Darrow DM Flashcards
What is metabolic syndrome
2 physical findings: waist circumference >40 inches men >35 in women apple shape 3 labs: HTN: >130/85 TG: >150 HDL-C 100
what does adipose tissue secrete
inflammatory and immune mediators “adipokines”
specific mediators secreted by adipose tissue
leptin, adiponectin, resistin, visfatin, TNF alpha, IL-6, thrombospondin, plasminogen activator 1
what does adipose tissue look like in obesity and insuline R
many macrophages, tissue secretes high levels adipokines and low levels adiponectin
why are thiazolinediones used in severe obestiy
decrease insulin R adipocyte differentiation is modified VEGF induced angiogenesis inhibited leptin levels decrease levels of certain IL (IL6) dec antiproliferative action adiponectin levels rise inhibit TSP1 expression
role of TSP1 in adipose tissue
activates TGF-beta which activaes PAI-1 which is procoagulant
what is worse
SQ fat or omental
omental
uric acid levels in metabolic synfrome
hyper
LDL levels in metabolic syndrome
low
plasminogen activator inhibitor levels in metabolic syndrome
high
levels of homocysteine in metabolic syndrome
increased
what is the initial step of tissue damage in DM
hyperglycemia mediated mitochondrial superoxide production
Dx criteria DM II
Random glucose >200 with Sx!
FBS> 126 repeatable
2 hour post meal BS >200 repeatable
HbA1c>6.5% repeatable
what can cause low HbA1c
HbF, hemolytic anemia, acute bleed, Vit C and E
Causes of DM II
genetic
TCF7L2 transcription factor for WNT signlaing for beta cell
environmental: visceral obesity, insulin R
causes of polyuria
CDRIPPED Cortisol escess DM Recovery from renal railure Ions (hyper Ca and hypo K) Parkinsons Psychogenic Polydipsia Enzyme-vasopressinase Drugs: lithium, demeclocycline, methicillin
What Ab can you detect in DM I
glutamic acid decarboxylase 65 insulin islet cell cytoplasmic Ab insulinoma assoc 2 autoAb zinc transporter Ab tyrosine phosphatase Abs
HLA DM I
DR3 DR4
Patient was Dx with DM I 20 yrs ago and on insulin since
she went on vacation and forgot insulin but no adverse effects except increased polyuria
most likely?
abnormal nuclear transcription factor in beta cells
defect in transcription factor hepatic nuclear factor results in what
decreased apo M and so decreased clearance of HDL which is not cardioprotective
inheritance of MODY (maturity onset diabetes of young)
autosomal dominant
what drugs are effeective in MODY 3 syndrome
sulfonylurea
what is defective in MODY2
glucokinase
how do MODY syndromes lead to diabetes
impaired glucose secretion of insulin
most common MODY
type 3
what type of diabetes resemlbles type I without the Ab
mutation of mitochondrial DNA
what medications can lead to diabetes
cyclosporine, tacrolimus, steroids, thiazides, beta blockers, olanzopine
what is stiffman synrome
immune mediated, R Ab that can lead to diabetes
what genetic syndromes can be associated with diabetes
downs
turners
klinefelters
friedreichs ataxia
Reasons for insulin resistance
aging endocrine disorders infections obesity uremia and hepatic disease hyperglycemia acanthosis nigricans, ataxia telangiectasia Stress pregnancy cortisone disorders of insulin
What drugs can produce hyperglycemia
beta blockers hormones, HAART alcohol, antipsycotics sympathomimetics thiazides, ticyclics oral contraceptives, opiates pentamidine, phenytoin indocin, isoniazid, imunosuppressants niacin
how does obesity lead to DM II
excess calories cause lipogenesis which block FA oxidation adn stimulate TG and LP synthesis with diacylglycerol and ceramide as byproducts that activate PKC that inhibits insulin R activity
TNF alpha is produced and increases insulin R
patient has DM and red bympy rash what is this called and what causes it
eruptive xanthomas from hyper TG and overproduction VLDL
assoc with DM
complications of eruptive xanthomas caused by increased VLDL
pancreatitis
in type I HLD what do you have increased amounts of
chylomicrons
in type IV HLD what do you have increased amounts of
VLDL
What is cheiropathy and what causes it
patient can’t bring hands together (prayer)
from glycating collagen
if cholesterol is high but TG is not suepr high what type of HLD is it
2B
what R is messed up in 2B HLD
LDL R messed up
type III HLD
E2/E2
chol=TG
what is increased in 2B HLD
APO B 100 and VLDL
most common type HLD with DM
2B the familial combined HLD
