Diabetes pathophysiology_fall 2012_cases

Case 1 n what are the actions of this hormone on fats

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Case #1 n What are the actions of this hormone on fats? Increases triglyceride synthesis Increases fatty acid transport into adipose tissue Inhibits lipolysis Activates lipoprotein lipase n What are the actions of this hormone on proteins? Increases transport of amino acids into cells Increases protein synthesis Decreases protein breakdown n Why did this patient lose weight? “Cell starvation” Depletion of energy stores (glycogen, fats, proteins)
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Case #1 n Why does this patient have polyuria &  polydipsia? Glucose is an osmotically active compound Glycosuria   increased water loss n What other hormones affect blood glucose? Glucagon Catecholamines Growth hormone Glucocorticoids
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Case #2 SL is a 6’2” 63 yo AA male with central  obesity.  While at routine checkup, he  mentions that he has been tired and  more easily fatigued lately.  His BP is  146/94.  Fasting laboratory values from 2  days ago include:  glucose 188 mg/dL,  A1c 8.5%.  His fasting blood glucose  today is 198 mg/dL.
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Case #2 n What is this patient’s diagnosis? Diabetes n How does insulin resistance lead to hyperglycemia? Liver:  insulin resistance +   glucagon  n Increased gluconeogenesis Muscle n 80% of glucose taken up by skeletal muscle n Primary site for insulin resistance Adipose tissue n Increased FFA (lipolysis)   insulin resistance & impaired insulin secretion n In the early stages of type 2 diabetes, hyperinsulinemia may be  observed.  Why? Hyperglycemia stimulates insulin release Because of insulin resistance, unable to efficiently utilize insulin Continual increase in glucose   stimulates more insulin release
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