NUR 612 Diabetes Mellitus/Metabolic Syndrome Questions and Complete Solutions

Explain the functions of glucose, fats, and proteins in meeting the energy needs of the body. The body uses glucose, fatty acids, & other substrates as fuel. The liver with hormones from the endocrine pancreas control fuel supply. Glucose is metabolized to CO2 and H2O. 4 kcal/g Fat is metabolized to glycerol and fatty acids. 9 kcal/g Protein is metabolized to amino acids. 4 kcal/g Briefly describe fat metabolism. triglycerides = 3 fatty acids linked by glycerol. Lipases break down triglycerides and glycerol can be used with glucose to produce energy or can be used to produce glucose. Almost every body tissue (except brain/nerve/RBCs) can use fatty acids interchangeably with glucose for energy. Fatty acids cannot be converted to glucose. The liver degrades fatty acids -- ketones. Briefly describe protein metabolism. Amino acids build proteins. Most are stored as body proteins but excess ones are converted to fatty acids, ketones, or glucose and stored/used. When metabolic needs exceed food intake and glucose synthesis is needed quickly, proteins must be broken down and the amino acids used as a major substrate for gluconeogenesis Briefly describe carbohydrate metabolism. Brain/Nervous system rely almost exclusively on glucose. About 2/3 glucose ingested is stored in liver as glycogen to keep blood glucose w/in normal range between meals. Glucose that is not used/stored as glycogen is converted in the liver to fatty acids and stored as triglycerides in fat cells. Gluconeogenesis process where the liver synthesizes glucose from amino acids, glycerol and lactic acid. It is then released into the circulation or stored as glycogen Glycogenolysis glycogen is broken down and glucose is released Characterize the actions of insulin with reference to glucose, fat, and protein metabolism. Promotes glucose uptake by target cells and provides for glucose storage as glycogen. Prevents fat and glycogen breakdown. Inhibits gluconeogenesis and increases protein synthesis. Type 1 DM Absolute insulin deficiency due to loss of beta cell function. It can be autoimmune or idiopathic. 95% is autoimmune (type 1A) and is triggered by an event like an infection, but also has a genetic component. Autoantibodies IAA, GAD, and IA-2 are seen. Type 1B is not autoimmune and has a large genetic component. It is associated with episodic DKA. Type 2 DM Impaired ability of the tissues to use insulin (insulin resistance); A relative lack of insulin (impaired beta cells) or impaired release of insulin in relation to blood glucose levels. In return, there is increased hepatic glucose production. Describe the metabolic syndrome and explain its associations with the development of type 2 DM. Metabolic syndrome: obesity (esp central), low HDL/high triglycerides, HTN, inflammation, abnormal fibrinolysis, etc. 80% to 90% of people with Type II diabetes are overweight. Central obesity correlates with insulin resistance. Insulin resistance and increased glucose production in obese people stem from increased concentration of free fatty acids. Describe diagnosis of DM. Diagnosis for DM requires one of the following: HgbA1C 6.5% OR FPG 126 (fasting plasma glucose after no cals for 8 hrs) OR 2 hour plasma glucose 200 (during an OGTT) OR symptoms of hyperglycemia/hyperglycemia crisis with a glucose random of 200. What does chronic hyperglycemia do to beta cells? chronic hyperglycemia can induce beta cell desensitization (down regulation) ("glucotoxicity"). What are actions of FFA (free fatty acids) in people with DM 2? FFAs are can lead to destruction of beta cells (lipotoxicity). In the peripheral tissues they cause insulin resistance/excess glucose by limiting glucose uptake and storage. FFA also act on the liver decreasing hepatic insulin sensitivity resulting in increased hepatic glucose production and hyperglycemia. Management of DM 1 v DM 2. Nutrition therapy. Exercise. Anti-diabetic agents. People with DM1 will need insulin DM 2 may or may not use insulin. Diagnosis of DKA Bicarb 15 Blood glucose 250 Acidosis 7.3 Ketones in blood and/or urine.