Lecture 90 - Diabetes Mellitus

Question 1

cut offs for dx of DM

Answer 1

Fasting Plasma Glucose: >126 (nL 200 (nl 6.5% (nl 200 + Sx of polyuria, polydipsia, weight loss

Question 2

what cell of the pancrease secretes insulin

describe the mechanism of this secretion

Answer 2

Beta Cell

GLUT 2 Receptor – Glucose enter the Beta Cell
Glucokinase – controls the rate of the glucose in to the Beta Cell
Increased Mitochondrial Acitivty
Increased ATP/ADP ratio
Closure of the Inward Rectifying K channel
Depolarization of the Cell
Opening of VG Calcium channels
Insulin packaged in vesicles; released when exposed to Ca2+

Question 3

effects of insulin on the:
liver
adipose
muscle

Answer 3

Liver –
Anabolic: Glycogen Synth, Fatty Acid Synth (shunting towards energy storage)
AntiCatabolic: Inhibits GNG, Glycogenolyisis, ketogenesis

Adipose –
Anabolic: Promotes Fatty acid uptake; Triglyceride formation and storage
AntiCatabolic: Inhibits Lipolysis

Muscle –
Anabolic: Glycogen synthesis; protein synthesis
Anticatabolic: Inhibits proteolysis

Question 4

what cells are indepdent of insulin for uptake of Glucose?

what cells are depedent

wjhat are the associated GLUT Transporters

Answer 4

Indepedent: RBC and Brain — GLUT 1

dependent – muscle, fat – GLUT4

Question 5

DKA is a/w with T1DM or T2DM

HLADR3,4 a/w T1DM or T2DM

Answer 5

T1DM

Question 6

Getational DM –

what % of women develop T2DM within 10 years

Answer 6

40% of women with Gestation DM develop T2DM within 10 years

Question 7

what are 3 monogenic forms of DM

Answer 7

MODY - Mutatins to Glucokinase genes (MODY 2)

Maternally Inherited DM and Deafness (MIDD) – mitochondrial DNA

Hereditary Hyperinsulinemia -(HHI) – mutattions to SUR1, KIR 6.2

Question 8

what drugs can cause DM

Answer 8

Niacin, Beta Blockers, Thiazide Diuretics –

Question 9

other secondary causes of DM

Answer 9

Pancreatic Disease – CF, cancer, pancreatitis

Other Endocrine d/o – acromegaly, cortisol excess

Question 10

what is DKA

how do you treat it?

Answer 10

States of Low Insulin, but Increased glucagon, catecholamine’s, Cortisol

Increased Lipolysis —> Increased FFA in Plasma —> FFA to Liver —> KETOGENESIS –> Ketonemia/Ketoniuria —> Decreased Alkali Rerserve —> Acidosis

Treatment: IV Fluids, Insulin, Electrolyte Management (K+)

Question 11

what fatal acute complication is more common in T2DM?

Answer 11

Hyperosmolar / Hyperglycemic States:

Question 12

what is a Hyperosmolar / Hyperglycemic States: describe the progression

Answer 12

after a trigger (infection) – decreased insulin but high glucagon

Utilization/Uptake, but High GNG —> increased Plasma Glucose
—> Glucose osmotic Diuresis —> urinary loses of H20 greater than that other electrolytes —> Dehydration
Hyperosmolar state —> Shock —-> Coma —-> Death

Question 13

chronic complications of DM

60-70% of DM deaths are due to_____

Answer 13

Retinopathy
Nephropathy
Amputations
DM related vascular Disease – 60-70% of DM deaths

Question 14

what are the two forms of DM retinal disease

treatment otpions

Answer 14

Nonproliferative DM Retinopathy (NPDR)

Proliferative DM Retinopathy (PDR)
Treatment: Laser coagulation therapy; destroy the new blood vessls
Anti Veg F treatments (bevacizumab)

Question 15

two forms of DM neuropathy

Answer 15

Peripheral Neuropathy –
Distal Symmetric Sensory Loss – Glove and stocking
Motor Neuropathy
CN 3, 4, 6, 7

Autonomic Neuropathy -- 
	Orthostatic Hypotension 
	Resting tachy
	Gastrointestinal Neuropathy  -- GI motility 
	Urinary Bladder Atony 
	Erectile Dysfunction