Diabetes

Question 1

• T1DM:
• Normal fasting? Oral? HbA1C?
• DM fasting? Oral? HbA1c?
• Prevalence?
• Associated with? (3)
• Immune mediated by? 2 at risk alleles? Protective? MHC on chrom? Allelle? Halo? Geno?
• 4 auto antibodies? DM with?

Answer 1

• 126, >200, >/= 6.5%
• 1:300
• Thyroid > Crohns > Addisons
• T cells; DQ2/8; DQ6; DRB1:0401; DRB1:0401 - DQB1 - 0302; DRB1:0401 - DQB1 - 0302 - DRB1:0301 - DQB1 - 0201
• Insulin, IA-2, GAD-65; ZnT8

Question 2

• T1DM:
• 4 possible triggers?
• Autoantibodies and age are good predictors of?
• 3 effects of insulin deficiency?
• primary prevention?
• Secondary?
• Tertiary? 2 drugs?

Answer 2

• Infections, diet, weight (accel. hypothesis), hygeine hypothesis)
• Insulin replacement
• Decrease glut 4 transport, increased glucose production, increased activity of hormone sens. lipase
• Stop autoimmue ab development
• stop clinical disease via insulin (oral)
• Preserve B cells and lower complications; anti-CD3 preserves C-pep; Abatacept blocks CD80:CD28 stim

Question 3

• T2DM:
• Epi? Normal amount of blood glucose? DM?
• Differences with T2DM? (3)
• Pathogensis? (2)
• Insulin? Glucagon?
• First line treatment?
• 2 Emergencies? More common in?
• Hormones to raise BG? (4) Lower?
• 3 things that happen with DKA?

Answer 3

• 9.3%; 5g; >7g
• Dyslipidemia, Family Hx, Insulin resistant
• Insulin resistance + Lower insulin secretion
• Low; high
• Diet and exercise
• DKA, Hypo (T1DM)
• GF, cortisol, NE, Glucagon; Insulin
• Lack of insulin and increased counter reg hormones; increased ketones via mitochondria FFA’s; hyperosmolar hyperglycemia

Question 4

• DM Complications:
• Biggest killer in T2DM?
• Lipids? (3)
• Procoagulant state? (2)
  1. ) Polyol pathway? Effects what?
  2. ) Hexosamine pathway?
  3. ) PKC/AGE Pathway?
• Retinopathy steps? (6) Start treating when?
• 3 nephro effects?
• 4 neuropathy types?
• CVD increased risk? #1 of? (3) Preventable?

Answer 4

• Ischemic heart disease
• High TG/VLDL; low HDL
• Low tPa and high PAI-1 (inhibits tPa)
  1. ) Glucose –> Sorbitol; effects eye
  2. ) Fructose –> Hexosamine
  3. ) Glyceraldehyde –> PKC –> 12 kinases
  3. ) Glyceraldehyde –> AGE –> Incr. glyc. –> Pro inflam
• Pericyte neuron drop out –> cap drop out –> BM thick –> Leaky fluid –> VEGF –> Neovasc; severe preprolf
• BM thickened; mesengial prolif; glomer oblit
• Mononeuritis (single side); Distal symmetric; Autonomic, DM Amyotrophy
• 3-5x; Blindenss, ESRD, non traumatic amputations