DM

Question 1

Acute presentation

Answer 1

Polydipsia, polyuria, polyphagia, weight loss
DKA (type 1)
Hyperosmolar coma (type 2)

Unopposed secretion of GH and EPI, exacerbating hyperglycemia

Question 2

Chronic presentation

Answer 2

Non enzyme glycosylation

1) small vessel disease
2) glucoma
3) nephropathy
4) large vessel atheroscleosis: CAD, PVD gangrene, limb loss and cerebrovascular disease

Osmotic damage (sorbital accumulation in organs with aldose reductase)

5) neuropathy (motor, sensory, autonomic)
6) cataract

Question 3

Small vessel disease

Answer 3

Diffuse thickening of basement membrane =>

retinopathy: hemorrhage, exudate, microaneurysm, vessel proliferation

Question 4

Nephropathy

Answer 4

Nodular sclerosis,
Progressive proteinuria,
Chronic renal failure
Arterioscelrosis leading to HTN
Kimmselstiel-Wilson nodules

Question 5

Test:

Answer 5

Tasting serum glucose
Oral glucose tolerance
HbA1c (reflects average over 3 months)

Question 6

Type 1

Answer 6

Genetic predisposition: weak (50% in twin), polygenic, HDL-DR3,4
Ketoacidosis: common
Classic presentation (polyuria, polydipsia, polyphagia, weight loss): common
Histology: islet leukocytic infiltrate

Question 7

Type II

Answer 7

Genetic predisposition: relatively strong (90% in twin), polygenic.
Ketoacidosis: rare
B cells: numbers variable with amyloid deposits
Histology: islet amyloid (AIAPP) deposits

Question 8

Diabetic ketoacidosis

Answer 8

Most important complication of Type I
Usually due to increase insulin requirement from stress (infection)
Excess fat breakdown
Increased ketogenesis from increased free FA
(beta-hydroxybutyrate >acetoacetate)

Question 9

DKA:

signs

Answer 9

Kussmal repiration (rapid/deep)
Nausea/vomoting
Abd pain,
psychosis/delirium
dehydration
fruity breath odor

Question 10

DKA:

lab

Answer 10

Hyperglycemia,
low pH,
low HCO3- (anion gap metabolic acidosis)
high blood ketone
Leukocytosis
Hyperkalemia (but depleted intracellular due to transcellular shift)

Question 11

DKA

complication

Answer 11

Life threatening mucormycosis,
Rhizupus infection
Cerebral edema,
cardiac arrhythmia
heart failure

Question 12

DKA

treatment

Answer 12

IV fluid
IV insulin
K+ (replete intracellular store)