ESS 3 Lecture Notes - Lecture 9: Hypoglycemia, Glycemic Load, Saturated Fat

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byzantiumwombat509

20 Oct 2016

School

UCSB

Department

Exercise & Sport Studies

Course

ESS 3

Professor

J A M I E S O N A E

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Document Summary

Body cells become resistant or less responsive to insulin. Risk factors (metabolic syndrome): a waist circumference greater than 35 inches for women and 40 inches for men, elevated blood pressure, unhealthy levels of certain blood lipids, abnormally high blood glucose levels. Most cases develop after age 45 (23% of americans over 60 have type 2 diabetes) Disease is increasing among children and adolescents posing serious health consequences. Type 2 diabetes is the most common form of diabetes. Primarily attributed to prevalence of obesity and decreased physical activity: 80% to 90% of type 2 diabetics are obese, genetics and lifestyle also affect risk. With insulin resistance, cells resist the effects of insulin impairing the uptake of glucose into cells. Normally, insulin binds to receptors on cell membranes and allows glucose to pass into cells. With insulin resistance, blood glucose levels increase. Pancreas overworks to make more insulin in an attempt to lower blood glucose.

Related Questions

Based on âMorgan: A case of Diabetesâ by Lisa Rubin and Clyde Freeman Herreid (National Center for Case Study Teaching in Science)

The Patient:

Morgan Water is a 27-year old Native American that lives on a reservation in Oklahoma. Nearly Â¼ of Morganâs tribe has diabetes but she has no direct family history of diabetes, heart disease, or other serious conditions. She is however obese (BMI = 32) and leads a sedentary lifestyle. Morgan has been suffering from an increasing persistence of symptoms including unusual thirst, dizziness, blurred vision, and numbness in her right foot. The symptoms have been developing over several months but as she is planning her wedding she attributed them to nerves. She is finally persuaded to see her family doctor. Her non-fasting blood glucose level was elevated so the doctor has her return the next morning for a fasting blood sample so they could more accurately measure her blood glucose and insulin. Her blood results are below:

Test	Morganâs values	Normal range	Pre-Diabetic range	Diabetic range
Plasma glucose, mg/dl	260	70 -139	140 - 199	â¥ 200
Fasting glucose, mg/dl	140	â¤ 99	100 - 125	â¥ 126
A1C, %	7.6	~ 5	5.7 â 6.4	â¥ 6.5
Fasting Insulin, mIU/ml	34	2 - 10	10 - 20	â¥ 20

Question 1:

Based on her history and blood results, what do you think is the most likely diagnosis for Morgan?

A. Type I Diabetes Mellitus

B. Type II Diabetes Mellitus

C. Pre-Diabetes

D. Cardiovascular Disease

Question 2:

What is the cause of Morganâs disease?

A. It is an auto-immune disorder that destroys the Î²-cells of her pancreas so she produces less

insulin than normal.

B. She has a genetic mutation that results in less insulin receptor being produced than normal.

C. She has developed insulin resistance, where her insulin receptors do not recognize the insulin her

body produces, likely due to her obesity.

D. There is no known cause, it can happen spontaneously.

Morgan is worried that she will have to spend the rest of her life giving herself injections but her doctor does not prescribe insulin injections.

Question 3:

Why would injections of insulin not help Morgan if she has hyperglycemia?

A. Her body is already producing excess insulin but not responding to it.

B. Her problem is with her insulin receptors responding to insulin.

C. Excess insulin will only exacerbate her insulin resistance.

D. All of the above.

Question 4:

Given Morganâs metabolic state, which of the following pathways would you expect to be active in Morganâs cells (select all that apply)?

A. Glycolysis

B. Gluconeogenesis

C. Î²-oxidation

D. Amino acid degradation

E. Protein synthesis

10. The organs associated with the Alimentary Canal share which similarity/similarities? They all belong to the lymphatic system They all belong to the gastrointestinal system Food does not pass directly through them during the process of digestion Food does pass directly through them during the process of digestion Both B and D \

11. Of the five basic functions of the digestive system, which one occurs first? Excretion Absorption Ingestion Peristalsis Digestion

12. The elimination of indigestible material from the body is called _______________. Peristalsis Absorption Defecation Ingestion

13. The pancreas helps to regulate metabolism and blood sugar levels through the release of insulin. Insulin tells the liver to stop sugar production to keep levels regulated within the blood stream. If a personâs pancreas does not function properly, they have a condition called diabetes, a metabolic disease that often requires monitoring of oneâs diet. People with Type 1 Diabetes have a pancreas with damaged islet cells, meaning no insulin is produced. People with Type 2 Diabetes have a pancreas that produces insulin properly, but their cells are resistant to this insulin due to various factors that often include but are not limited to obesity, lack of exercise, or poor diet choices. Certain foods, specifically starches and sugars, affect diabetics in different ways. Type 1 diabetics must limit their consumption of sugars in order to keep their blood sugar levels stable. Type 1 diabetics often achieve regulation of blood sugars through injections of insulin. Type 2 diabetics must still pay attention to their diets, but not all of them are dependent on manual injections of insulin. Because Type 2 Diabetes is often brought on through a poor diet, Type 2 diabetics are advised to monitor their food choices to prevent weight gain and achieve a more balanced diet overall. Approximately 90% of Americans with diabetes have Type 2. Which are contributing factors to developing Type 1 Diabetes? Poor liver function Poor pancreatic function Sedentary lifestyle All of the above

14. There are five activities that occur within the gastrointestinal system: â¢ Ingestion â the taking in of food or drink â¢ Peristalsis â the movement of food along the digestive tract â¢ Digestion â the breakdown of food and drink by both mechanical and chemical mechanisms â¢ Absorption â the passage of food into the cardiovascular and lymphatic systems â¢ Defecation â the elimination of substances the body canât use Many digestive disorders and diseases can be tied to an activity within the gastrointestinal system. For example, inflammation of the digestive tract, commonly known as inflammatory bowel disease, is an example of a gastrointestinal activity breakdown. An inflamed digestive tract means digestion is painful and hindered in some way, affecting the rest of the gastrointestinal activities coming after it. An inability to break down lactose, or âlactose intolerance,â is another example of a breakdown that can occur within the gastrointestinal system. Another example of a breakdown in gastrointestinal activities is an eating disorder, where food is either withheld or ingested at a fast rate. Some disorders include the elimination of food through vomit, in essence reversing some of the activities of the gastrointestinal system. A final example of a breakdown in gastrointestinal activities is constipation, which can often lead to further problems such as bowel impaction if not corrected immediately. A balanced diet is recommended to keep the gastrointestinal system functioning properly, and many over the counter medications can help to correct some breakdowns if caught early enough. Foodborne illness, or food poisoning, happens when spoiled or contaminated food is consumed. A common symptom of food poisoning is vomiting. Though microbes can move from the stomach and into the intestines after vomiting occurs, the food itself gets thrown up, stopping its travel through the gastrointestinal system. During which activity is the food thrown up? Peristalsis Absorption Ingestion Digestion

15. The skin is a vital organ that covers the entire outside of the body, forming a protective barrier against pathogens and injuries from the environment. The skin is the body's largest organ; covering the entire outside of the body, it is about 2 mm thick and weighs approximately six pounds. It shields the body against heat, light, injury, and infection. The skin also helps regulate body temperature, gathers sensory information from the environment, stores water, fat, and vitamin D, and plays a role in the immune system protecting us from disease. The color, thickness and texture of skin vary over the body. There are two general types of skin; thin and hairy, which is more prevalent on the body, and thick and hairless, which is found on parts of the body that are used heavily and endure a large amount of friction, like the palms of the hands or the soles of the feet. Basically, the skin is comprised of two layers that cover a third fatty layer. These three layers differ in function, thickness, and strength. The outer layer is called the epidermis; it is a tough protective layer that contains the melanin-producing melanocytes. The second layer (located under the epidermis) is called the dermis; it contains nerve endings, sweat glands, oil glands, and hair follicles. Under these two skin layers is a fatty layer of subcutaneous tissue, known as the subcutis or hypodermis. The skin contains many specialized cells and structures: â¢ Basket Cells: Basket cells surround the base of hair follicles and can sense pressure. They are evaluated when assessing overall nerve health and condition. â¢ Blood Vessels: Blood vessels carry nutrients and oxygen-rich blood to the cells that make up the layers of skin and carry away waste products. â¢ Hair Erector Muscle (Arrector Pili Muscle): The arrector pili muscle is a tiny muscle connected to each hair follicle and the skin. When it contracts it causes the hair to stand erect, and a "goosebump" forms on the skin. â¢ Hair Follicle: The hair follicle is a tube-shaped sheath that surrounds the part of the hair that is under the skin and nourishes the hair. It is located in the epidermis and the dermis. â¢ Hair Shaft: The hair shaft is the part of the hair that is above the skin. â¢ Langerhans Cells: These cells attach themselves to antigens that invade damaged skin and alert the immune system to their presence. â¢ Melanocyte: A melanocyte is a cell that produces melanin, and is located in the basal layer of the epidermis. â¢ Merkel Cells: Merkel cells are tactile cells of neuroectodermal origin located in the basal layer of the epidermis. â¢ Pacinian Corpuscle: A pacinian corpuscle is a nerve receptor located in the subcutaneous fatty tissue that responds to pressure and vibration. â¢ Sebaceous Gland: Sebaceous glands are small, sack-shaped glands which release an oily substance onto the hair follicle that coats and protects the hair shaft from becoming brittle. These glands are located in the dermis. â¢ Sensory Nerves: The epidermis is innervated with sensory nerves. These nerves sense and transmit heat, pain, and other noxious sensations. When they are not functioning properly sensations such as numbness, pins-and-needles, pain, tingling, or burning may be felt. When evaluating a skin biopsy, total number, contiguity, diameter, branching, swelling, and overall health of the sensory nerves are assessed. â¢ Stratum Corneum: The stratum corneum is outermost layer of the epidermis, and is comprised of dead skin cells. It protects the living cells beneath it by providing a tough barrier between the environment and the lower layers of the skin. The stratum corneum is useful for diagnosis because in some conditions it will become thinner than normal. â¢ Sweat Gland (Sudoriferous Gland): These glands are located in the epidermis and produce moisture (sweat) that is secreted through tiny ducts onto the surface of the skin (stratum corneum). When sweat evaporates, skin temperature is lowered. If you use a product to moisturize your hair, which part of the integumentary system are you targeting? Hair follicle Hair shaft Blood vessels Melanocyte

salmonraven953

Based on âMorgan: A case of Diabetesâ by Lisa Rubin and Clyde Freeman Herreid (National Center for Case Study Teaching in Science)

The Patient:

Test	Morganâs values	Normal range	Pre-Diabetic range	Diabetic range
Plasma glucose, mg/dl	260	70 -139	140 - 199	â¥ 200
Fasting glucose, mg/dl	140	â¤ 99	100 - 125	â¥ 126
A1C, %	7.6	~ 5	5.7 â 6.4	â¥ 6.5
Fasting Insulin, mIU/ml	34	2 - 10	10 - 20	â¥ 20

The recommendation of Morganâs doctor was to improve her exercise, good nutrition, and weight loss. He recommends meeting with a nutritionist to assist Morgan in her weight loss goals. When Morgan got home and told her family the diagnosis they however had LOTS of suggestions on how she can lose weight. Below is a description of the advice given to her by three family members.

Best friend Savannah:

âYou know how Iâve been losing weight? Well, Iâve been on the Atkinsâ Diet. I heard about it on TV. Itâs great! You get to eat steak, chicken wings, and all the good stuff. All you have to do is limit carbohydrate intake. You should definitely give it a try. This diet has been around for years and it has worked for lots of people, including me.â

*Note: Atkinâs Diet recommends: 10% carbohydrates, 55% fats, 35% protein

Brother Alan:

âI think the best thing for you to do is exercise and stop eating all of that pizza and candy and food filled with fat. Our people never used to eat that junk. I say eat meals that are nutritionally balanced and high in fiber and low in refined sugars and saturated fats. And run a lot. Stop sitting around the house.â

Grandfather:

âMorgan, it is true that it is best to live in harmony and balance â to eat a nutritionally balanced diet that includes carbohydrates, proteins, and âgoodâ fats to meet your bodyâs needs. That is good. But look to your heritage. Our people were never overweight before we started eating âcivilizedâ food. Look to our native diet. I think you should look to traditional herbal remedies for help. What Alan says is true. Exercise is good. But it is sometimes not enough. Our people have always looked to natural medicine for cures. They will lift your spirits and energize you. Then you will lose weight and you will be healthy again. I hear the herbs from the diet shop are safe and good. But you must take them like the medicine label says. It canât hurt to try them.â

*Note: these herbal supplements Morganâs grandfather is recommending contain the herb

ephedra (ephedrine).

Question 5:

Given Morganâs metabolic state, what is the primary fuel source for her cells currently?

A. Carbohydrates (glucose)

B. Fats

C. Proteins

D. It is a balance of all three

Question 6:

Metabolic ketoacidosis is a common problem with diabetics, which is caused by which of the following?

A. Excessive oxidation of fatty acids, leading to an accumulation of ketone bodies in the blood.

B. Excessive oxidation of glucose, leading to an accumulation of ketone bodies in the blood.

C. Excessive oxidation of proteins, leading to an accumulation of ammonia in the blood.

D. Hyperglycemia.

Question 7:

Which weight loss suggestion is designed to achieve some level of ketosis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

Question 8:

One major side effect of the herbal supplement can be hot flashes and increased perspiration due to increased thermogenesis, what is the likely cause of the heat production?

A. Increasing the activity of phosphfructokinase-1.

B. Increasing the activity of the pyruvate dehydrogenase complex.

C. Increasing the activity of citrate synthase.

D. Increasing the activity of uncoupling proteins.

Question 9:

Would substituting fiber and complex carbohydrates (larger % cellulose) for the simple sugars and starches (high sucrose and amylose/amylopectin) help Morgan lose weight, why?

A. Yes, because complex carbohydrates like cellulose are largely indigestible so they pass through

the digestive tract without being absorbed.

B. Yes, cellulose contains less glucose residues than amylose or amylopectin.

C. Yes, because the fructose in sucrose is much more responsible for weight gain than the glucose.

D. No, because cellulose, amylose, and amylopectin are all composed of glucose so it doesnât

matter.

Question 10:

Which weight loss suggestion will lead to an increased need for gluconeogenesis?

A. Atkins Diet

B. Exercise

C. High fiber diet

D. Herbal treatments

ESS 3 Lecture Notes - Lecture 9: Hypoglycemia, Glycemic Load, Saturated Fat

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