Endocrinology CIS Flashcards Preview

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Flashcards in Endocrinology CIS Deck (28)
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1

What happens to insulin secretion in conditions of hyperglycemia, GI hormones, and beta-adrenergic stimulation?

Increases

2

What happens to insulin secretion in the presence of catecholamines and somatostatin?

Decreases

3

Essentials of T1D diagnosis

Polyuria, polydipsia, and weight loss associated with random plasma glucose of 200 mg/dL or more

Plasma glucose of 126 or more after an overnight fast on multiple occasions

Ketonemia, ketonuria, or both

Islet autoantibodies frequently present

4

Essentials of diagnosis for T2D

Many age 40+ and obese

Polyuria, polydipsia. Ketonuria and weight loss generally uncommon at time of dx. Candidal vaginitis in women may be initial manifestation. Many patients have few or no symptoms

Plasma glucose of 126 or more after overnight fast on multiple occasions. Two hours after 75 g oral glucose, diagnostic values are 200 mg/dL or more

HbA1c 6.5% or more

HTN, dyslipidemia, and atherosclerosis are often associated

5

Insufficient insulin leads to reduced tissue uptake of glucose. This leads to intracellular _____ and extracellular _____

Hypoglycemia; hyperglycemia

6

Insufficient insulin leads to reduced tissue uptake of glucose, causing intracellular hypoglycemia. What are the downstream effects of this?

Glucogenesis and gluconeogenesis

Breakdown of fats —> high levels of ketones —> DKA

Decreased protein synthesis —> cachexia, lethargy, polyphagia

Decreased gamma globulins —> susceptibility to infections, impaired wound healing

7

Insufficient insulin leads to reduced tissue uptake of glucose, causing extracellular hyperglycemia. What are the downstream effects of this?

Hyperosmotic plasma —> dehydration of cells —> hyperglycemic coma

Blood glucose exceeds renal threshold —> glucosuria —> osmotic diureses —> polyuria, polydipsia, hypokalemia, hyponatremia

8

What is the renal threshold for glucose?

180-200 mg/dL

9

Effects of insulin on glucose uptake and metabolism:

Insulin binds its receptors —> protein activation cascades —> ______ synthesis —> translocation of ____ transporter to PM and influx of glucose —> _________ —> triglyceride

Glycogen; GLUT4; glycolysis

10

______ is a facilitative glucose transporter located in the PM of the liver, pancreatic, intestinal, kidney cells as well as in the portal and hypothalamus areas.

GLUT2

11

GLUT2 has ____ affinity and _____ capacity; transporting dietary sugars, glucose, fructose, and galactose in large range of physiological concentrations, displaying large bidirectional fluxes in and out of cells

Low; high

12

Insertion of GLUT2 into the ____ membrane of enterocytes induces the acute regulation of intestinal sugar absorption after a meal.

Apical

13

Is GLUT2 insulin-dependent?

No, GLUT2 protein itself initiates a protein signalling pathway triggering glucose signal from the PM to the transcription machinery

14

Is GLUT-4 insulin dependent?

Yes; it is responsible for the majority of glucose transport into muscle and adipose cells in anabolic conditions

15

Describe the process of osmotic diuresis

Increased BG —> increased glomerular filtration of glucose —> increased osmotic pressure of renal tubular fluid —> decreased water reabsorption —> osmotic diuresis

16

What are causes of high anion gap metabolic acidosis?

MUDPILES

17

What is high anion gap metabolic acidosis? How does diabetic ketoacidosis contribute?

In HAG metabolic acidosis, H+ is added from an extra source

In DKA, the liver produces beta-hydroxybutyric acid

18

How is anion gap calculated? What is normal anion gap?

Anion gap = Na - (Cl + HCO3)

Normal = 10-12 mM/L

19

DKA is characterized by glucose greater than _______, serum positive for ________, and metabolic acidosis with blood pH less than _______ and serum bicarb less than ______

250 mg/dL; ketones; 7.3; 15 mEq/L

20

The anion gap is usually due to ___________ as the charges of the other unmeasured cations and anions tend to balance out

Negatively charged plasma proteins

21

While calculating anion gap, it is important to adjust for ______

Hypoalbuminemia

22

What happens to the plasma osmolarity in conditions of hyperglycemia?

Increases, especially in the setting of osmotic diuresis

23

Following osmotic diuresis in conditions of hyperglycemia, ECF volume ________, leading to shock and decreased _________, eventually leading to what 3 conditions?

Decrease; GFR

Increased glucose in urine

Acidosis

Azotemia (increased BUN)

24

DKA can be differentiated into mild, moderate, or severe based on what factors?

Venous pH (<7.3, <7.2, <7.1)

Serum bicarb (<15 mEq/L, <10, <5)

Alteration in mental status (alert, alert/drowsy, stupor/coma)

25

In treating a patient with diabetic ketoacidosis, which is given first: normal saline or insulin?

NS - because it is important to deal with hyperosmolality prior to insulin administration

26

What is the protocol for treating abnormal potassium levels in someone presenting with DKA?

Do not start replacing K until closer to 4 and acidosis starts to move toward normal, because as you correct the acidosis the K will begin to normalize

27

When treating DKA, glucose levels are usually reduced to about 200-250 and held there while volume repletion continues. What happens when you correct too quickly?

Increased risk of cerebral edema, worsening coma, and respiratory failure

28

NaHCO3 is usually not needed in the treatment of DKA. Patients with what condition might require a bicarb drip in order to normalize their acid/base status?

Renal failure