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Pathology > Lecture 14 Diabetes Mellitus > Flashcards

Lecture 14 Diabetes Mellitus Flashcards

1
Q

What are the two types of diabetes mellitus?

A

Deficiency of insulin & insulin resistance

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2
Q

Define diabetes inspidus

A

deficiency of antidiuretic hormone

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3
Q

Where are peptide hormones produced?

A

Beta cells of islets of langerhans (pancreas)

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4
Q

Where does glucagon bind to?

A

Cell membrane receptors

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5
Q

What requires insulin to absorb glucose?

A

skeletal muscle cells and fat cells

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6
Q

What do not require insulin to absorb glucose?

A

Neurons

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7
Q

What does insulin do?

A

Makes cell uptake glucose and amino acids. ^glycogen and fatty acid synthesis. Decreases lipolysis, proteinolysis and gluconeogenesis.

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8
Q

Where is insulin released from?

A

B-cells

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9
Q

How is insulin release controlled?

A

direct feedback. Some autonomic control and CCK releases it. B-cells absorb glucose via glucose transporter GLUT2.

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10
Q

What are the acute consequences of insulin deficiency?

A

Hyperglycaemia, ketosis, acidosis, hyperosmolar state.

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11
Q

What are the chronic consequences of insulin deficiency?

A

CV disease, nephropathy, neuropathy, retinopathy

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12
Q

What is type 1 diabetes mellitus?

A

Autoimmune destruction of B-cells

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13
Q

What can trigger Type 1?

A

Viral infections (coxsackie or rubella viruses). Gene (HLA) subtype suseptibility. Childhood.

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14
Q

Symptoms of type 1?

A

Polyuria, polydipsia, hunger, weight loss.

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15
Q

Where (in normal glomerulus filtration) is glucose resorbed?

A

proximal renal tubule

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16
Q

What is the threshold for resorption of glucose for glomerulus?

A

10mmol/l

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17
Q

Polyuria->

A

glycosuria -> osmotic polyuria

18
Q

Define polydipsia

A

Very thirsty

19
Q

How is someone biochemically diagnosed with DM?

A

Fasting plasma glucose at or above 7.0mmol/l. 11.1mmol/l two hrs after 75g glucose of random test 11.1

20
Q

What are the acute presentations of diabetes mellitus?

A

Ketoacidosis, hyperosmolar nonketotic stat, hypoglycaemia, diabetic foot

21
Q

What is ketoacidosis?

A

Rapid break down of fat and protein releasing ketones and acid into blood. In DM type 1

22
Q

What is hyperosmolar nonketotic state?

A

Severe dehydration in DM type 2

23
Q

What are the chronic presentations of DM?

A

Macrovascular and Microvascular diseases

24
Q

What is retinopathy?

A

Proliferation of blood vessels in retina, retinal haemorrhages.

25
Q

Examples of macrovascular diseases?

A

Ischaemic heart disease, stroke, peripheral vascular disease. (effect coronary arteries, aorta, brain and limb arteries)

26
Q

Examples of microvascular diseases?

A

Retinopathy, diabetic neuropathy, nephropathy

27
Q

Notes on neuropathy?

A

Microangiopathy of vasa nervosum -> peripheral numbness/tingling, neuropathyic pain, weakness.

28
Q

Effects of autonomic neuropathy

A

Vomiting, diarrhoea, constipation, impotence, incontinence, anorgasmia, postural hypotension

29
Q

Define vasa nervosum

A

Small arteries that provide blood supply to peripheral nerves

30
Q

How can someone gain nephropthy?

A

Microangiopathy of glomerular capillaries.

31
Q

Pathology of nephropathy?

A

Nodular and diffuse glomerulosclerosis

32
Q

Clinical effects of nephropathy?

A

Chronic renal failure (nephrotic syndrome); hypertension

33
Q

What is type 2 DM?

A

Noninsulin dependent, Peripheral insulin resistance, B-cell response to glucose delayed or absent.

34
Q

What is gestational DM?

A

diabetes triggered by pregnancy (hormonal changes)

35
Q

What are the risk factors for gestational diabetes?

A

Maternal age, fam history of type 2, African/North American, previous babe over 4Kg. Smoking.

36
Q

What are the dangers to mother of gastational diabetes?

A

^ risk of DM type 2 later in life, hypertension, pre-eclamsia/clampsia (one of more convulsions. Obstructed labour.

37
Q

Dangers of gastational diabetes for child?

A

Risk of DM type 2 later in life, obesity, macrosomia, neonatal hypoglycaemia, jaundice, respiratory distress syndrome.

38
Q

What is macrosomia?

A

Excessive child growth in uterus

39
Q

What are the causes for secondary DM?

A

Chronic pancreatitis, CF, pancreatic surgery, endocrine disease (cushing’s syndrome), Corticosteroids.

40
Q

What is haemachromatosis?

A

Hereditary disorder where iron salts are deposited in tissue -> liver damage/DM

41
Q

Infections more likely with DM. Give top two examples

A

Osteomyelitis (inflam of bone or bone marrow) and septicaemia.

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