Disease and the Human Body exam 2

Important of glucose homeostasis? range?

fuel for the brain and tissues: (70-140mg/dL)

Prediabetic range postprandial

140-180

glycogen/glucagon

stored glucose; glucose intake

Insulin mechanism? liver? muscle? fat?

insulin binds to receptors on…

1. 1. Liver: promotes glycogen synthesis

2. 2. Muscle: enhances glucose uptake

3. 3. Fat: inhibit lipolysis

Primary transporter for glucose in muscle

GLUT-4

glycogenolysis

to create sugar in liver; released by glucagon

Hypoglycemia increases what hormones?

1. 1. Epinephrine

2. 2. Glucagon

3. 3. Growth Hormone: decreases insulin sensitivity

4. 4. Cortisol:

Glucose uptake in brain

you do not need insulin

Glucose uptake in Liver

when insulin occurs, glycogen breaks down and returns to blood

Glucose uptake in skeletal muscle

every contraction increase ability for insulin to work

glucose uptake adipose

only when eating; adipocytes will store bind to receptors and let in glut-4; stores as tryglycerides

Hyperglycemia symptoms

1. 1. Excessive hunger/ thirst

2. 2. fatigue

3. 3. frequent urination

4. 4. blurred vision

5. 5. sleepy after eating

Hypoglycemia symptoms

1. 1. hunger

2. 2. shaking or tremors

3. 3. sweating

4. 4. dizziness

5. 5. fast heart rate and anxiety

6. 6. headache

Insulin resistance steps

1. 1. excessive carb consumption

2. 2. elevates blood sugar

3. 3. stimulate insulin, but no more receptors

4. 4. causes increase in systemic inflammation

leads to insulin failure

Type 1 diabetes

beta cells kills itself; aka insulin-dependent Diabetes, diagnosed in kids and young adults; lack of insulin production

Main Symptoms in Type 1

1. 1. Hyperventilation

2. 2. Smell acetone

3. 3. abdominal pain

Diabetic Ketoacidosis

Untreated T1D; result of reduced insulin concentration with increase in counter hormones; activates lipase (fatty acids)

What causes beta cell death in t1d

Chemokine release → insulitis → death

Management of T1D

1. 1. Lifelong insulin therapy

2. 2. Blood glucose monitoring

3. 3. diet exercise

4. 4. insulin pumps and CGM

Gestational DIabetes

glucose intolerance first diagnosed during pregnancy

Pathpphysiology of Gestational Diabetes

1. 1. Placental hormone lactogen blocks insulin

2. 2. sex hormones further insulin resistance

3. 3. Pancreas can not effectively compensate

4. 4. hyperglycemia

Diagnosing Gestational diabetes

Oral Glucose Tolerance Test

gestational diabetes risk factors? Managemnt

1. 1. Obesity

2. 2. Family history of diabetes

3. 3. advanced maternal age

fix diet and exercise first; monitor for T2D after birth

Gestational Diabetes Maternal Risks? fetal?

1. Maternal: Increased preeclampsia; c section

2. Fetal: macrosomia - large baby, neonatal hypglycemia

T1D Onset and cause

Autoimmune attack on B-cells; inability for pancreas to produce insuline

Symptoms of T1D

1. 1. rapid weight loss

2. 2. rapid breathing

3. 3. increased urination

4. 4. hyperglycemia

5. 5. acetone smell

Gestational Diabetes Onset and Cause

Maternal Hyperglycemia due to decreased ability to regulate insulin

Gestational diabetes clinical diagnosis

failing an oral glucose tolerance test

T2D def? what %

chronic metabolism disorder causing insulin resistance; 90% of all cases

insulin resistance

reduced response of muscle, liver, and adipose tissue to insulin. B-cells overproduce to compensate and eventually exhaust themselves

Non modifiable risk factors of T2D

1. 1. Genetics/ family history

2. 2. age

3. 3. ethnicity

Modifiable risk factors of T2D

1. 1. Body composition

2. 2. Sedentary lifestyle

3. 3. Diet high in refined sugars

4. 4. chronic stress/poor sleep

Mechanisms contributing to insulin resitance include

1. 1. Lipotoxicity: excess fatty acids interfere w insulin

2. 2. Inflammation

3. 3. Mitochondrial Dysfunction

Visceral fat

secretes more inflammatory cytokine → increases insulin resistance

Liver role in insulin resistance

increased glucogenesis despite high insulin; excess fatty acid accumulation

Systemic damage T2D has on body

1. 1. glycation (AGEs)

2. 2. Oxidative stress

3. 3. chronic inflammation

affects blood vessels, nerves, and major organs

T2D damage to cardiovascular syste, (2 diseases)

1. 1. Atherosclerosis: Excess glucose damagea blood vessels, leading to plaque buildup

2. 2. Hyperlipidemia: dysregulated lipid metabolism

T2D macrovascular complications

1. 1. Cardiovascular disease

2. 2. Hypertension

Hypertension in type 2

insulin resistance → sodium retention → increased BP; double stroke risk

Diabetic Neuropathy? Symptoms?

nerve damage due to prolonged hyperglycemia

1. 1. Numbness in foot, tingling, loss of sensation; can give ulcers

Diabetic kidney disease

damage to glomeruli from high glucose levels → protein leaking in urine; leads to chronic kidney disease (CKD)

Symptoms of Diabetic Kidney DIsease

Early stages: proteinuria (albumin in urine)

Late stages: reduced kidney function and swelling (edema)

Diabetic Retinopathy

damage to retinal blood vessels → vision impairment and blindness

stages of diabetic retinopathy

1. 1. Non Proliferative stage: hemorraghes, microaneurysms

2. 2. Proliferative stage: abnormal blood vessel growth, retinal detachment

Chronic inflammation complications

insulin resistance triggers cytokine release → worsens inflammation → worsens atherosclerosis, neuropathy, and nephropathy

Diabetes T2 can also cause

1. 1. Alzhemers/cognitive decline

2. 2. increased infection

3. 3. diabetic foot ulcers → risk of amputation

Mental health impact from T2D

increased depression, anxiety and stress related

interventions to decrease complications

1. 1. keep HbA1c below 7%

2. 2. BP and lipid control

3. 3. lifestyle changes

4. 4. early screening and monitoring

Oxidative stress cause on T2D

causes tissue damage and endothelial dysfunction

Ketoacidosis signs

low serum bicarbonate levels: high level of acid in blood. Levels are low bc her body is low on insulin, and is breaking down fats for glucose

Fasting Plasma Glucose (FPG)? complication?

Patient fasts for at least 8 hours before blood draw; may miss postprandial hyperglycemia; essential for diagnosis

Fasting plasma glucose (FPG) diagnostic ranges

Normal: <100mg/dL

Prediabetic: 100-125

Diabetic: >126

Oral Glucose Tolerance Test (OGTT)

Used to detect gestational diabetes; patient fasts then consumes 75g of glucose then measured in 30min increments

HbA1c Test? complication?

Reflects average blood glucose over 2-3 months; may be inaccurate for anemic patients

Oral glucose TT ranges

Normal: <140

Prediabetes: 140-199

Diabetes: >200

HbA1c Test ranges

Normal: <5.7%

Prediabetic: 5.7-6.4%

Diabetes: >6.5%

Random plasma glucose test (RPG)

used for symptomatic individuals; less reliable; diabetic if >200

What tests are essential for diagnosis

FPG and OGTT

What tests are best long term

HbA1c test is best

Who should get screened

1. 1. adults >45

2. 2. overweight individuals

3. 3. women w history of gestational

How often should you get screened

every three years

A patient with HbA1c of %6.0 is classified as?

prediabetic

challenges in diagnosis

1. 1. asymptomatic patients

2. 2. glucose level variability

3. 3. barriers to screening (cost, access)

where is there higher prevalence for diabetes

Appalachian and southern states

What ehtinities are at higher risk

african american, hispanic, asian american, native american

Gender risks

men tend to get diagnosed later in life

risk factors

Nonmodifiable: Genetics, ethnicity, genes, aging

Modifiable: Obesity and Visceral fat, sedentary lifestyle, unhealthy diet, chronic stress and sleep dep.

Lifestyle change impacts

by improving at least 2 lifestyle factors, 12% decrease in diabetes

Obesity-diabetes connection

excess fat increases inflammation, leading to insulin resistance.

Visceral fat produces pro-inflammatory cytokines

Women have higher risk for diabetes why?

Due to menopause hormonal fluctuations women have less glucose metabolism efficiency

Unhealthy diets increase risk

High-refined carbs intake → blood sugar spikes

Processed foods and trans fats → impair insulin sensitivity

Meditteranean Diet and DASH diet

M: Fish and oils

DASH: Low sodium

How exercise makes T2D less likely

2000 weekly mets = less likelihood of T2D

Enviromental factors

lower income, food deserts, stress and work

Diabetes prevention methods

1. 1. Weight management: losing even 5-10% of weight

2. 2. Diet changes

3. 3. exercise

4. 4. stress management

DIetary changes

eat more whole foods, fiber rich diets → improves glucose control

role of blood sugar control in diet

carb intake directly impacts blood glucose; protein and fat influence insulin response

Glycemic Index(gi)

measures how quickly food raises blood sugar

Glycemic Load (GL)

Considers both GI and portion size

Fiber reccomended intake

25-30g fiber/day; increase glucose absorption

Protein reccomonded intakeq

moderate intake; too much spikes glucose

Fat reccomendations? Healthy? unhealthy?

Healthy fats (MUFA, PUFA) improve insulin sensitvity

Unhealthy (trans and saturated fats) increase cardiovasc. risks

Mediterranean diet

high in healthy fats, fibers, and antioxidants

Low carb and Keto diets

can reduce insulin resistance

Plant based diets

improve insulin sensitivity and reduce inflammation

DASH diets

focuses on BP control alone with glucose management; low sodium

PLate method

half a plate of non-starchy veggies; ¼ carbohydrate food; ¼ protein food

How exercise affects blood suagr

Increases glucose uptake in muscles; enhances insulin sensitivity for 24-48 hours post-exercise

Aerobic exercise

improves cardiovascular health and glucose control

Resistance training

improves insulins sensitivity and muscle glucose uptake

HIIT

increases insulin sensitivity more efficiently, drastically improves insulin-stim glucose disposal

Exercise guidlines

150 min/week of moderate-intensity aerobic exercise

Strength training 2x per week

Monitor blood suagr before and after exercise

Benefits of weight loss

improves insulin sensitivity, lowers fasting glucose and HbA1c, reduces triglycerides and inflammation

Weight loss Strategies to lose 5-10%

caloric deficit of 500-750kcal/day (1 lb per week)

3-6 months

Diet best for hypertension?

DASH; low sodium

Main diet focus

whole foods, low GI carbs, consistent meal timing

Transtheoretical model

1. 1. precontemplation

2. 2. contemplation

3. 3. preparation

4. 4. action

5. 5. maintenance brief

CBT strats

1. identify thought patterns

2. set realitic goals

3. Use habit stacking or positive reinforcement