Category: Diabetes mellitus

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Implications of suppressed TCA cycle in Diabetes Mellitus

A 22- year-old diabetic comes to the Accident and Emergency department. She gives a 2-day history of vomiting and abdominal pain. She is drowsy and her breathing is deep and rapid. There is distinctive smell from her breath. She has been diagnosed with Diabetic ketoacidosis. Diabetic ketoacidosis is a complication of uncontrolled diabetes mellitus. The TCA cycle in diabetes mellitus is suppressed and the excess Acetyl co A, resulting from fatty acid oxidation is channeled towards the pathway of ketogenesis. Which of the following intermediates of TCA cycle is depleted in Type 1 Diabetes mellitus to suppress TCA cycle? A)...

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Implications of maternal hyperglycemia

Case details A pregnant mother with a history of long-standing uncontrolled diabetes mellitus has come for a routine check up. The examination reveals a normal pregnancy. Blood chemistry reveals random blood glucose – 165 mg/dl and Glycated hemoglobin (HbA1c) of 10.5 %. What are the possible complications in a fetus under such conditions of maternal hyperglycemia? A. Fetal hyperglycemia B. Large fetal size C. Hypoglycemia after birth D. Fetal hyperinsulinemia E. All of the above. See the image below and try to find out the answer Figure- Showing the implications of maternal hyperglycemia. The correct answer – E- all of the...

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Mechanism of action of Insulin ?

Case details A 16-year-old type 1 diabetic female checks her finger stick blood glucose before a meal. She injects herself subcutaneously with exogenous insulin and then starts to eat. As Insulin is absorbed in to her blood, it binds to insulin receptors that activate: A. Tyrosine kinase B. Adenylate cyclase C. Cyclic AMP D. Protein kinase C E. Phospholipase C The correct answer is- A- Tyrosine kinase. Insulin binding to its receptor stimulates intrinsic tyrosine kinase activity (figure -1) leading to receptor auto phosphorylation and the recruitment of intracellular signaling molecules, such as insulin receptor substrates (IRS). IRS and other...

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Role of Insulin in Diabetic ketoacidosis

Case details An 8-year old boy, a known diabetic (type 1 DM), has been brought to emergency room in a state of coma. His breathing is rapid and deep, and his breath has a fruity odor. His blood glucose is 480 mg/dL. The attending physician has administered IV fluids, insulin, and potassium chloride. A rapid effect of insulin in this situation is to stimulate A. Gluconeogenesis in liver B. Fatty acid release from adipose C. Glucose transport in muscle D. Ketone utilization in the brain E. Glycogenolysis in the liver Answer- The right answer is- c) Glucose transport in muscle....

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Case study- Renal glycosuria

Case details A 22-year-old man collapsed from dehydration during maneuvers in the desert and was sent to the emergency. A high level of glucose was observed in his urine. He was suspected of being a diabetic. Further tests, however, determined that his serum insulin level was normal. A glucose tolerance test exhibited a normal pattern; further testing of the urine revealed that only D-glucose was elevated. Other sugars were not elevated. The patient was diagnosed with, ‘Renal glycosuria’. This patient’s elevated urinary glucose and his dehydration episode are caused by a deficiency in which of the following? A. GLUT 2...

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Hyperglycemia induced complications in diabetes mellitus

A 65-year-old man with a history of type 2 diabetes mellitus is complaining of blurred vision and numbness in his toes. Laboratory results are significant for an increased BUN and creatinine, indicative of renal failure and high HbA1c indicative of chronic persistent hyperglycemia. Out of the several mechanisms proposed, one mechanism responsible for hyperglycemia induced complications in diabetes mellitus is non enzymatic attachment of excess glucose with structural proteins by forming covalent bonds. This reaction should be best described as- A. Acylation B. Carboxylation C. Hydroxylation D. Esterification E. Glycation The correct answer is E- Glycation. In diabetes mellitus, insulin...

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Fructose 2, 6 Bis phosphate and regulation of glycolysis

Case details A patient presents with dizziness, fatigue and tremors. A finger stick test indicates blood glucose of 36mmol/L. Of the allosteric activators of glycolysis in the liver, which of the following is the most important in maintaining a normal blood glucose level? A. Citrate B. ATP C. Fructose 2, 6 bisphosphate D. Glucose-6-Phosphate E. Acetyl Co A The correct answer is- C- Fructose 2,6 bisphosphate Generally, enzymes that catalyze essentially irreversible steps in metabolic pathways are potential sites for regulatory control.  Although most of the reactions of glycolysis are reversible, three are markedly exergonic and must therefore be considered...

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Answer- Case study- Gestational Diabetes Mellitus and Neonatal hypoglycemia-A patient who had gestational diabetes has just delivered …

A patient who had gestational diabetes has just delivered a 10 lb baby. The baby appears “jittery” and heel stick glucose is 30 mg/dL. Which of the following mechanisms is the explanation for the newborn’s hypoglycemia? A. The mother’s relative hyperinsulinemia B. The baby’s relative hyperinsulinemia C. The mother’s hyperglycemia D. The baby’s hyperglycemia E. Placental insulin production Answer- The correct answer is- B- The baby’s relative hyperinsulinemia. Gestational diabetes is a condition characterized by high blood glucose levels that is first recognized during pregnancy. The condition occurs in approximately 4% of all pregnancies. Almost all women have some degree...

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Case study- Gestational Diabetes and neonatal hypoglycemia-A patient who had gestational diabetes has just delivered ..

A patient who had gestational diabetes has just delivered a 10 lb baby. The baby appears “jittery” and a heel stick glucose is 30 mg/dL. Which of the following mechanisms is the explanation for the newborn’s hypoglycemia ? A. The mother’s relative hyperinsulinemia B. The baby’s relative hyperinsulinemia C. The mother’s hyperglycemia D. The baby’s hyperglycemia E. Placental insulin production For answer follow the link http://usmle.biochemistryformedics.com/answer-case-study-gestational-diabetes-mellitus-and-neonatal-hypoglycemia-a-patient-who-had-gestational-diabetes-has-just-delivered/ Please help Biochemistry for Medics by “CLICKING ON THE ADVERTISEMENTS” every time you visit us. Thank you!

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