34 Pathophysiology of Type 2 Diabetes Mellitus

Question 1

Primary site for de novo lipogenesis

Answer 1

Liver

Question 2

Primary storage for triglycerides

Answer 2

Adipose tissue

Question 3

Main effects of insulin signaling in the muscle (3)

Answer 3

Glucose uptake/metabolism
Protein synthesis/growth
Suppression of atrophy/autophagy

Question 4

Main effects of insulin signaling in adipose tissue (4)

Answer 4

Glucose uptake
Lipogenesis
Gene regulation
Suppression of lipolysis

Question 5

Main effects of insulin signaling in the liver (2)

Answer 5

Lipogenesis
Suppression of glucose production

Question 6

Predominant glucose transporters in the brain (2)

Answer 6

Glut1 and Glut3

Question 7

Abdominal fat vs subcutaneous fat:
More lipolytically active

Answer 7

Abdominal fat

Question 8

Abdominal fat vs subcutaneous fat:
Greater complement of adrenergic receptors

Answer 8

Abdominal fat

Question 9

Abdominal fat vs subcutaneous fat:
Resistant to antilipolytic effects of insulin

Answer 9

Abdominal fat

Question 10

Abdominal fat vs subcutaneous fat:
Releases more adiponectin

Answer 10

Subcutaneous fat

Question 11

Abdominal fat vs subcutaneous fat:
High levels of HSD11B1

Answer 11

Abdominal fat

Question 12

Abdominal fat vs subcutaneous fat:
Increased local cortisol production

Answer 12

Abdominal fat

Question 13

Predominant insulin receptor isoform in the brain

Answer 13

IR-A

Question 14

Primary site of glucose disposal after a meal

Answer 14

Skeletal muscle

Question 15

Maternal insulin secretion increases by how much in pregancy

Answer 15

250%

Question 16

Mechanism as to how calcineurin inhibitor contributes to diabetes

Answer 16

Decreased insulin secretion

Question 17

Most common adverse effect of bromocriptine use in diabetes

Answer 17

Nausea

Question 18

Onset of action of rapid acting insulins

Answer 18

<5 mins: Aspart (Fiasp)
10-20 mins: Aspart (Novolog), Lispro (Humalog), Glulisine (Apidra)

Question 19

Time to peak of rapid acting insulins

Answer 19

0.5-1.5 hours

Question 20

Duration of action of rapid acting insulins

Answer 20

3-5 hours

Question 21

Onset of action of regular human insulin

Answer 21

30-45 mins

Question 22

Onset of action of NPH insulin and long acting insulins

Answer 22

60-120 mins

Question 23

Time to peak of regular human insulin

Answer 23

2-4 hours

Question 24

Duration of action of regular human insulin

Answer 24

4-8 hours

Question 25

Time to peak of NPH insulin

Answer 25

4-8 hours

Question 26

Duration of action of NPH insulin

Answer 26

12-20 hours

Question 27

Three cardinal abnormalities in T2DM

Answer 27

Resistance to action of insulin in peripheral tissues Defective insulin secretion Increased glucose production by the liver

Question 28

Earliest detectable abnormality in those predisposed to T2DM

Answer 28

Insulin resistance

Question 29

This monogenic form of diabetes is characterized by the presence of insulin resistance, acanthosis nigricans, and hyperandrogenism

Answer 29

Type A insulin resistance

Question 30

This monogenic form of diabetes is characterized by severe intrauterine growth restriction, abnormal facies, and death within 1-2 years of life

Answer 30

Donohue syndrome (leprechaunism)

Question 31

This monogenic form of diabetes is associated with short stature, protuberant abdomen, and abnormalities of teeth and nails. Pineal hyperplasia was a characteristic in the original description of this syndrome.

Answer 31

Rabson-Mendenhall syndrome

Question 32

Mutation in the lamin A gene can cause a face-sparing familial partial lipodystrophy, also commonly referred to as:

Answer 32

Dunningan syndrome

Question 33

Mutation in the lamin A gene can cause this syndrome characterized by partial lipodystrophy, postnatal growth retardation, and craniofacial and skeletal malformations.

Answer 33

Mandibuloacral dysplasia syndrome

Question 34

Acquired generalized lipodystrophy is also known as:

Answer 34

Seip-Lawrence syndrome

Question 35

First polymorphism identified for T2DM

Answer 35

Gly972Arg in IRS1

Question 36

Mutations in these genes are thr most common cause of neonatal diabetes

Answer 36

KCNJ11 and ABCC8

Question 37

A variant in this gene found almost exclusively in the Samoan population is associated with a large increase in BMI per risk allele and is also associated with a paradoxical decrease in risk of developing T2DM

Answer 37

CREBRR

Question 38

Main glucose transporter involved in uptake in muscle and dipose

Answer 38

GLUT4

Question 39

Effect of insulin action on the endothelium

Answer 39

Vasodilation

Question 40

Effect of insulin stimulation on cardiomyocyte (2)

Answer 40

Increased glucose oxidation and hypertrophy Suppressed fatty acid oxidation and autophagy

Question 41

Primary site of glucose disposal after a meal

Answer 41

Skeletal muscle

Question 42

Primary deacetylase of mitochondria

Answer 42

Sirt3

Question 43

Enzyme that catalyzes the transfer of acyl chain from carnitine to CoA

Answer 43

CPT2

Question 44

Enzyme that mediates the uncoupling of oxidative phosphorylation in brown adipose tissue for thermogenesis

Answer 44

UCP1

Question 45

Lipoatrophy in HIV is primarily associated with the use of:

Answer 45

Older thymidine analogue NRTIs