Diabetes

Question 1

diagnostic criteria for diabetes

Answer 1

1. symptoms of DM + random plasma glucose >200mg/dL 2. fasting glucose >125mg/dL x2 3. 75g glucose load –> glucose conc >200 2 hr later (140-200 = impaired glucose tolerance)

Question 2

impaired glucose tolerance - epic and natural hx

Answer 2

causes damage to large vessels/atherosclerosis (but not small) can progress to diabetes over time 16% of US pop

Question 3

risks of gestational diabetes

Answer 3

increased risk to develop non-pregnant diabetes increased risk of eclampsia increased risk of large infant

Question 4

metabolic syndrome

Answer 4

some combo of 3 or more of: obesity, hyperlipidemia, HTN, impaired glucose tolerance

Question 5

describe DKA

Answer 5

lack of insulin, increase in glucagon –> gluconeogenesis –> when you run out of NAD make ketones and beta hydroxybutyrate

Question 6

which tissues can take up glucose in the absence of insulin

Answer 6

liver and RBCs via GLUT2 (insulin independent)

Question 7

tx for DKA

Answer 7

replete fluids insulin to regain metabolic control - monitor via acid levels in blood. (glucose will normalize quickly, but lipolysis will continue to for longer –> acidosis)

Question 8

do T2D pts get ketoacidosis?

Answer 8

NO! they might have really high glucose, but they make enough insulin to avoid total breakdown in physiology (no ketones, no acidosis, normal bicarb) can get hyperosmolar non-ketonic coma instead (HONK)

Question 9

high risk HLA types for T1D

Answer 9

IDDM1 on chrom 6 - bad = DR3, DR4, +DQ - protective = DR2/DQ IDDM2 on chrom 11 - bad = shorter promoter other markers for autoimmunity - bad = DR/DQ, CTLA-4

Question 10

what is most predictive of T1D diabetes development?

Answer 10

circulating islet antibodies: GAD-65 autoantibodies, insulin autoantibodies, IA-2 autoantibodies

Question 11

what ethnicity has the highest risk for T2D

Answer 11

hispanic

Question 12

are genetics more impt in T1D or T2D?

Answer 12

T2D

Question 13

MODY-2

Answer 13

maturity onset diabetes of the young autosomal dom mutation in glucokinase gene (glucose sensor) –> higher serum glucose b/f insulin is released

Question 14

T2D - describe insulin resistance in liver and fat

Answer 14

liver: insulin regulates (decreases) OUTPUT of glucose fat: insulin increases glucose uptake up fat tissue and OUTPUT of FFAs from fat cells

Question 15

hormones made by fat tissues

Answer 15

adiponectin leptin

Question 16

adiponectin

Answer 16

made by fat tissue increases insulin sensitivity LOW in T2D

Question 17

leptin

Answer 17

made by fat tissue - increases w/ increasing fat storage –> inhibits appetite

Question 18

GLP-1

Answer 18

secreted by jejunum in response to eating increases insulin release and responsiveness, decreases glucagon release slows stomach emptying, inhibits appetite

Question 19

glucose toxicity

Answer 19

chronic exposure to high levels glucose results in decreased insulin secretion and decreased muscle and liver response to insulin - tx w/ insulin and oral meds –> reversal = honeymoon period

Question 20

diabetic microangiopathy

Answer 20

diffuse BM thickening, endothelial injury and increased protein leakage microangiopathy –> ischemia complications: peripheral microangiopathy, retinopathy, nephropathy, neuropathy

Question 21

diabetic glomerulopathy

Answer 21

KW nodules

Question 22

islet changes in T1D

Answer 22

early: islitis - autoimmune attack on beta cells –> beta cell death late: islet atrophy - absence

Question 23

islet changes in T2D

Answer 23

early: no change mid course: beta cell malfunction later: beta cell depletion/atrophy late: amyloid deposits in islets

Question 24

what is this?

Answer 24

T1D early islitis

Question 25

what is this?

Answer 25

T2D late stage - amyloid deposits

Question 26

what is this?

Answer 26

diabetic microangiopathy