3. Type 2 diabetes - pathogenesis, clinical manifestation

Question 1

what is the pathogenesis of type 2 diabetes ?

Answer 1

insulin resistance

with time there is progressive beta cell failure giving insulin deficiency

Question 2

most individuals with type 2 diabetes have what other associations ?

Answer 2

visceral obesity

hypertension

vascular endothelial dysfunction

dyslipidemia = high TG , low hdl , postprandial hyperlipemia

Question 3

hat is the pathogenesis of type 2 diabetes ?

Answer 3

8 principles leading to hyperglycaemia

1_ decreased peripheral glucose uptake with endogenous hepatic glucose production

2- increased lipolysis = accumulation of FFA

3- compensatory insulin secretion from b cells = eventually reaching a maximum and deteriorates

4- inappropriate release of glucagon form alpha cells = esp post prandial

5- impaired insulin secretion and excessive glucagon secretion = facilitated by incretin defect

6- incretin defect = not adequate response to incretin in meal ingestion and islet cell resistance

7 = hypothalamic insulin resistance
elevated sympathetic drive
impairs circulation insulin to suppress glucose production

8 ) renal tubular glucose absorption enhanced

Question 4

what is the pathogenesis of diabetic retinopathy ?

Answer 4

1) sorbital accumulation
glucose metabolised to sorbitol = aldostrenoreductase
= increased osmolarity , cell edema = oxygen radicals

2) basmenet membrane glycosilation of vasculature = thickening of the basement membrane
3) activation of protein kinase c by VEGF and neovascularisation
4) micro aneurysm formation = serves as a site for fluid and lipid leakage = DIABETIC MACULAR EDEMA FORMATION

Question 5

what are the clinical manifestations of type 2 diabetes ?

Answer 5

polyurea
polydyspsia
polyphasgia