DM Flashcards
What is type Ia DM?
Immune mediated destruction of islet cells
What is type Ib DM?
idiopathic destruction of islet cells
What is the endocrinopathy that causes DM?
Somtatostatinoma
What are the diseases that can lead to DM?
Pancreatitis, CF, CA
What is the hormone that causes GDM?
Progesterone
What is the normal fasting plasma glucose levels?
<100 mg/dL
What is the normal plasma glucose level 2 hours after a meal?
<140 mg/dL
What is the diabetic fasting bg level?
> 126 mg/dL
What is the diabetic bg level 2 hours after glucose load?
> 200 mg /dL
What are the cells that are destroyed in DM I?
Beta cell destruction
True or false: any drop in beta cells will change bg levels?
False-there are more beta cells that needed to meet demand
What are the genes that are associated with DM I?
DQ and DR genes of the MHC class II
What are the two haplotypes that are associated with DM I?
DR3 and DR4
What are the antibodies that can be detected in DM I?
autoantibodies to islet cells, insulin, others
Are the antibodies responsible for the destruction of islet Beta cells?
no, infiltration of activated T lymphocytes in beta cells is.
What are the two possible triggers for DM I?
Toxins or viruses
What is the effect of breastfeeding on the development of DM I?
Decreases risk
What is the effect of living in first world countries on DM I?
Increases risk
How could viruses theoretically cause the development of DM I?
Molecular mimicry
What happens to gluconeogenesis in DM I?
increases
What happens to glycogenolysis in DM I?
Increases
What happens to glycolysis in DM I?
Decreases
What happens to lipolysis/ketone production in DM I?
Increases
What causes blurred vision seen in DM I?
Hyperosmolar state
What causes the weight loss seen in DM I?
Depletion of water
Loss of muscle mass
What causes the weakness/dizziness seen in DM I?
Postural hypotension
K loss and loss of muscle catabolism
What causes the paresthesias seen in DM I?
Temporary peripheral sensory nerve dysfunction
What causes LOC with DM I?
Dehydration of tissues
DKA
What are the three ways to manage DM I?
Diet
Edu
Insulin
Why can insulin not be given PO?
Peptide would be degraded by GI
What are the two causes of DM II?
Insulin resistance or secretory defect (or both)
What happens to Beta cell mass in DM II?
Increase since there is no uptake of glucose
What happens to the insulin receptors in DM II?
Less of them OR decrease affinity to insulin
What are the three adipokines?
Leptin
IL-6
TNF-alpha
What is the effect of adipokines?
Recruits immune cells
Can an increase in insulin and beta cell mass overcome insulin resistance?
Yes
What causes the increased beta cell stress in DM II?
Increased ER stress
Adipokines
Ectopic fat deposition in islets
What is metabolic syndrome?
Hyperglycemia associated with:
Hyperinsulinemia
Dyslipidemia
HTN
Metabolic syndrome can lead to what?
CAD and Stroke
What is the effect of insulin on Na retention?
Increases
What is the effect of insulin on VLDL secretion?
Increases
What is the effect of insulin on vascular smooth muscle cell proliferation? What does this result in?
Increases–results in atherosclerosis
What is the significance of metabolic syndrome on management?
Changes therapeutic approach
Which DM type has a higher concordance rate between monozygotic twins?
Type II
What are the genes that predispose someone to DM II involved in?
Beta cell function
Why are infections more common in DM II?
high sugar blood = good for bacteria
What are the classic, severe signs/symptoms of DM II?
Polyuria, polydipsia, blurred vision, weakness
What are the pharmacologic strategies toward DM II?
- Increase insulin secretion or action
- Inhibits gluconeogenesis
- Inhibit glucose digestion/absorption
- Suppress glucagon
What is the effect of drugs that mimic GLP1 on treating DM II?
Promotes insulin secretion
What is the effect of drugs that inhibit DDPP4 on treating DM II?
inhibits GLP1 degradation
What is the effect of drugs that sulfonylurease and meglitinde analogs on treating DM II?
Inhibits that ATP sensitive K pump on beta cells which closes the channel and causes a depolarization
What is the effect of drugs that thiazolidinediones on treating DM II?
Promote the expression of GLUT1 and GLUT4, and thus increase glucose uptake in peripheral tissues
What are the symptoms of hypoglycemia?
Tachycardia Sweating Tremors Nausea Hunger
What are neuroglycopenia symptoms
Irritability Confusion HA Speech difficulty Blurred vision LOC
What is the treatment for hypoglycemia?
Glucagon/glucose
What causes DKA?
insulin deficiency causes lipolysis, causing acidification of the blood
When is DKA seen in DM II pts?
Sepsis, trauma, or surgery
What are the treatment goals of DKA?
Restore plasma volume
Reduces glucose
Correct acidosis
Replenish electrolytes
