DM and hypoglycemia darrow Flashcards
skin issues in DM
diabetic dermopathy finer peples acanthrosis nigricans bullous diabeticorum vitiligo
metabolic syndrome
waist circumference >40" men >35" women TGs >150 HDL 130/85 glucose >100 apple or Tasmanian devil shape
what are the mediators of metabolic syndrome?
leptin abnormal adiponectin resistin visfatin TNF-alpha IL-6 thrombospondin plasminogen activator-1
TSP1
expressed by adipose tissue -> activates TGF-beta -> activated PAI-1 which is procoagulant
TPS1 is inhibited PPARy agonists (TZDs)
lean people adipose tissue
few macros
secretes high levels of adiponectin
low levels of inflammatory cytokines
obese people adipose tissue
lots of macros
tissue secretes high levels of many adipokines and low levels of adiponectin
is omental or sub-Q fat healthier
sub-Q
what happens to uric acid levels in metabolic syndrome
increased
what type of cholesterol is increased in metabolic syndrome
small dense LDLs
what happens to plasminogen activator levels in metabolic syndrome?
increased
this is bad b/c increases coagulation
what happens to platelet aggregation in metabolic syndrome
increased
what happens to homocysteine levels in metabolic syndrome?
increased
what is the initial step in both micro and macrovascular damage
tissue damage by hyperglycemia-mediated mitochrondrial superoxide production
Criteria to Dx DM
random glucose >200 with symptoms
FBS >126
2 hour post meal >=200 (2x)
HbA1C>=6.5% (2x)
what TF is associated with type II
TCF7L2
part of WNT pathway which activates frizzled which controls beta cell development and fnx
what ion imbalances can cause polyuria
hypercalcemia
hypokalemia
both of these affect distal tubule
Abs in DMI
zinc transporter Abs glutamic acid decarboxylase 65 (GAD65) Abs insulin Abs tyrosine phosphatase Abs islet cell Abs insulinoma-associated Abs
what HLA is associated with DMI
HLA-DR3
MODY defect
TFHNF 1-> decreased apoM -> decreased clearance of HDL which in this case is not cardioprotective
inheritance of DMII vs MODY
DMII- polygenic
MODY- monogenic, autosomal dominant
age of onset of DMII vs MODY
DMII- >40
MODY <25
penetrance of DMII vs MODY
DMII- variable (10-40%)
MODY 80-90%
obesity of DMII vs MODY
DMII usually obese
MODY not usually obese
MODY 3
HNF1alpha mutation
TF
most common
responds to SUs
Medications which can cause DM
cyclosporine tacrolimus steroids thiazides beta-blockers olanzopine
reasons for insulin resistance
AEIOU Has Poorly Controlled Diabetes Aging Endorcinre Infections Obesity Uremia Hyperglycemia Acanthrosis nigricans Stress Pregnancy, pancreatic disorders, polygalndular failure syndrome Cortisone Disorders of insulin, myotonic Dystrophy
Drugs that cause hyperglycemia
beta-blockers glucocorticoids Oral contraceptives Pentamidine Niacin Olanzapine (anti-psychotic) cyclosporin
obesity with mm
excess calories -> increased lipogenesis -> excess malonyl CoA -> blocks fatty acyl CoA oxidation -> TG and LP synthesis -> increased DAG and ceramide -> activate PKA pathways -> inhibit insulin R
obesity and liver
visercal fat -> TNF-apha and resistin -> block insulin R
obesity and pancreas
TNF-alpha effects -> kills B cells
Type IV
XANTHOMAS
hepatic overproduction of VLDL
may be acquired in DM
cheriopathy
glycate your collagen can’t bring fingers together
what are CAD equivalents
DM cerebral aa disease AA PVD should be on a statin
IIb hyperlipidemia
most common in DM
HTN and obese
NO xanthomas
lactescent plasma
III hyperlipidemia
equal elevation of TGs and chol
Whipple’s triad
-symptoms and signs of hypoglycemia (confusion, sweating, tachy)
-low glucose at time of event
-reversal with glucose
MUST check for insulinoma
sympathoadrenal signs
glucose <60 sweating tachy anxiety tremulous nausous most common in post prandial hypoglycemia
neuroglycopenic signs
glucose <50 blurred vision fatigue dizziness HA confusion seizures coma death most common in fasting hypoglycemia
Dx insulinoma
- serum glucose
- serum insulin and C-peptide (when glucose in <5
- fast up to 72 hours with glucose and insulin
- serum B-hydroxybutyrate
Tests for insulinomas
endoscopic US
Ca stimulated angiography
Tx for insulinoma
Surgery Frequent food Diazoxide Verapamil Octreotide
nesidioblastosis
hyperplasia of beta cells
causes hypoglycemia after eating
Causes of hypoglycemia
Re-ExPLAINS
renal disease
exogenous drugs, exercise
pit insufficiency, pregnancy, post gastrectomy
liver failure
adrenal insufficiency, acidosis, alcohol, artifactual
islet cell tumors, infection, immune mediated
neoplasms
sepsis, spurious
drugs causing hypoglycemia
SAP
SUs
alcohol, ASAs, antidysrrhymics, abx, acetaminophen overdose
pentamidide
how does hypoglycemia precipitate CV events
- triggers inflammation via CRP, IL6, VEGF
- induces increased platelet and neutrophil activation
- increases adrenaline -> increased cardiac work load
- underlying endothelial dysfunction -> vasodilation