3.4.2 Diabetes Mellitus and Treatment Flashcards
Which medical student had pre-diabetes before doing an lifestyle overhaul?
Miles Sanderson
What are some of the possible causes of Type I DM?
Definitive: Congential Rubella
Putative: enteroviruses, rotaviruses, componets of infant’s diet, association with certain genotypes
What are some factors that can cause islet beta cells to be lost or become dysfunctional in Type II DM?
Glucotoxicity, Lipotoxicity, Inflammation, Genetic Factors, Insulin resistance, “pancreatic exhaustion”
What could lead to a better prognosis in patients with Type I DM?
The preservation of a small number of islet beta cells
How can the adipocyte act as an endocrine organ leading to hyperglycemia and against hyperglycemia?
Which type of diabetes is highly associated with obesity?
Type II DM
What are some of the characteristics of the younger children that are being diagnosed with Type II DM?
Minority children (AA, H, AI)
Girls
Mean age: 13 y/o
Family history of DM
Obese (BMI >30)
What is the WHO definition of diabetes?
A chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
What type of diabetes is characterized by AI destruction of islet cells later in life?
Latent Autoimmune Diabetes of Adults (LADA)
Describe the natural history of Type I DM and its stages.
Describe the increase in DM worldwide?
EXPLOSIVE (similar to taking a dump after a late night taco bell run after a night of heavy drinking)
How does insulin secretion, insulin resistance, postprandial glucose, and fasting glucose changing during the three stages of Type II DM?
What is the functional model of pancreatic development in Type I DM?
Islet cell neogenesis -> functional islet cell mass -> islet cell apoptosis/loss (due to AI destruction)
What are some of the potential sites for the original defect leading to type II DM?
pancreas, liver, muscle, fat
What are some of the abnormalities that arise from a (relative) lack of insulin?
Glucose, lipid, protein, and electrolyte metabolism
What are the prevelances of Type I DM, Type II DM, undiagnosed DM, and IGT in the US?
What type of diabetes has an “absolute” lack of insulin? “Relative” lack?
Absolute: Type I DM
Relative: Type II DM
Describe the nature inheritabilty of type II DM
Polygenetic with strong environmental factors
(complex genetic susceptibility with weak penetrance)
Who are at the greatest risk for developing DM?
Lower socioeconomic class
Minorities
What is the major characteristic of Type I DM?
Chacterized by near-total or complete loss of beta islet cells
What are the three phases in the natural history of Type II DM?
IGT, undiagnosed diabetes, known diabetes
Describe each of these phases of islet cells during the progression of Type I DM.
What type of DM is becoming more and more prevalent in the US?
Type II DM in young adults and children
How has the mortality of diabetes changed over time?
Increasing
Over time, what factors can play a role in the progressive loss of islet cell capacity?
inflammatory, glucose, and lipid toxicity
Insulin resistance leads to what complications associated with Type II DM?
What two conditions involving insulin lead to Type II DM?
Insulin deficiency and insulin resistance
What are some of the key triggers of Type II DM?
Obesity and Age
