ML: Diabetes

Buildup of Acetyl-CoA

- Converted to ketone bodies or to cholesterol - Caused by the excess use of fats and proteins for energy production

Insulin

-Assists carbohydrates (sugars and starches), that are broken down into glucose, enter the cells. -Is produced and secreted by the pancreas

Hyperglycemia

-Increased levels of blood glucose -Can lead to damaged nerves and blood vessels, heart disease, stroke, kidney disease, blindness, dental disease, and amputations. - Increases susceptibility to other diseases, loss of mobility with aging, depression, and pregnancy problems.

A Hb A1C result for a diabetic patient is 6.0%. What conclusion can be made regarding this patient's carbohydrate management? 1. The results are inconclusive and should be repeated with a different method. 2. The patient is probably not following dietary recommendations. 3. The patient is compliant with diet and medication.

3. The results demonstrate compliance with diet and medication. The Hb A1C result is < 7.0%, indicating glycemic control for most adults with diabetes.

Hormones involved in carbohydrate metabolism

Pancreatic Insulin Pancreatic glucagon Adrenal gland cortisol Epinephrine

Which statements are TRUE regarding the testing and diagnosis of gestational diabetes (GDM)? (Select all that apply.) 1)Testing typically occurs during a woman's first prenatal visit in those with risk factors. 2)Testing is not necessary in pregnant women not previously know to have diabetes. 3)A 2013 NIH panel recommended screening with a 2 hour 75 g glucose load followed by another 2 hour 100 g glucose tolerance test. 4)Women with GDM are typically screened for persistent diabetes at 6-12 weeks postpartum.

1 and 4 The testing and diagnosis of GDM is typically accomplished during a woman's first prenatal visit in those individuals with risk factors. In pregnant women not previously know to have diabetes, testing for GDM is usually done at 24-28 weeks of gestation. In addition, women with GDM are typically screened for persistent diabetes at 6-12 weeks postpartum. Moreover, women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. A 2013 NIH panel recommended the two-step approach of screening with a 1-hour, 50-g glucose load test (GLT) followed by a 3-h 100-g oral glucose tolerance test (OGTT) for those who screen positive

A patient has a fasting plasma glucose (FPG) performed at an outpatient laboratory. He has fasted as instructed. The result of the FPG is 135 mg/dL. What does this result indicate and what, if any, further action is recommended by the ADA? 1. This is considered an elevated FPG and needs further evaluation and confirmed using repeat testing. 2. This is considered a decreased FPG a repeat of the test is recommended in one year 3. Sufficient documentation for diagnosis of diabetes 4. Needs no further evaluation; this is a normal FPG

1. The ADA considers a FPG of ≥ 126 mg/dL as elevated. In the absence of unequivocal hyperglycemia, the results should be confirmed using repeat testing. UNLESS clinical diagnosis is clear, the same test is to be repeated using a new blood sample for confirmation

The 2015 American Diabetes Association (ADA) updated guidelines include which of the following recommendations for diabetes screening/diagnosis? (Select all that apply.) 1) Testing should begin at age of 60, especially if the individual is overweight or obese. 2) If test results are normal, testing should be repeated in ≥3 year intervals. 3) A1C ≥6.5% is one of 4 screening options for diabetes diagnosis. 4) A fasting plasma glucose (FPG) ≥ 300 mg/dL is another screening option for diabetes diagnosis.

2 and 3 The update ADA 2015 guidelines include recommendations for screening for diabetes and criteria for the diagnosis of diabetes. Testing should begin at age 45. The criteria for diabetes diagnosis uses 4 options for screening tests: Hemoglobin A1C ≥6.5% FPG ≥126 mg/dL (7.0 mmol/L) 2 hour plasma glucose (PG) ≥200 mg/dL (11.1 mmol/L) during oral glucose tolerance test (OGTT) (75 g) Random PG ≥200 mg/dL (11.1 mmol/L) in persons with symptoms of hyperglycemia or hyperglycemic crisis

The 2018, the American Diabetes Association (ADA) updated guidelines include which of the following recommendations for diabetes screening/diagnosis? (Select all that apply.) More than one answer is correct. 1. Testing should begin at age 50, especially if the individual is overweight or obese. 2. If test results are normal, testing should be repeated in ≥ 3-year intervals. 3. A1C ≥ 6.5% is one of four screening options for diabetes diagnosis. 4. A fasting plasma glucose (FPG) ≥ 300 mg/dL is another screening option for diabetes diagnosis.

2 and 3 Testing should begin at age 45. If results are normal, testing should be repeated in ≥ 3-year intervals. The criteria for diabetes diagnosis uses four options for screening tests: Hemoglobin A1C ≥ 6.5% FPG ≥ 126 mg/dL (7.0 mmol/L) 2 hour plasma glucose (PG) ≥ 200 mg/dL (11.1 mmol/L) during oral glucose tolerance test (OGTT) (75 g) Random PG ≥ 200 mg/dL (11.1 mmol/L) in persons with symptoms of hyperglycemia or hyperglycemic crisis

A physician is evaluating a 45-year-old obese male for diabetes and orders a plasma glucose at time of evaluation and a Hb A1C one week later. The patient has a family history of diabetes and currently exhibits symptoms of diabetes. What would be the best course of action if these are the blood glucose results? Casual blood glucose: 208 mg/dL Hb A1C one week later: 7.2% 1. Order insulin levels; if decreased, diagnose diabetes 2. Patient meets criteria for diagnosis of diabetes 3. Order a C-peptide for diagnosis 4. The patient is at risk for diabetes (pre-diabetic); monitor for diabetes with yearly FPG levels

2. A casual blood glucose ≥ 200 mg/dL on a patient with symptoms and an A1C≥ 6.5% meet diagnostic criteria for diabetes.

Which of the following is a disadvantage of using the Hb A1C test over blood glucose measurement for diabetes screening? 1. A fasting specimen is not required. 2. Conditions that shorten red blood cell (RBC) survival will reduce exposure of RBCs to glucose, thereby lowering the Hb A1C test value. 3. Greater specimen stability. 4. Less fluctuations occur in day-to-day test levels caused by stress and illness.

2. Conditions that shorten RBC survival (eg, hemolytic anemia, homozygous sickle cell trait, pregnancy, or recent significant blood loss) will reduce exposure of the RBCs to glucose, thereby lowering the Hb A1C test value.

Whole blood glucose values are ____________ plasma glucose values. 1. Greater than 2. Lower than 3. Equal to

2. Whole blood glucose values are lower than plasma glucose values. For this reason, point-of-care whole blood glucose meters are programmed to correct the value before presenting the result; therefore, the whole blood glucose meter result correlates to serum or plasma results.

Which of the following statements best describe Hb A1C? 1. A glycated protein formed from the enzymatic addition of a glucose molecule to Hb A 2. A glycated protein that is an index of carbohydrate management over a 24-hour period 3, A glycated protein that is an index of carbohydrate management over two to three months 4. A glycated protein formed from the nonenzymatic addition of a glucose molecule to albumin

3. Hb A1C is the nonenzymatic addition of a glucose molecule to Hb A. After a rearrangement, the addition is irreversible. The concentration of Hb A1C relates to the individual's average glucose concentration over two to three months

A 70-year-old type 2 diabetic patient is comatose and in the emergency department. STAT blood glucose and serum ketones are ordered. Blood glucose is 650 mg/dL Serum ketones are negative What is the best conclusion? Glucose result is acceptable for type 2 diabetic patient 2. Because of the glucose and ketone result, the patient now has type 1 diabetes 3. The glucose result is critical and the patient should be evaluated for hyperosmolar nonketotic coma. 4. Urine glucose should be measured

3. The blood glucose value is critical and with negative ketones is consistent with type 2 diabetes. The elderly type 2 diabetic is at risk for a hyperosmolar nonketotic coma. The patient becomes dehydrated due to increased urine excretion to lower the blood glucose.

Which statement best describes ketones and their involvement in ketoacidosis? 1. Ketones are produced in body when insulin levels are high and acetyl CoA is low. 2. Acetone, acetoacetate, and beta-hydroxybutyrate are acids that when in excess, can raise the blood pH. 3. Decreased ketones can result in a metabolic acidosis. 4. Increased ketones can result in a metabolic acidosis referred to as ketoacidosis. Type 1 diabetic patients are especially at risk.

4.

Which statement about diabetes is FALSE? 1) Diabetes can result when insulin concentrations are absent or reduced. 2) Diabetes can result if insulin action is impaired. 3) Diabetes can produce polydipsia and polyuria. 4) Diabetes can produce weight loss as a result of the excess buildup and storage of protein.

4. Weight loss from diabetes results from increased utilization of proteins and fats for energy. Diabetes is considered a metabolic disorder that results when insulin concentrations are absent or reduced, or when insulin action is impaired (referred to as insulin resistance). Without cellular uptake of blood glucose for energy, the balance of metabolizing carbohydrates, fats, and proteins for energy is lost. This results in hyperglycemia and the excess use of fats and proteins for energy production. Polydipsia (increased thirst), polyuria (increased volume of urine), and unexplained weight loss are symptoms of diabetes. Polydipsia and polyuria occur as the body tries to lower blood glucose concentrations with increased urinary excretion of glucose. Weight loss results from increased utilization of proteins and fats for energy

Which of the following patients is MOST at risk for hyperosmolar nonketotic coma? A 70-year-old type 1 diabetic patient A 70-year-old type 2 diabetic patient A 15-year-old type 1 diabetic patient A 25-year-old type 2 diabetic patient

A 70-year-old type 2 diabetic patient Ordinarily, ketones are negative in a type 2 diabetic patient. Because the elderly often have reduced renal excretion and impaired cardiac function, a type 2 elderly diabetic is at risk for developing a hyperosmolar nonketotic coma.

Diabetes mellitus

A complex group of diseases with a variety of causes: It is a chronic disorder of metabolism and is characterized by elevated blood glucose levels (hyperglycemia) - Patients with DM do not produce/produce inadequate amounts of insulin or the body uses it incorrectly (Qualitative/Quantitative problem)

Which of the following are key changes or revisions contained in the updated 2018 ADA guidelines? 1. Recommendations for cardiovascular disease risk and that all hypertensive patients with diabetes monitor blood pressure at home 2. Recommendations to help ensure appropriate use of the A1C test to diagnose diabetes and for monitoring glycemic control in people with diabetes 3. Recommendations for screening youth for type 2 diabetes 4. Recommendations that all pregnant women with pre-existing type 1 or type 2 diabetes should consider daily low-dose aspirin starting at the end of the first trimester to reduce the risk of pre-eclampsia. 5. All the above

All the above.

Symptoms of Diabetes

Polydipsia (increased thirst) and Polyuria (increased volume of urine) occur as the body tries to lower blood glucose concentrations with increased urinary excretion of glucose. Unexplained weight loss results from increased utilization of proteins and fats for energy. (higher cholesterol, ketones, and glucose.)

Which of the following hormones is mainly responsible for the entry of glucose into the cell for energy production? Epinephrine Glucagon Cortisol Insulin

Correct Answer: Insulin Insulin is the hormone that is mainly responsible for the entry of glucose into the cell for energy production. Epinephrine and glucagon promote glycogenolysis (conversion of glycogen to glucose), which increases plasma glucose. Cortisol, along with glucagon, increases gluconeogenesis (formation of glucose from noncarbohydrates), which also raises plasma glucose concentration.

Which statement s are TRUE about the roles of insulin and glucagon in the regulation of normal blood glucose? (Select all that apply.) 2) After a meal, blood glucose levels rise and trigger the release of insulin from the beta cells of the pancreas. 2) The release of insulin into the blood steam causes blood glucose to be excreted in the urine and a breakdown of glycogen levels within the liver and muscle tissue. 3) The hormone glucagon is released from the beta cells of the pancreas and causes the liver to produce more glycogen from the excess glucose in the blood stream. 4) The release of insulin is mainly triggered by food (chiefly food containing absorbable glucose).

Correct Answers: 1 and 4 It is true that insulin is released from beta cells of the pancreas in response to blood glucose levels rising. This release is mainly triggered by eating. Insulin does not cause glucose to be excreted into the urine nor does the hormone breakdown glycogen within the liver and muscle tissue. Instead, insulin helps glucose become absorbed into the liver and muscle tissue. Glucagon is released from the alpha cells of the pancreas and helps the liver breakdown glycogen to produce more blood glucose into the blood stream.

More than one answer is correct. Please select all correct answers 1 )Insulin is a hormone produced and secreted by the pancreas. 2) With the help of insulin, glucose enters into the body's cells to be used for energy production. 3) Insulin is responsible for breaking down ingested carbohydrates into glucose. 4) When an individual has diabetes, the pancreas either does not produce adequate insulin or the body incorrectly uses the insulin or both.

Correct Answers: 1, 2, and 4 -Insulin is a hormone produced and secreted by the pancreas. With insulin's help, glucose enters cells throughout the body and is used for energy production. When an individual has diabetes the pancreas does not produce adequate insulin or the body incorrectly uses the insulin or both. On the other hand, insulin is not involved in the breakdown of carbohydrates into glucose.

Adrenal gland cortisol

Cortisol is a steroid hormone produced by the adrenal gland and promotes gluconeogenesis. It is released in response to stress and low blood glucose levels. It functions to increase blood glucose through gluconeogenesis.

Gestational diabetes mellitus (GDM)

Diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes

Type 2 Diabetes

Due to a progressive insulin secretory defect on the background of insulin resistance. Accounts for approx. 90% of all diabetes

Type 1 Diabetes

Due to β-cell destruction, usually leading to absolute insulin deficiency. Inherited Autoimmune disorder.

Epinephrine

Epinephrine is a hormone produced by both the adrenal glands and certain neurons. It serves as a neurotransmitter that increases glycogenolysis.

In recent years, the American Diabetes Association (ADA) recommended reporting which of these values to correlate with Hb A1Cas a further indicator of glycemic control? Estimated average glucose Blood urea nitrogen Microalbumin Insulin

Estimated average glucose In 2008, the ADA recommended calculating and reporting the estimated average glucose (eAG) with Hb A1C measurement results. eAG is a glucose concentration level calculated from a patient's Hb A1C result.

Specific types of diabetes due to other causes:

Examples include monogenic diabetes syndromes (eg, neonatal diabetes and maturity-onset diabetes of the young), diseases of the exocrine pancreas (eg, cystic fibrosis), and drug- or chemical-induced diabetes (eg, treatment of HIV/AIDS or after organ transplantation).

Glucagon

Released into the blood stream when blood glucose levels begin to decrease (overnight or after heavy exercise) from pancreatic alpha cells. The glucagon signals the liver and muscle tissue to degrade or breakdown the stored glycogen into glucose and raises blood glucose levels.

Which statement relative to the treatment and management of diabetes is FALSE? 1) For type 1 diabetes, and more severe type 2 diabetes, medication may be required to control blood glucose levels. 2) Weight reduction, increase in exercise, and a more balanced diet can improve blood sugar levels. 3) Anti-diabetic drugs, such as metformin and sulfonylureas, may be used to treat diabetics. 4) A combination of insulin injections and anti-diabetic drugs should not be used together.

FALSE: A combination of insulin injections and anti-diabetic drugs should not be used together.

Gestational diabetes is diagnosed with the same testing and criteria used for the diagnosis of diabetes for a nonpregnant adult. True or False

False

True or false? Class 2 diabetes was formerly called insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes and most often occurs in childhood or young adult years. Class 2 represents about 10% of diabetes cases.

False: Type 1 is characterized by this question.

Pancreatic glucagon

Glucagon is a hormone produced by the alpha cells of the pancreas and stimulates glycogenolysis and gluconeogenesis, causing an increase in blood glucose. It has the opposite effect as that of insulin.

_________________ is the metabolic process whereby glycogen is broken down or hydrolyzed in the liver into glucose which is released into the bloodstream.

Glycogenolysis The breakdown or hydrolysis of glycogen in the liver (s well as kidneys, muscle and brain) into glucose which is released into the bloodstream is termed glycogenolysis. Glycolysis is the oxidative breakdown/metabolism of glucose to produce energy. Glycogenesis is the conversion of excess glucose into glycogen as a cellular storage mechanism. The reversal of glycogenolysis whereby glucose is synthesized within the body from non-carbohydrate substances, such as pyruvate, lactate, glycerol, and certain amino acids, is termed gluconeogenesis.

Metabolic processes that serve to regulate the production, metabolism and the storage of carbohydrates within the body:

Glycogenolysis Glycolysis Glycogenesis Gluconeogenesis

Six months ago, a 55-year-old female had a fasting plasma glucose (FPG) greater than 200 mg/dL on two occasions. She was diagnosed as having type 2 diabetes and treatment was started. Along with routine FPG's which of the following tests would most likely be used to monitor glycemic control? Hb A1C Insulin C-peptide Urine glucose

Hb A1C FPG is performed to monitor diabetes, often weekly or even daily. The ADA also recommends that a Hb A1Cbe tested at least two times each year in patients who are meeting treatment targets and have stable glycemic control

Which of the following hormones inhibits gluconeogenesis, the formation of glucose from noncarbohydrate sources such as amino acids, glycerol, and fatty acids? Insulin Epinephrine Cortisol Glucagon

INSULIN Gluconeogenesis is the formation of glucose from noncarbohydrates when carbohydrate intake is absent (a fasting state). The hormones cortisol, along with glucagon and epinephrine, all stimulate this metabolic pathway. Insulin, however, inhibits this pathway and is therefore the correct answer.

Type 2 Diabetes: Prediabetes

Increased levels of glucose but not high enough to diagnose. Suggestive of higher risk for T2D

Pancreatic Insulin

Insulin is the main regulatory hormone produced and secreted by the pancreatic beta cells. It stimulates the uptake of glucose and the movement of glucose from blood to cells for energy production. Insulin also stimulates glycogenesis, inhibits glycogenolysis, and regulates protein synthesis.

What condition can be described as the occurrence of blood glucose levels that are higher than normal, but not high enough to diagnose diabetes and suggests an individual at an increased risk for developing type 2 diabetes 1. Type 1 ketogenic diabetes 2. Gestational diabetes 3. Prediabetes 4. Idiopathic diabetes

PREDIABETES Prediabetes usually occurs when blood glucose levels are higher than normal, but not high enough to diagnosis diabetes. The condition suggests an individual is at an increased risk for developing type 2 diabetes. Many people with prediabetes develop type 2 diabetes within 10 years. However, modest weight loss and moderate physical activity may often help people with prediabetes delay or even prevent type 2 diabetes. In the US approximately 1 in 3 adults have prediabetes

True or false? Insulin is the main regulatory hormone produced and secreted by the pancreatic beta cells. It stimulates the uptake of glucose and the movement of glucose from the blood to cells for energy production.

TRUE Insulin is the main regulatory hormone produced and secreted by the pancreatic beta cells. It stimulates the uptake of glucose and the movement of glucose from blood to cells for energy production. Insulin also stimulates glycogenesis, inhibits glycogenolysis, and regulates protein synthesis.

Glycogenolysis

The breakdown or hydrolysis of glycogen in the liver (as well as kidneys, muscle and brain) into glucose which is released into the bloodstream.

80% of the energy produced by the body is derived from...

The combustion of carbohydrates. When carbohydrate metabolism is severely limited, the cells begin to oxidize fat reserves for energy, and proteins are degraded to amino acids which in turn are converted to glucose in an attempt to support energy production

Glycogenesis

The conversion of excess glucose into glycogen as a cellular storage mechanism.

Glycolysis

The oxidative breakdown or metabolism of glucose to produce energy

Gluconeogenesis

The reversal of glycogenolysis whereby glucose is synthesized within the body from non-carbohydrate substances, such as pyruvate, lactate, glycerol, and certain amino acids.

According to the 2018 ADA guidelines, a Hb A1C result ≥ 6.5% can be used to diagnose diabetes True or False?

True

One of the ADA's option for diagnosis of diabetes is the use of a 2 hour plasma glucose (PG) ≥ 200 mg/dL during oral glucose tolerance test (OGTT) (75 g). Moreover, the definitive diagnosis of gestational diabetes is made with a glucose challenge test of 100 g or 75 g glucose and timed blood glucose measurements (OGTT). True or False

True There remains some disagreement on the use of the oral glucose tolerance test (OGTT) in diabetes testing and diagnosis. Those that recommend using OGTT assert that the OGTT better detects diabetics who are at risk for developing complications associated with diabetes.

True or false? There is an emerging global epidemic of diabetes that has been traced to rapid increases in overweight people, including obesity, and physical inactivity.

True! Worldwide, about 347 million people have diabetes. There is an emerging global epidemic of diabetes that has been traced to rapid increases in overweight people, including obesity, and physical inactivity. By 2030, diabetes is predicted to become the 7th leading cause of death in the world.