Case 2: When Life Is Too Sweet Flashcards
What do the letters of PITCHIN stand for and what does each one do?
Phagocytes: WBC that engulf phagocytose pathogens
InTerferons: small proteins released by virus-infected cells to increase macrophage activity
Complement: proteins that attract phagocytes to foreign bacteria
Histamines: Inflammatory response, secreted (with heparin) by mast cells
Natural killer cells: lymphocytes that lyse infected foreign cells
What two things cause issues with immunity?
excessive response (autoimmune) inadequate response (immunodeficiency)
What are the three stages of wound healing?
- inflammation: fills with clot and cells (neutrophils first, mast, macrophage, etc)
- tissue formation: increased macrophages and fibroblasts to make granulation tissue (increased keratinocytes)
- tissue remodeling: re-epithelialization, decreased cellular density of granulation tissue, ECM remodeled, formation of scar
What does the exocrine portion of the pancreas produce, how much of the pancreas does it make up and what cells secrete?
digestive enzymes (produced by acinar cells), bicarbonate ions to small intestine 99%
What does the endocrine portion of the pancreas produce, how much of the pancreas does it make up and what cells secrete?
insulin (beta cells) and glucagon (alpha cells)
islets of Langerhans (also secrete somatostatins and pancreatic polypeptide)
1%
What happens when you eat (hormone in response to glucose)? How much glucose is normally in blood 2 hours after meal?
increased blood glucose detected by beta cells beta cells secrete insulin increased uptake of glucose from blood 8-10 mmol/L
How does insulin work and what does it effect?
activates second messengers
change in metabolism and change in genes (growth)
What does glucagon do?
low glucose = break down of glycogen
How are AGEs formed? What is good for measuring hyperglyscaemia and T2DM?
when glucose binds to proteins or lipids (glycation)
in RBC, glucose to haemoglobin
HBA1c good for measuring hyperglycaemia and T2DM
How are lipid intermediates formed?
decreased insulin = free fatty acids and LI
What do the numbers in a blood pressure reading mean?
systolic: pressure as blood pushes through heart
dystolic: pressure maintained by arteries between heartbeats
What causes T1DM?
autoimmune
destruction of islets of Langerhans so less insulin released
Why are diabetic foot ulcers common?
decreased macrophages, slow collagen formation, decreased cell proliferation, decreased formation of new blood vessels
What is happening with T2DM? And what can it cause?
insensitivity to insulin
nerve damage, insensitivity in limbs
damage to retinas, kidneys, liver, pancreas, stomach, muscle
increased amount of ADVANCED GLYCATION END PRODUCTS
What is the cause of hyperglycaemia? What can it cause?
capacity of glucose transporters exceeded, some glucose remains in filtrate, less H2O reabsorbed (H2O goes from low concentration to high concentration)
dehydration
In the nephron, glucose is cotransported on what molecule from what concentration to what concentration?
sodium
from high concentration in tubule to low concentration in cells lining nephron
What does noradrenaline do?
constriction of kidney arterioles
decreased filtration and H2O secretion
constriction of vessels to increase BP
What does ADH do? Where is it released from and what stimulates its release?
increase H2O reabsorption and constricts blood vessels (urine production decreases)
posterior pituitary
decreased BP and increased salt in blood
What does renin-angiotensin aldosterone do?
increase salt and water absorption
What substance does endothelium produce to increase blood flow?
nitric oxide
What happens in atherosclerosis?
increased glucose and lipid intermediates damages endothelium
inflammatory response
increased glucose in blood, increased clotting
LDL (bad) cholesterol deposits on artery walls
What are the three reasons insulin insensitivity occurs in T2DM?
decreased affinity between insulin and receptor
decreased number of receptors (receptor down regulation
decreased effectiveness of receptor
What two medications decrease blood pressure and how?
diuretics: decrease reabsorption of NA+ and therefore water
calcium channel blockers: relaxation of smooth muscle
How does obesity lead to insulin resistance?
obesity to increased free fatty acids and glucose to hyperinsulinaemia to insulin resistance
What do biguanides (metformin) do?
prevent production of new insulin from liver and increase sensitivity
What do SGLT2 inhibitors do?
decrease glucose reuptake from filtrate
What do alpha-glucosidase inhibitors do?
competitive inhibitors of enzymes in small intestine where carbs are digested
What do ACE inhibitors do?
decrease salt and water retention
INHIBIT PRODUCTION OF ANGIOTENSIN II
What is ACE?
ANGIOTENSIN CONVERTING ENZYME
What does angiotensin II cause?
aldosterone secretion in kidneys which leads to water retention and salt reaborption
