Diabetes Flashcards
Metabolic syndrome features
BP - more than 140/90
Central obesity - more than 94cm in males (37 inches) and 80 cm in F (31 inches)
FASTING hyperglycemia over 6mmol/L
Dyslipidemia - decreased HDL <1mmol/L and increased TGs >2mmol/L
Microalbuminemia
Diabetes diagnostic levels
Fasting glucose >7mmol/L
Random plasma glucose >11.1
HbA1c >48
T2DM cause
Linked to metabolic syndrome and insulin resistance
T1DM cause
CD4 and CD8 destruction of beta cells in islets of langerhans
Describe the EXOCRINE function of the pancreas
Produces HCO3 and digestive enzymes - lipase, amylase, protease
What two hormones stimulate the production of HCO3 and digestive enzymes (separately), and where are they produced?
SECRETIN is produced by S cells of the DUODENUM, stimulates HCO3 secretion to buffer gastric acid
CCK - produced by I cells, stimulates digestive enzyme release
Where are the exocrine stuff released by the pancreas?
Into acinar ducts by acinar cells
Where is the endocrine stuff of the pancreas released from and to?
Islets of Langerhans, released into bloodstream
Islets of Langerhans - cells and function
Alpha cells - glucagon
Beta cells - insulin
Delta cells - releases somatostatin, which regulates the alpha and beta cells
D1 - vasoactive peptide which stimulates water movement into pancreas
PP - pancreatic polypeptide, self regulates secretion activities
What is C-peptide? What do low levels of it suggest?
A breakdown product of pro-insulin (it is broken down into c peptide and insulin), therefore if low, suggests insulin deficiency
What causes acute pancreatitis?
IGETSMASHED
H= hyperlipidemia
E = ERCP
D = drugs
Symptoms of acute pancreatitis
Severe abdo pain, radiating to the back, relieved by sitting forward
Symptoms of acute pancreatitis
Severe abdo pain, radiating to the back, relieved by sitting forward
What markers are elevated in acute pancreatitis? Which is better clinically?
Amylase - mildly elevated
Lipase - better marker
What is seen on histology of acute pancreatitis?
Coagulative necrosis
Complications of acute pancreatitis
Hypocalcemia - due to digestive enzymes mixing with visceral fat, resulting in calcium soaps (fat necrosis)
Hypoglycemia
Shock
Name three patterns of damage
Periductal (obstruction)
Perilobular (ischemia)
Pan lobular (all three)
Name another cause of diabetes related to the pancreas
Chronic pancreatitis
Causes of chronic pancreatitis
ALCOHOL
CYSTIC FIBROSIS
IGG4 AUTOIMMUNE
STONES/TUMOURS/OBSTRUCTION
Symptoms of chronic pancreatitis + complication
Abdo pain, radiates to back
Weight loss due to malabsorption
Complications
DIABETES
Cancer
Pseudocysts
Histology of chronic pancreatitis
Fibrosis, loss of exocrine parenchyma, calcification, duct dilation, thick secretions
What liver pathology can diabetes cause?
NAFLD
What is NAFLD? What are the two types?
NAFLD is hepatic steatosis in non-alcoholics = too much fat in liver
Simple steatosis = benign fatty infiltration
NASH = non-alcoholic steatohepatitis = fatty infiltration AND inflammation
Consequence of a particular type of NAFLD?
NASH can lead to cirrhosis
Name a congenital disorder that can lead to diabetes
Haemochromatosis
Haemochromatosis
Problem
Staining
Investigations
Symptoms
Mx
Staining - Prussian blue stain
Problem - Iron deposition disorder due to mutation at HFE gene at 6p21.3, leading to increased iron absorption in gut and deposition around the body, which can lead to various problems (cardiomyopathy, hypogonadism)
AUTOSOMMAL RECESSIVE
Invx - Raised ferritin, iron, and reduced total iron binding capacity
Symptoms - bronze skin, diabetes, hepatomegaly/cirrhosis, cardiomegaly, hypogonadism
Epidemiology - middle aged caucasians
Desferoxiamine
