hyperglycaemia. |
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How does Insulin resistance progress with the T2DM?
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Generally becomes more significant as the disease progresses with time
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What race of people have the highest rates of T2DM in age 45-54 populations? |
Pima Indians |