Endo Review 2 (not comprehensive)

Question 1

Who should you screen for T2D?

Answer 1

Anyone obese or with 1+ risk factors.

Anyone 45 or older (repeat every 3 years)

Question 2

Glycemic goals in different populations?

Answer 2

In healthier people, try for HbA1c

Question 3

Key proteins in skeletal muscle insulin resistance?

Answer 3

AMPK (exercise pathway)

ADK (insulin receptor pathway)

Question 4

Key proteins in liver insulin resistance?

Answer 4

FOXO1 (normally inhibits gluconeogenesis, but AKT–>FoxO1 is inhibited in T2D).
SREBP1c (stimulated lipogenesis, remains insulin-sensitive)

Question 5

Key proteins in adipocyte insulin resistance?

Answer 5

1. LPL (increased lipid uptake)
2. SREBP1c (increased lipid synthesis)
3. HSL (increased FA breakdown)

In T2D, AKT inhibition of HSL is broken.

Question 6

Which type of diabetes is characterized by amyloid deposition in the islet cells?

Answer 6

T2D

Question 7

Are T2 diabetics at first for hyperosmolar hyperglycemic non-ketosis (HHNK)?

Answer 7

Guess so

Question 8

When does the loss of 1st phase insulin response occur in T1D?

Answer 8

During the “pre-diabetes” stage.

Question 9

Findings in mild retinopathy?

Answer 9

Microaneurysms
Dot hemorrhages
Hard exudates

Question 10

Findings in moderate retinopathy?

Answer 10

Soft exudates (cotton wool spots)
Venous bleeding
IRMA

Question 11

Types of diabetic neuropathy?

Answer 11

Distal symmetric sensorimotor polyneuropathy (peripheral neuropathy)
Autonomic neuropathy
Polyradiculopathy
Mononeuropathy

Question 12

Name the antihyperglycemic meds for T2D

Which drugs work on the: Liver? Kidney? Skeletal muscle? Gut? Pancreas?

Answer 12

 Metformin (liver)
 Sulfonylureas (pancreas)
 Thiazolidinediones (muscle)
 Meglitinides/Glinides (pancreas)
 Glucosidase inhibitors (gut)
 Incretin Mimetics (gut)
 Incretin Enhancers (gut)
 Sodium Glucose Transporter inhibitors (SGLT-2) (kidney)
 Insulin (lots of places)

Question 13

Which drugs can cause hypoglycemia?

Answer 13

Sulfonylureas and Meglinitinides/Glinides (according to Kendra’s notes)

Question 14

What’s one weird side effect of TZD’s?

Answer 14

Bone loss

Question 15

Peak time of regular human insulin? What about Lispro?

Answer 15

Regular: 2-4h
Lispro: 1h

Question 16

Causes of hypoglycemia?

Answer 16

1. Insulin-mediated
 Hyperinsulinism
 Insulinomas
 Exogenous insulin or insulin secretagogues 
 Autoimmune hypoglycemia
2. Failure of Counter-regulation 
 Growth hormone deficiency
 Cortisol deficiency

Question 17

If you see multiple insulinomas, what are you thinking?

Answer 17

MEN-1

Question 18

Pathophys of EtOH-induced hypoglycemia?

Answer 18

1. Depletion of hepatic glycogen
2. EtOH oxidation to acetic acid generates NADH
3. NADH inhibits lactate+amino acids–> pyruvate (part of gluconeogenesis)
   - Occurs 6-36hrs after meal.

Question 19

Cause of death from severe hypoglycemia? Epi?

Answer 19

Prolonged QT elongation (which is also aggravated by autonomic neuropathy).
Epi: leading cause of death in T1D

Question 20

One big advantage of pancreatic islet transplant?

Answer 20

Increased adrenal medulla (and neurogenic) response to hypoglycemia.