Diabetes

Question 1

Requirements (2) to develop diabetes

Answer 1

1. Insulin resistance

2. Decreased insulin secretion

Question 2

Which signal pathway is disrupted in insulin resistant pt?

Answer 2

PI3K kinase to confer a metabolic signal

Question 3

Pathological steps when PI3K kinase pathway is disrupted (5)

Answer 3

1. Metabolic signal disrupted
2. Lipolysis
3. Release FFA
   4a. FFA trigger hepatic production of glucose
   4b. FFA damage of beta cells
4. Hyperglycemia

Question 4

Incretin effect?

Answer 4

Potentiates effect of insulin and suppresses glucagon

Question 5

Glucagon dysfunction in insulin resistant

Answer 5

Alpha cell depends on beta cell secretion to regulate
=> Decreased insulin –> decreased inhibition of glucagon –> glucagon stimulates liver to produce glucose –> hyperglycemia

Question 6

How much beta cells damaged at time of dx normally?

Answer 6

50%

Question 7

Maturity Onset Diabetes of the Young (MODY)

Answer 7

1. Inherited
2. 1-2 % DM in youth
3. Autosomal Dominant : mutation glucokinase gene and/or mitochondrial genes
   => defect in glucose sensor
   => defect of insulin secretion

Question 8

MODY presentation

Answer 8

early in life with strong family hx AND negative antibodies

Question 9

Tx for MODY

Answer 9

sulfonylureas or insulin

Question 10

Gestational diabetes

Answer 10

1. Insulin resistance due to hormonal changes/weight gain
2. Occurs in 4% of pregnancy women
3. 30-40% develop T2DM within 10 years

Question 11

Gestational diabetes presentation & complication

Answer 11

• 2nd-3rd trimester
• Complication:
  1. bigger babies
  2. mother and babies risk developing T2DM later in life

Question 12

Gestational diabetes dx

Answer 12

1. Fasting glucose > 95 mg/dl

2. 2-hr OGTT > 155mg/dl

Question 13

Pancreatic Diabetes

Answer 13

DM resulting from removal of or injury to pancreas (surgery, pancreatitis)
=> beta cell loss results in insulin deficiency

Question 14

Pre-Diabetes criteria (3)

Answer 14

1. Fasting glucose: 100-126 mg/dl
2. 2h OGTT: 140-200 mg/dl
3. HbA1C: 5.7-6.4%

Question 15

Metabolic syndrome criteria

Answer 15

Three of more:

1. Waist circumference > 40 in (men) or > 35 in (women)
2. Triglycerides > 150 mg/dl
3. HDL 130/85
4. Fasting glucose > 100 mg/dl

Question 16

Hypoglycemia Unawareness

Answer 16

No longer have adrenergic symptoms of hypoglycemia after many hypoglycemic episodes

Question 17

Symptoms of Hypoglycemia (adrenergic vs. neuroglycopenic)

Answer 17

1. Adrenergic (too much Epi)
   * Sweating, Tremor, Tachycardia, Anxiety, Hunger
2. Neuroglycopenic:
   * Dizzy, HA, confusion, convulsion, LOC

Question 18

Hypoglycemia Dx

Answer 18

1. Measure C peptide (endogenous vs. exogenous)

2. glucose