Exam 2 PHLT 304
Type 1 vs Type 2 diabetes
(1) B-cell deficiency (2) Reduced insulin sensitivity in target cells (1) Child or adolescent onset (2) Adolescent or adult onset (1) Approximately 10% of diabetes (2) Approximately 90% of diabetes (1) Requires insulin for treatment & diet and exercise for management (2) Weight loss, diet, and exercise for treatment (1) Rapid development (2) Slow development
Type 1 diabetes Mellitus (T1DM)
(Previously called juvenile diabetes) - Insulin deficiency due to loss pancreatic islet B-cells - loss of beta cells due to autoimmunity in 70%-90% of patients - generally leads to absolute insulin - no prevention - no cure
Stage 3 of CKD
- Anemia - Early bone disease - Moderate to severe loss of kidney function
Proposed contributing factors for increase in severe maternal morbidity
- C-section deliveries - Increases in maternal age - preexisting chronic disease - pre-pregnancy obesity
Renin - angiotensin system
- Controls water and salt reabsorption by kidneys - Stimulates production of blood cells
Physical defects with FASD
- Distinctive facial features - small head circumference and brain size - heart defects - vision/hearing problems - slow physicial growth
Stage 4 of CKD
- Fatigue, swelling, nausea, vomiting - Severe loss of kidney function
Stage 2 of CKD
- High Blood Pressure with protein in urine - Mild to moderate loss of kidney function
Preeclampsia
- High blood pressure with protein in urine in urine &/or edema after week 20 - signs of damage to other organs - potentially fatal for mother and child - affects 4% of pregnancies in the US
Insulin is released in response to higher blood glucose levels, and it lowers blood sugar by:
- Increasing glucose uptake by muscles - Increases conversion of glucose to glycogen (glycogenesis) - Suppresses glycogenolysis and gluconeogenesis (conversion of glycogen or amino acids to glucose) - Suppresses lipolysis (breaking down stored fat for fuel)
Stage 5 of CKD
- Kidney failed - Dialysis goes into end-stage renal disease
Kidney Functions
- Maintain fluid balance and salt levels - Remove toxic wastes - Hormone synthesis
Men and age
- Older fathers: several issues including - Higher sperm mutation rate - increased risk of schizophrenia - Increased risk of bipolar disorder
Eclampsia
- Preeclampsia + seizures/convulsions - more severe - may result in seizures and coma
Erythropoietin
- Produced by kidneys in response to tissue hypoxia (oxygen deficiency) - stimulates production of blood cells
Gestational diabetes
- Seen in women who did not have diabetes before pregnancy - Affects 2-10% of pregnancies in the US Test for it at 24-28 weeks of pregnancy Increased risk for: - large size of baby (more likely to need C-section) - high bp - preeclampsia - 50% go on to have type 2 diabetes Risks, excess weight gain by mother: - baby is too large - obesity during childhood
Blood Pressure
- Systolic - top number - pressure through arteries when heart contracts - Diastolic - bottom number - pressure through arteries between contractions - normal ( 120 / 80 ) - hypertensive (140 / 90 )
Risk factors for infertility
- age - chemical exposure including tobacco, alcohol, certain medications - stress - chronic disease: diabetes, heart disease, obesity, high blood pressure, autoimmune disorders
Symptoms of CKD
- anemia or low red blood count cell, which can cause fatigue and weakness - extra fluid in the body, which can cause high blood pressure - weakened immune system - loss of appetite or nausea - confusion, problems with memory, depression - low calcium levels which can cause bone disease and heart disease - high potassium levels in the blood, which can cause irregular or abnormal heartbeat and lead to death
Pre-diabetes
- blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes
How to reduce risk of Type 2 Diabetes
- change in eating habits - weight loss - increase physical activity - reduce stress - sleep - diet
Risk factors of kidney disease
- diabetes - high blood pressure - age 60 and older - overuse of pain medicine (aspirin, naproxen, ibuprofen) - overuse of alcohol - use of street drugs (cocaine, heroin, amphetamines)
Social and behavioral issues with FASD
- difficulty in school - poor scoial skills - trouble getting along with others - difficulty planning or working toward a goal - problem staying on task
Leading causes of maternal mortality in US (CDC; up to 1 year after pregnancy)
- heart conditions - infection - bleeding - blood clots
Brain and central nervous system problems with FASD
- intellectual disability - learning disorders - poor memory - difficulty with problem solving and resoning - rapid mood changes
Consumption of alcohol by pregnant women
- is the leading preventable cause of developmental disorders and birth defects in the U.S - can cause poor social skills and behavioral difficulties in her child - may produce intellectual disability and learning disorders in her child (all of the above)
Maternal Mortality (WHO, deaths up to 42 days after end of pregnancy)
- leading causes of maternal mortality globally - Hemorrage (27%) - Hypertension in pregnancy (14%) - Infection (11%) - Unsafe abortion (3%)
Risk factors of post partum depression
- low social support - difficulties with pregnancy - mother of multiples
Prevention of kidney disease
- manage diabetes - lower high blood pressure - stop smoking and minimize exposure to second hand smoke - stay hydrated - eat a healthy diet, exercise, manage weight - reduce salt intake: high sodium increases blood pressure - don't overuse drugs
Chemical/envrionmental exposures in pregnant women
- mercury - lead - excess vitamin A (in skin treatments) it can cause birth defects
Cigarette smoking and pregnancy risks
- miscarriage/stillbirth - placenta previa - pre-term birth - low birth weight - sids
Infertility
- not able to get pregnant or stay pregnant after 1 year (up to age 35)
Stage 1 of CKD
- often no symptoms - below normal to mild loss of kidney function
Each C-section increases risk of
- placenta previa - placenta accreta - gravid hysterectomy
Plan pregnancies ahead
- prenatal vitamins and healthy diet - example: folid acid and neural tube defects - neural tube defects: failure of neural tube closure by week 4 (day 28 after conceptions) often occurs before mother knows she is pregnant
Glucagon helps maintain blood glucose levels between meals:
- secreted by alpha cells of pancreas in response to low blood sugar - stimulates glycogenolysis in liver = causes a rise in blood glucose, keeping blood sugar levels within the appropriate range.
Risks of placenta accreta
- severe maternal blood loss - blood transfusions - hysterectomy - death Rates have quadrupled since the 1980s
Kidney Stones
- solid piece of material - form when high levels of certain minerals in urine Symptoms - sharp pain in back, side, groin, or lower abdomen - if the stone is really small; you may not have symptoms Treatment - medical care to break up and/or remove stones
Cortisol
- stimulated by chronic stress - effects are like those of epinephrine: increases circulating levels of substrates(fuel); ensures the mobilization of fuels for the body STRESS HORMONES FUNCTION AS ANTI-INSULIN HORMONES - BUILDUP OF FUEL IN THE CELLS
Epinephrine
- stimulated by immediate stress and exercise - suppresses insulin secretion; promotes glucagon secretion - increases circulating levels of glucose and fatty acids by *increasing glycogenolysis *increasing gluconeogenesis * increasing fat mobilization
Management of type 1 diabetes
- taking insulin - carbohydrate, fat, and protein - frequent blood sugar monitoring - eating healthy foods - exercising regularly and maintaining a healthy weight (WITHOUT INSULIN, GLUCOSE BUILDS UP IN THE BLOODSTREAM)
Type 1 diabetes
10% of individuals with diabetes - increasing worldwide - incidence rate varies between countries - highest in scandavia - less common in Europe, North America & Australia - least common in Asia
Placenta previa
3rd trimester bleeding, placenta covers the cervix; increases risk to baby and mother
Gestation Period
40 weeks - begin the count from the first day of your last period - end at birth Three trimesters 1st week: weeks 1-12 2nd week: weeks 13-28 3rd week: weeks 29-40
Average number of nephrons per kidney
900,000 to 1 million; range to approx. 200,000 - 2.5 million per kidney
Most common severe maternal morbidity procedures
= blood transfusions = hysterectomy = ventilation/temporary tracheostomy
Listeriosis and pregnancy
A food-borne illness that can cause fetal death at any stage of pregnancy.
Which of the following are true regarding gestational diabetes?
A. Gestational diabetes can occur during pregnancy due to hormonal changes in a woman's body B. Gestational diabetes does not typically affect the baby C. Half of the women who experience gestational diabetes develop Type 2 diabetes later D. All of the above E. Only A and C E. Only A and C
The chain of the infection includes the following:
A. Mode of transmission B. Portal of entry C. Reservoir D. Causative Agee's E. All of the above E. All of the above
Glycogenesis
A. Occurs in the liver and involves the conversion glycogen and glucose B. Is a sign of diabetes C. Occurs in the liver and involves the conversion of glucose to glycogen D. None of the above C. Occurs in the liver and involves the conversion of glucose to glycogen
There are different ways of making vaccines, and some existing types of vaccines include:
A. Toxoid vaccines, that create immunity to a toxin produced by the pathogen B. MRNA vaccine C. Live vaccine made using attenuated (weakened) virus D. All of the above D. All of the above
If a pregnant woman is exposed to a chemical that causes birth defect, the effects on the fetus will always be the same regarding embryo/fetus
A. True B. False B. False
According to the CDC. There is NO helmet for sports that is concussion - proof
A. True B. False A. True
Osteoporosis is a condition where the bones are less dense, leading to an increased risk of fracture.
A. True B. False A. True
Stage 1 chronic kidney disease may be present without any symptoms
A. True B. False A. True
Causes of kidney disease include
A. Type 2 diabetes B. High blood pressure C. Chronic use of certain prescription medicines D. All of the above E. Only A and B D. All of the above
Uremia
Accumulation of toxic constituents in the blood; usually occurs with severe kidney disease
Rates of involuntary pregnancy loss
Approx. 40-60% of conceptions do not result in successful birth (not including intentional abortions) - Early embryo mortality - 10-15% of known pregnancies end in miscarriage - approx. 1% of pregnancies end in still birth
C-sections (cesarean sections)
Approx. 9.6% of C-sections in the U.S are not necessary
Type 1 diabetes
Body makes little to no insulin
Syphillis and pregnancy
Can be fatal to fetus or new born. It's reccomended to test all women during pregnancy; treatment is available too
Risks of pregnancy and nicotine
Causes toxiciy to the nervous system of the developing fetus off spring effects - type 2 diabetes - diabetes - hypertension - neurobehavioral defects
Maternal Morbidity
Conditions that result from or are aggraved by pregnancy
Consequences of change in SER
Consequence of too much fuel in cells: - increased production of reactive oxygen species (ROS) that is implicated in development of Type 2 Diabetes - accumulation of visceral (deep abdominal fat) around the organs - this fat is very metabolically active Insulin resistance: - if liver becomes fatty, it doesn't respond well to insulin signals to shut down glucose production - excess fuel can cause fatty tissue deposits in muscle, interfering with insulin 1
Gluconeogensis
Conversion of amino acids to glucose
Stillbirth
Death in womb after week 20
Gestational hypertension
Develops during pregnancy
Gestational Diabetes
During pregnancy, hormonal changes can decrease the body's sensitivity to the effect of insulin - more common in overweight mothers - risk to child - usually goes away after delivery (if it doesn't, then it's called type 2 diabetes) - half of women who had gestational diabetes develop Type 2 diabetes later
Type 2 diabetes
Fasting plasma glucose 126 mg/dl - body doesn't make enough insulin or doesn't use insulin well - too much glucose stays in the blood and not enough reaches the cells
Pre-diabetes
Fasting plasma glucose between 100-125 mg/dl
Alcohol and pregnancy (FASD)
Fetal Alcohol Spectrum disorders (1% of births) - no amount of alcohol is safe during pregnancy
Subsistence efficiency ratio
Food intake compared to calories expended in physical activity Paleolithic times: ratio was 3:1 Now: ratio is 7:1 More food + less activity -> more substrate (fuel) in cells -> precursor to metabolic dysregulation in cells
If blood glucose drops too low
Glucagon secretion -> glycogenolysis in liver breaks down glycogen to glucose and releases glucose to blood
Diabetes
Health condition that affects how your body turns food into energy - Most of the food you eat is broken down into sugar (also called glucose) and released into your blood stream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body's cells for use as energy. If you have diabetes, your body either doesn't make enough insulin or can't use the insulin it makes as well as it should.
Risk factors of CKD
Heart disease, obesity, and family history of CKD can be passed down
Common causes of CKD
High blood pressure and Diabetes
Hyperglycemic
High blood sugar
Insulin
Hormone secreted by beta cells of pancreas
Blood pressure & kidneys
Hypertension is both a cause and consequence of CKD - hypertension is high blood pressure - blood pressure is related to the amount and size of the blood vessels and resistance within and around the vessels
Ectopic pregnancy
Implantation in the fallopian tube or outside uterus
insulin resistance
Inability of muscle, fat, and liver cells don't respond well to insulin & can't easily take up glucose from blood - pancreas produces more insulin to help glucose enter cells - blood glucose levels remain healthy as long as there enough insulin to overcome the cells weak response to insulin
If blood sugar is too high
Insulin Secretion -> Glycogenesis in liver converts glucose to glycogen
Chronic kidney disease in adults
It is very common for adults to have CKD. 15% of US adults have it and 9 in 10 adults don't know they have it.
Glycogenolysis
Liver breaks down glycogen to glucose and releases glucose to blood
Hypoglycemic
Low blood sugar
Macronutrients in the body
Macronutrients from food: protein, carbohydrates, fat - brain needs continuous supply of glucose
result from fasting plasma glucose
Normal = less than 100 mg/dl prediabetes = 100 - 125 mg/dl diabetes = 126 mg/dl or higher
Prenatal health
Occuring, existing, or performed prior to birth
Placental abruption
Placenta separate from uterine wall; fetus without enough oxygen/nutrients
A person with diabetes
There isn't enough insulin to move glucose into the cells, so after eating blood glucose levels continue to rise
Nephron
Unit of filtration in the kidney
Stage of preganacy and prenatal check ups
Weeks 4 to 28 : (every 4 weeks) Weeks 28 to 26 : (every 2 weeks) Weeks 36 to birth : (every week)
Lead exposure in pregnant women
causes damage to the brain and nervous system, slowed growth and development, learning and behavior problems, hearing and speech problems
Post partum depression
happens in 1 to 9 women - more intense and last longer than "baby blues"
Insulin resistance
is the PRECURSOR to type 2 diabetes
Glycogenesis
liver converts glucose to glycogen
Spontaneous abortion
misscarriage (before week 20) - 2/3 of misscarried fetuses have chromosomal abnormalites
Placenta accreta
placenta attaches too deeply to wall of the uterus - can cause severe blood loss
"baby blues"
worry, sadness, tiredness after pregnancy that usually resolves on its own in a few days
Preventable infections during pregnancy
•Hepatitis B (HBV): get tested; vaccinate •Influenza: vaccinate •Zika virus: can cause severe fetal brain defects -Don't travel to areas with Zika -Use condoms if your partner has lived in or traveled to an area with Zika
