Gen Path Exam 2 - Pathology of Diabetes Flashcards
1
Q
Syndrome with disordered carbohydrate metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combo of insulin resistance and inadequate insulin secretion to compensate
A
Diabetes mellitus
2
Q
Leading cause of end-stage renal disease, adult-onset blindness, and nontraumatic lower extremity amputations resulting from atherosclerosis of arteries
A
Diabetes
3
Q
Due to pancreatic islet beta cell destruction predominantly by an autoimmune process, and these pts are prone to ketoacidosis
A
Type 1 diabetes mellitus
4
Q
Most prevalent form of diabetes mellitus
A
Type 2 diabetes mellitus
5
Q
Due to insulin resistance, mainly caused by visceral obesity, with a defect in compensatory insulin secretion
A
Type 2 diabetes mellitus
6
Q
Used to be termed juvenile-onset diabetes mellitus, or ketosis-prone diabetes mellitus, or insulin-dependent diabetes mellitus
A
Type 1 diabetes mellitus
7
Q
Used to be termed adult-onset diabetes mellitus,
ketoacidosis-resistant diabetes mellitus or non-insulin-dependent diabetes mellitus
A
Type 2 diabetes mellitus
8
Q
Known as latent autoimmune diabetes in adults
A
Type 1.5 diabetes
9
Q
Autoimmune diabetes that begins in adulthood and does not need insulin for glycemic control at least in the first 6 months after diagnosis
A
Type 1.5 diabetes
10
Q
Shares genetic, immunologic, and metabolic features with both Type 1 and Type 2 diabetes mellitus
A
Type 1.5 diabetes
11
Q
Some consider it to be a slowly progressive form of Type 1 diabetes mellitus, while others consider it a separate distinct form of diabetes
A
Type 1.5 diabetes
12
Q
Refers to disorders due to monogenic defects in beta-cell function, with little or no defect in insulin action that was observed in non-obese children, adolescents, and young adults
A
Maturity-onset diabetes of the young
13
Q
Characterized by carbohydrate intolerance during pregnancy usually resolving after delivery
A
Gestational diabetes mellitus
14
Q
Diabetes that develop secondary to some other identifiable etiology or acquired disease
A
Secondary diabetes
15
Q
Pt has hyperglycemia with little or no endogenous insulin secretion
A
Type 1 diabetes mellitus
16
Q
Onset of disease is abrupt with marked polyuria, polydipsia, polyphagia, weight loss, fatigue
A
Type 1 diabetes mellitus
17
Q
Highly prone to ketosis; pts frequently present for tx in an intial episode of diabetic ketoacidosis
A
Type 1 diabetes mellitus
18
Q
Marked sensitivity/brittleness to exogenous insulin administration, particularly with regular insulin
A
Type 1 diabetes mellitus
19
Q
In Type 1 diabetes mellitus, a prodromal phase of polyuria, polydispia, and weight loss may precede the development of what?
A
Diabetic ketoacidosis
20
Q
Type 1 diabetes mellitus incidence most commonly peaks during what times in a person’s life?
A
Middle of first decade
Time of growth acceleration of adolescence
21
Q
Pts maintain some endogenous insulin secretory capability by pancreatic beta-cells despite the overt abnormalities of glucose homeostasis, including fasting hyperglycemia and/or carbohydrate intolerance
A
Type 2 diabetes mellitus
22
Q
Pts are NOT absolutely dependent on insulin for life
A
Type 2 diabetes mellitus
23
Q
Why are pts with Type 2 diabetes mellitus relatively resistant to development of ketosis in the basal state?
A
They have retention of endogenous insulin secretory capabilities
24
Q
Generally demonstrate marked resistance or insensitivity to the metabolic actions of endogenous as well as exogenous insulin, in part as the result of decreased insulin receptors
A
Type 2 diabetes mellitus
25
Have a failure of postreceptor coupling and of intracellular insulin action that is also a major cause of insulin resistance
Type 2 diabetes mellitus
26
Can have a long presymptomatic phase, leading to a 4-7 year delay in diagnosis
Type 2 diabetes mellitus
27
Type 2 diabetes mellitus occurs most commonly in what people?
40 years and older
28
Females with gestational diabetes mellitus will exhibit an increased risk for what?
Perinatal morbidity and mortality
Developing Type 2 diabetes mellitus later in life
29
What can greatly reduce the chance of developing over Type 2 diabetes mellitus after having gestational diabetes during pregnancy?
Control of weight after pregnancy
30
What are the causes of secondary diabetes?
Genetic defects of Beta cell function
Genetic defects in insulin action
Genetic syndromes
Disease of exocrine pancreas
Drug/chemical induced
Infections
31
In Type 1 diabetes mellitus, what is increased urination (polyuria) a consequence of? What is this secondary to? What is the result?
Osmotic diuresis, secondary to sustained hyperglycemia
Result = loss of glucose, water, electrolytes in urine
32
In Type 1 diabetes mellitus, what is increased thirst (polydipsia) a consequence of?
Hyperosmolar state
33
In Type 1 diabetes mellitus, what is the initial weight loss due to?
Loss of water, glycogen, triglycerides
Reduced muscle mass as AA's are diverted to form glucose and ketone bodies
34
A common feature of Type 1 diabetes mellitus is _________ _______, despite normal or increased appetite
weight loss
35
In Type 1 diabetes mellitus, what is postural hypotension a result of?
Decreased plasma volume
36
What is a serious prognostic sign in Type 1 diabetes mellitus?
Hypotension in recumbent position
37
What may be present at the time of diagnosis of Type 1 diabetes mellitus, particularly when the onset is subacute?
Paresthesias
38
In Type 1 diabetes mellitus, what is paresthesias due to?
Temporary dysfunction of peripheral sensory nerves
39
How is temporary dysfunction of peripheral sensory nerves/paresthesia in Type 1 diabetes mellitus usually resolved?
Insulin replacement (restores glycemic levels)
40
What does temporary dysfunction of peripheral sensory nerves/paresthesia in Type 1 diabetes mellitus suggest?
Neurotoxicity from sustained hyperglycemia
41
Why does blurred vision often develop in Type 1 diabetes mellitus?
Lenses/retina exposed to hyperosmolar fluids
42
What does the fruity breath odor of acetone suggest?
Diabetic ketoacidosis
43
Why does a patient's level of consciousness vary depending on the degree of hyperosmolality in Type 1 diabetes mellitus?
Minimal = insulin deficiency slowly develops, sufficient water intake maintained
Stupor or coma = vomiting due to ketoacidosis, dehydration progresses, compensatory mechanisms to maintain osmolarity are inadequate
44
What type of weight loss are features of more slowly developing insulin deficiency in Type 1 diabetes mellitus?
Loss of subcutaneous fat
Loss of muscle
45
What contributes to muscle wasting and weakness in Type 1 diabetes mellitus?
K+ loss
Catabolism of muscle protein
46
What exacerbates the dehydration and hyperosmolality during Type 1 diabetes mellitus? What is produced that interferes with oral fluid replacement?
Diabetic ketoacidosis
Produces anorexia, nausea, vomiting
47
Which people are typically asymptomatic initially for Type 2 diabetes mellitus?
Obese
48
Patients with Type 2 diabetes mellitus may present with evidence of what complications because of disease present for awhile before diagnosis?
Neuropathic
Cardiovascular
49
What are common initial complaints of women with Type 2 diabetes mellitus?
Skin infection
Pruritus (itchy)
Candidal vulvovaginitis
UTIs
50
Where is fat typically found in obese patients with Type 2 diabetes mellitus?
Abdomen, chest, neck, face
51
Mild ________ is often present in obese patients with Type 2 diabetes mellitus
hypertension
52
Type 2 diabetes mellitus is more common in women who have experienced what things in pregnancy?
Delivered large babies (>9 lbs)
Polyhydramnios (extra amniotic fluid)
Preeclampsia
Unexplained fetal loss
53
Lab findings of diabetes mellitus
HbA1c >/= 6.5%
Fasting plasma glucose >/= 126
Oral glucose tolerance test w/ plasma glucose >/= 200
Casual/random plasma glucose >/= 200
54
_______ is useful for diabetes screening and diagnosis in routine clinical practice and this
test is preferred because of ease of administration and reliability
HbA1c
55
The major form of glycohemoglobin is termed ______, which normally comprises only 4 to 6% of the total hemoglobin
HbA1c
56
Glycosylated hemoglobin is abnormally high in diabetics with chronic hyperglycemia and reflects what?
Metabolic control
57
___________ ___________ is produced by nonenzymatic condensation of glucose molecules with free amino groups on the globin component of hemoglobin
Glycosylated hemoglobin
58
The __________ the prevailing ambient levels of blood glucose, the ___________ the level of glycosylated hemoglobin will be
higher; higher
59
Since glycohemoglobins circulate within red blood cells whose life span lasts up to 120 days, they generally reflect the state of glycemia over the preceding ______________
2-3 months
60
When should HbA1c testing be performed in all patients with diabetes?
Document degree of glycemic control initially
Continuing care
61
What is the HbA1c value?
Decreased risk of diabetes mellitus
HbA1c < 5.7%
62
What is the HbA1c value?
Prediabetes: increased risk of diabetes mellitus
5.7-6%
63
What is the HbA1c value?
Prediabetes: higher risk of diabetes mellitus
6.1-6.4%
64
What is the HbA1c value?
Consistent w/ diagnosis of diabetes mellitus
6.5% and higher
65
How is the fasting plasma glucose test confirmed?
Repeat testing on a different day
66
When is an oral glucose tolerance test done?
2 hrs after a 75g glucose load
67
Commonly used to aid in the diagnosis of diabetes mellitus and reflects the rate of absorption, uptake by tissue
Oral glucose tolerance test
68
What are the 3 classic symptoms of hyperglycemia?
Polyuria
Polydipsia
Unexplained weight loss
69
Individuals with glucose levels higher than normal but not high enough to meet the criteria for diagnosis of diabetes mellitus are considered to have what?
Prediabetes (aka impaired glucose tolerance)
70
What is the diagnosis of prediabetes?
Fasting plasma glucose: 100-125
Oral glucose tolerance test w/ a plasma glucose: 140-199
HbA1c: 5.7-6.4%
71
If allowed to persist at high enough levels in the susceptible diabetic, hyperglycemia will progress to what?
Diabetic ketoacidosis
72
What is a less common but complication of hyperglycemia, but has a higher fatality rate?
Hyperosmolar hyperglycemic syndrome (HHS)
73
What are the 4 acute complications of diabetes mellitus?
Hyperglycemia
Diabetic ketoacidosis
Hyperosomolar hyperglycemic syndrome (HHS)
Hypoglycemia
74
T/F: Diabetic ketoacidosis is more commonly seen in patients with Type 2 diabetes mellitus
FALSE, more commonly seen in Type 1 diabetes mellitus
75
Diabetic ketoacidosis results from the inability of the body to metabolize _______ as rapidly as they are produced and the failure of the body to compensate for the decrease in _____ via renal and respiratory mechanisms
ketones; pH
76
Diabetic ketoacidosis usually occurs with a persistently high blood glucose > ____ mg/dL, and is often precipitated by __________
250; infection
77
Signs and symptoms:
Headache
Flushed face
Weakness
Fatigue
Hunger
Confusion
Disorientation
Nausea
Vomiting/abdominal cramps/diarrhea
Dyspnea
Deep, rapid respirations
Fruity breath
Hypotension
Weak pulse
Polydipsia
Polyuria
Polyphagia
Loss of consciousness
Diabetic ketoacidosis
78
Diabetic-related complication marked by severe hyperglycemia, resultant extreme hypertonic dehydration and absence of significant ketoacidosis
Hyperosmolar hyperglycemic syndrome (HHS)
79
What do patients with Hyperosmolar hyperglycemic syndrome typically present with?
Impaired consciousness or coma
80
Is Hyperosmolar hyperglycemic syndrome more common in Type 1 or Type 2?
Type 2 diabetes mellitus
81
The large number of patients with _______ disease suggests that these patients have a tendency to Hyperosmolar hyperglycemic syndrome because of their decreased ability to compensate for the __________ by excreting glucose
kidney; hyperglycemia
82
In many patients with Hyperosmolar hyperglycemic syndrome, a precipitating acute illness such as what is present?
Infection
MI
Stroke
83
Hyperosmolar hyperglycemic syndrome and diabetic ketoacidosis have a similar pathophysiology.
What is the difference?
In HHS:
Hyperglycemia increases osmotic gradient
Water, electrolytes, glucose lost in urine
Causes glycosuria and more severe dehydration
Risk for cardiovascular collapse
84
What are the 3 symptoms of Hyperosmolar hyperglycemic syndrome?
Weakness
Polyuria
Polydipsia
85
Despite the severe dehydration in HHS, patients may have normal blood pressure, however, many will demonstrate significant ___________ ___________
orthostatic hypotension
86
In HHS, blood glucose values are usually > _____ mg/dL in patients with HHS, and like DKA, HHS is serious and can be fatal, with a ______% mortality rate
600; 40-60%
87
In addition to altered mental status and confusion, other neurologic signs are often present such as hemisensory defects, transient hemiparesis, aphasia or seizures
Hyperosmolar hyperglycemic syndrome
88
What is the most common complication that occurs in pts being treated for diabetes mellitus?
Hypoglycemia
89
Often arises from failure to ingest sufficient foods following insulin administration, exercise w/o sufficient intake of food, over-administration of insulin, sulfonylureas or meglitinides, or presence of infection/other disease
Hypoglycemia
90
T/F: The clinical manifestations of hypoglycemia
are nonspecific, vary among persons, and can change from time to time in the same person
True
91
Neuroglycopenic symptoms of hypoglycemia result from depriving the brain of its
primary fuel, glucose, and can be divided into what 2 categories?
Neurogenic and neuroglycopenic
92
Which symptom of hypoglycemia?
Triggered by the autonomic nervous system
Neurogenic
93
Which symptom of hypoglycemia?
Tremulousness, tachycardia, palpitations, anxiety (catecholamine mediated)
Neurogenic
94
Which symptom of hypoglycemia?
Diaphoresis, hunger, paresthesias (acetylcholine release)
Neurogenic
95
Which symptom of hypoglycemia?
Due to diminished glucose supply to CNS
Neuroglycopenic
96
Which symptom of hypoglycemia?
Weakness, dizziness, tingling, difficulty concentrating, blurred vision, confusion, behavioral change, seizure, coma
Neuroglycopenic
97
Major cause of death = complications from end-stage renal disease
Type 1 diabetes mellitus
98
Major cause of death = macrovascular diseases leading to myocardial infarction and stroke
Type 2 diabetes mellitus
99
What are the 10 chronic complications of diabetes mellitus?
Macrovascular disease
Microangiopathy
Renal disease
Hypertension
Neuropathy
Ocular
Ulceration/gangrene of feet
Skin/mucous membrane
Oral
Increased risk of infection
100
Diabetes mellitus induces ___________ and a markedly increased predisposition to accelerated _____________ especially in the aorta and large- and medium-sized arteries
hypercholesterolemia; atherosclerosis
101
T/F: Except for its greater severity and earlier age of onset, atherosclerosis in diabetics is
indistinguishable from that in non-diabetics
True
102
Diabetics have a 3 to 7.5 times greater incidence of death from __________ causes compared to the non-diabetic population
cardiovascular
103
The incidence of myocardial infarction is _____ as high in diabetics as in non-diabetics
2x
104
Patients with diabetes have an increased stroke _________ and _________ (primarily due to the accelerated development of cervical carotid artery atheromas)
incidence; severity
105
What results in more severe brain injury and a poorer stroke outcome?
Hyperglycemia at time of stroke
106
______ atherosclerosis and arteriolosclerosis also constitute part of the macrovascular disease seen in diabetics
Renal
107
Microvascular disease caused by ________ changes results in multiple pathologic complications in people with diabetes mellitus
capillary
108
A characteristic pattern of wall thickening of small arterioles and capillaries which causes narrowing of the lumen
Hyaline arteriosclerosis
109
Widespread; responsible for ischemic changes in the kidney, retina, brain, and peripheral nerves, as well as the vascular lesion associated with hypertension
Hyaline arteriosclerosis
110
One of the most consistent morphologic features of diabetes mellitus
Microangiopathy
111
What is microangiopathy characterized by?
Diffuse thickening of basement membranes
112
Most evident in the capillaries of the skin, skeletal muscle, retina, renal glomeruli, and renal medulla and underlies the development of diabetic nephropathy, retinopathy, and
some forms of neuropathy
Diffuse thickening of basement membranes (microangiopathy)
113
Prime targets of diabetes mellitus
Kidneys
114
Second to MI as cause of death from diabetes mellitus
Renal failure
115
What are the 3 renal lesions seen in diabetes mellitus?
Glomerular
Renal vascular (nephrosclerosis)
Pyelonephritis
116
In the kidneys, the characteristic pathologic changes in the glomerulus leads to what?
Diabetic nephropathy
117
Where are these important lesions seen?
Capillary BM thickening
Diffuse mesangial sclerosis
Nodular glomerulosclerosis (Kimmelstiel-Wilson)
Glomerulus
118
Increase in mesangial matrix associated with mesangial cell proliferation and basement membrane thickening
Diffuse mesangial sclerosis
119
Pathognomonic glomerular lesion of DM characterized by ball-like deposits of a laminated matrix in the periphery of the glomerulus
Nodular glomerulosclerosis (Kimmelstiel-Wilson)
120
What is diabetic nephropathy characterized by?
Persistent albuminuria
121
Kidney excreting more albumin than normal in urine
Microalbuminuria
122
Without specific interventions, ~ 80% of patients with T1DM and 20 - 40% of those with T2DM will develop overt _________________ with ______________over the ensuing 10 to 15 years, that is usually accompanied by a relentless decline in _______ and ___________
nephropathy w/ macroalbuminuria; GFR; hypertension
123
Difference between microalbuminuria and macroalbuminuria
Micro: albumin excretion > 30 but < 300 mg/day
Macro: albumin excretion > 300 mg/day
124
What is the leading cause of chronic renal failure in the US?
Diabetic nephropathy
125
What is one of the most significant long-term complications in terms of morbidity and mortality for individual patients with DM?
Diabetic nephropathy
126
Hyaline arteriolosclerosis affects both __________ and ________ renal arterioles in patients with DM
afferent; efferent
127
An acute or chronic inflammation of the kidneys that usually begins in the interstitial tissue and then spreads to involve the tubules
Pyelonephritis
128
One special pattern of acute pyelonephritis, __________ _________, is much more prevalent in diabetics than in non-diabetics
necrotizing papillitis
129
What develops with progressive renal involvement?
Hypertension
130
____________ and ____________ atherosclerosis is accelerated with hypertension in diabetes mellitus
Coronary; cerebral
131
How many adult patients with diabetes mellitus have hypertension?
2/3
132
What are the 2 types of diabetic neuropathies?
Peripheral (sensory)
Autonomic
133
What are the 2 subtypes of peripheral (sensory) neuropathy?
Distal symmetric polyneuropathy
Isolated (peripheral) neuropathy
134
Most common form of diabetic peripheral neuropathy
Distal symmetric polyneuropathy
135
Type of neuropathy where defects in nerve function arise in a “stocking-glove” pattern
Distal symmetric polyneuropathy
136
In distal symmetric polyneuropathy, sensory involvement usually occurs first and is generally bilateral, symmetric, and associated with dulled perception of __________, ________, and ________, particularly in the _________ extremities
vibration; pain; temp; lower
137
Can result also result in hypersensitivity to light touch and occasionally severe “burning” pain and discomfort of the lower extremities, particularly at night; can become physically incapacitating and emotionally disabling
Distal symmetric polyneuropathy
138
Long-term complications are insensitivity of the feet, leading to repeated “silent” trauma that predisposes to neuropathic plantar ulcers or bone deformities of the feet secondary to repeated "silent" fractures
Distal symmetric polyneuropathy
139
What causes peripheral (sensory) neuropathy in people with diabetes mellitus?
Axonal degeneration
Segmental demyelination
Sorbitol accumulation
140
This form of diabetic neuropathy has been attributed to vascular disease/ischemia in blood vessels supplying nerves or traumatic nerve damage
Isolated (peripheral) neuropathy
141
Involvement of the distribution of only one nerve (“mononeuropathy”), or of several nerves (“mononeuropathy multiplex”) is characterized by sudden onset with subsequent recovery of all or most of the function
Isolated (peripheral) neuropathy
142
Mononeuropathy involving cranial nerves affecting eye movement (III [oculomotor], IV [trochlear], or VI [abducens]) or peripheral nerves can occur
Isolated (peripheral) neuropathy
143
What are the 3 clinical disturbances/manifestations of autonomic neuropathy?
Cardiovascular
GI
Genitourinary
144
Which clinical disturbance/manifestation of autonomic neuropathy?
Orthostatic/postural hypotension
Tachycardia
Decreased HR variability
Cardiovascular
145
Which clinical disturbance/manifestation of autonomic neuropathy?
Esophageal motility abnormalities
Bouts of diarrhea at night
Gastroparesis (decreased in T1DM; increased in T2DM)
GI
146
Which clinical disturbance/manifestation of autonomic neuropathy?
Neurogenic bladder (hesitancy, weak stream, dribbling)
Impotence
Genitourinary
147
What are the 3 ocular complications in diabetes?
Retinopathy
Cataracts
Glaucoma
148
What are the 3 main categories of diabetic retinopathy?
Background/simple
Pre-proliferative
Proliferative/malignant
149
Consisting of microaneurysms, hemorrhages,
exudates, and retinal edema
Background/simple retinopathy
150
Arteriolar ischemia manifested as cotton-wool spots (small infarcted areas of retina)
Pre-proliferative retinopathy
151
Consisting of newly formed vessels
Proliferative/malignant retinopathy
152
A leading cause of blindness in the U.S., particularly since it increases the risk of retinal detachment
Proliferative/malignant retinopathy
153
Up to 20% of patients with T2DM have
__________ at the time of diagnosis
retinopathy
154
__________ ________ occur in diabetic patients and seem to correlate with both the duration of diabetes and the severity of chronic hyperglycemia
Premature cataracts
155
What is twice as high in diabetic patients as in age-matched non-diabetic persons and may contribute to the premature occurrence of cataracts?
Non-enzymatic glycosylation of lens protein
156
DM raises the risk of __________ glaucoma by ~ 36%
open-angle
157
T/F: Closed-angle glaucoma does not have an increased risk associated with DM
True
158
What is the leading cause of hospitalization in patients with DM?
Foot ulcers
159
Why are patient symptoms with foot ulcers usually less than would be expected from clinical findings?
Loss of sensation due to peripheral neuropathy
160
They are usually secondary to a combination of factors, including peripheral vascular insufficiency, repeated trauma (unrecognized because of sensory loss), and superimposed
infection
Foot ulcers
161
First step to gangrene and lower extremity
amputation
Foot ulcer
162
What has greatly reduced the frequency of gangrene of the foot?
Prophylactic foot care
163
Plaque-like reddened areas with a central area
that fades to white-yellow, found on the anterior surfaces of the legs
Necrobiosis lipoidica diabeticorum
164
The skin becomes very thin and can ulcerate easily
Necrobiosis lipoidica diabeticorum
165
Thickening of skin and epidermis giving skin a “leather-like texture”
Scleroderma diabeticorum
166
Typically affects patient with T2DM, mainly on upper back and neck
Scleroderma diabeticorum
167
When scleroderma diabeticorum affects the fingers, hands or toes it is sometimes called what?
Digital sclerosis
168
The skin on toes fingers and hands become waxy, thick, and tight, with joint stiffness
Digital sclerosis
169
A chronic, blistering disease that causes an extremely pruritic rash typically seen on the buttocks and the extensor surfaces of the arms and legs that is most frequently associated with associated with gluten-sensitive enteropathy (celiac disease), but is also seen in some patients with T1DM
Dermatitis herpetiformis
170
Associated both T1DM and T2DM and affects skin coloration due to autoimmune reaction to pigmentation
Vitiligo
171
The skin in the axilla, groin, and back of neck is hyperpigmented and hyperkeratotic with a typically dark and velvety appearance
Acanthosis nigricans
172
It is thought to be associated with significant insulin resistance
Acanthosis nigricans
173
Most common cutaneous finding in DM and affects ~50% of diabetics
Diabetic dermopathy
174
Presents as shiny round or oval reddish-brown lesions on thin skin of the lower extremity, also known as “shin spots”; usually not painful and do not require tx
Diabetic dermopathy
175
Associated with uncontrolled blood sugars and extremely high triglycerides
Eruptive xanthomatosis
176
High risk for pancreatitis in patients w/ this finding
Eruptive xanthomatosis
177
Can produce erythema and edema of intertriginous areas below the breasts, in the axillas, and between the fingers
Candidal skin infections
178
Causes candidal vulvovaginitis in most chronically uncontrolled diabetic women with persistent glucosuria and is a frequent cause
of pruritus
Candidal skin infections
179
Name the oral complications of poorly controlled DM
Xerostomia
Bacterial, viral, fungal infection
Poor wound healing
Increased incidence/severity of caries
Gingivitis and perio
Abscesses
Burning mouth/tongue
180
Oral findings in patients with uncontrolled DM most likely relate to excessive loss of _______ through urination, altered response to infection, ____________ changes, and possibly, increased _________ concentrations in saliva
fluids; microvascular; glucose
181
Why do patients with DM get dry mouth/xerostomia?
Increased urine -> decreased extracellular fluid -> decreased saliva secretion
182
What levels are low in the saliva of a person with DM?
Ca2+
Phosphate
Fluoride
183
What levels are high in the saliva of a person with DM?
Glucose
184
T/F: Adults with uncontrolled DM have more severe manifestations of periodontal disease than do adults without diabetes
True
185
What type of DM is perio associated with?
Both Type 1 and Type 2
186
What oral lesions are more common in patients with DM?
Candidiasis
Traumatic ulcers
Lichen planus
Delayed healing
187
What type of DM are oral lesions associated with?
Type 1
188
May lead to oral symptoms of paresthesias and tingling, numbness, burning, or pain caused by pathologic changes involving nerves in the oral region
Diabetic neuropathy
189
Abnormal elevation of what can decrease immune function via effect on neutrophil activity, phagocytosis, immunoglobulin, complement function, antigen presentation by monocytes, intercellular adhesion molecules, cytokines, nitric oxide-mediated microvascular relaxation, neutrophil/monocyte sequestration, and generation of oxygen free radicals?
Blood and tissue glucose concentration
190
Patients with DM exhibit enhanced susceptibility to infections. Name a few.
Skin infections
TB
Pneumonia
Pyelonephritis
191
An autoimmune disease in which destruction of pancreatic beta-cells in the islets of Langerhans in the pancreas are caused primarily by immune effector cells reacting against endogenous beta-cell antigens
Type 1 DM
192
In Type 1 DM, after 80 - 90% of the beta-cells are destroyed, ___________ develops and diabetes may be diagnosed
hyperglycemia
193
What do patients with Type 1 DM need to reverse this catabolic condition, prevent ketosis, decrease hyperglucagonemia, and normalize lipid and protein metabolism?
Exogenous insulin
194
What is the major factor in the pathophysiology of Type 1 DM?
Autoimmunity
195
In Type 1 DM, certain _______ ___________ may stimulate the production of antibodies against a viral protein that trigger an autoimmune response against antigenically similar beta-cell molecules
viral infections (mumps, rubella, coxsackie B)
196
Approximately 85% of Type 1 DM patients have circulating ________ _____ ___________, and the
majority also have detectable ____________ ______________ before receiving insulin therapy
islet cell antibodies; anti-insulin antibodies
197
The most commonly found islet cell antibodies in Type 1 DM are those direct against what?
Glutamic acid decarboxylase
198
Enzyme found within pancreatic beta-cells
Glutamic acid decarboxylase
199
The prevalence of Type 1 DM is increased in patients with other autoimmune diseases, such as...
Graves disease
Hashimoto thyroiditis
Addison disease
200
A higher prevalence of islet cell antibodies and anti-GAD antibodies have been found in patients with what autoimmune disease?
Hashimoto thyroiditis
201
What are the major genetic determinants of Type 1 DM?
Polymorphisms of class II human leukocyte antigen (HLA) genes that encode DR/DQ
202
Approximately 95% of patients with T1DM have which genetic polymorphism?
HLA-DR3 or HLA-DR4
203
Are heterozygotes or homozygotes at a greater risk for Type 1 DM?
Herterozygotes
204
What is a specific marker of Type 1 DM susceptibility?
HLA-DQs
205
T/F: Some haplotypes confer strong protection against Type 1 DM
True! (ex: HLA-DR2)
206
Which type of DM is a heterogeneous and multifactorial complex disease that involves interactions of genetics, environmental risk factors, and inflammation?
Type 2
207
What are the 2 defects that best characterize Type 2 DM?
Insulin resistance
Beta-cell dysfunction -> inadequate insulin secretion
208
What must exist for Type 2 DM to occur?
Insulin resistance and inadequate insulin secretion
209
In the progression from normal to abnormal glucose tolerance in Type 2 DM, what levels increase first?
Postprandial blood glucose
210
What response is unaltered during the induction of insulin resistance in Type 2 DM?
Postprandial glucagonlike peptide-1 (GLP-1)
211
What levels are increased during the induction of insulin resistance and glucose intolerance in Type 2 DM?
Glucagon
Glucose-dependent insulinotropic polypeptide GIP)
212
Insulin resistance has been attributed to increased levels of what 2 things in plasma?
Free fatty acids
Proinflammatory cytokines
213
What does insulin resistance lead to in muscle cells?
Decreased glucose transport
214
What does insulin resistance lead to in the liver?
Increased glucose produciton
215
What does insulin resistance lead to in fat cells?
Increased breakdown
216
What is an essential component in the development of Type 2 DM and does not necessarily follow the stage of insulin resistance?
Beta-cell dysfunction
217
Beta-cell function actually ___________ early in the disease process in most patients with T2DM, mainly as a _____________ measure to counter insulin resistance and maintain euglycemia
increases; compensatory
218
What is a major risk factor for development of T2DM?
Obesity
219
What is the most important environmental factor causing insulin resistance?
Obesity
220
____________ plays an important role in the pathophysiology of T2DM, wherein there is an pancreatic islet cell dysfunction in the which the reciprocal relationship between the glucagon-secreting alpha-cells and the insulin-secreting beta-cells is lost
Hyperglucagonemia
221
What does hyperglucagonemia lead to?
Hyperglycemia
222
Genome-wide association studies of single-nucleotide polymorphisms (SNPs) have
identified a number of genetic variants that are associated with what 2 things?
Beta-cell function
Insulin resistance
223
What appear to increase the risk for T2DM?
Some SNPs
Over 40 independent loci
224
Susceptibility to T2DM may also be affected by _________ variants involving ________ hormones, which are released from endocrine cells in the gut and stimulate insulin secretion in response to digestion of food
genetic; incretin
225
A syndrome of insulin resistance that has been proposed to explain the frequent association of hypertension, insulin resistance, abdominal obesity, hyperlipidemia, and accelerated atherosclerosis
Metabolic syndrome
226
Pts with what syndrome are at a high risk for development of T2DM?
Metabolic syndrome
227
What are the 3 important morphologic changes that present in the pancreas?
Reduced number and size of islets
Leukocytic infiltrates in islets
Amyloid deposition within islets
228
Which morphologic change in the pancreas?
This change most often is seen in T1DM,
particularly with rapidly advancing disease
Reduced number and size of islets
229
Which morphologic change in the pancreas?
Principally composed of T-lymphocytes
Leukocytic infiltrates in islets
230
Which morphologic change in the pancreas?
Most often seen T1DM at the time of clinical presentation
Leukocytic infiltrates in islets
231
Which morphologic change in the pancreas?
Begins in and around capillaries and between
cells
Amyloid deposition within islets
232
Which morphologic change in the pancreas?
At advanced stages, the islets may be virtually obliterated; fibrosis also may be observed
Amyloid deposition within islets
233
Which morphologic change in the pancreas?
Similar amyloid lesions may be found in older non-diabetics, apparently as part of normal aging
Amyloid deposition within islets
234
Which morphologic change in the pancreas?
More often seen in T2DM
Amyloid deposition within islets
235
What is the type of amyloid associated with T2DM?
Islet amyloid polypeptide
236
What is co-secreted with insulin from pancreatic beta-cells in the ratio of approximately 100:1?
Islet amyloid polypeptide
237
What is the precursor of islet amyloid polypeptide?
Pro-islet amyloid polypeptide
238
What 2 things have been linked to T2DM and loss of islet beta-cells
Islet amyloid polypeptide
Pro-islet amyloid polypeptide
