Nichols Diabetes

Question 1

The essence of diabetes is hyperglycemia. The bad thing about hyperglycemia is that it causes excess glucose to stick to everything. ESPECIALLY BASEMENT Membranes

Answer 1

.

Question 2

What’s the bad thing about Sorbitol Pathway?

Answer 2

It eventually turns things into FRUCTOSE which is an even STRONGER glycosylator than glucose is.

Question 3

KNOW the BIG THREE…mechanisms of long term complications

Answer 3

1) AGEs
- Glucose binds to peptides, this complex interacts with collagen to trap albumin in BM, LDL in arterial atheromas (atherosclerosis), and interactes with AGE receptors (RAGE) to form ROS like superoxide

2) Protein Kinase C:
- Forms profibrogenic TGF-beta (BM thickening)
- forms pro-angiogenic (VEGF) ….retinopathy

Polyol
- glucose—–sorbitol via aldose reductase—–fructose using NADPH. This NADPH was suppusoed to be used to reduce glutathione which you need to break down ROS. But not its used to make fructose, a terrible glycosylator.

Question 4

Insulinitis with T cells…..what type of D

Answer 4

D1

Question 5

Amyloidosis of islets

Answer 5

D2

Question 6

Hyperglycemia impairs immune system? How?

Answer 6

Neutrophil function is impaired.

Question 7

How does Hyperglycemia disable neutrophil function

Answer 7

Excess glucose causes upregulation of CD11 on neutrophils and upregulation of ICAM, VCAM, and E selectin on endothelial surfaces. All of this leads to sticky vessels and disables the neutrophils from geting to the site of infection.

Question 8

C3 and hyperglycemia

Answer 8

hyperglycemia causes unactivated complement (C3) to bind to staph. This inhibits the activation of active forms of complement like C5

Question 9

KNOW..TOO MUCH SUGAR IMPAIRS BACTERIAL KILLING by reducing oxidative burst.

Answer 9

Blame it on the sorbitol. Overactive sorbitol pathway steals NADPH which is needed to make the superoxide in phagosomes.

Question 10

TEST»»

Answer 10

Too much ROS is a characteristic of the BIG 3, too little ROS (superoxide) is a mechanism of diabetic infection

Question 11

Resistin

Answer 11

hormone that makes cells resistant to nsulin.

Also inhibits neutrophil chemotaxis

Question 12

Constitutive activation of Neutrophil extracellular trap formation..

Answer 12

Reduces response to pathogens

Question 13

ALL this leads to greater rate of infection in:

Answer 13

skin, feet, lungs, urinary tract

Question 14

Furuncle

Answer 14

Follicle that is infected. Breaks through the BM and into the subcutaneous fat.

Question 15

Furuncle cause

Answer 15

staph

Question 16

Carbuncle

Answer 16

Coalescence of furuncles…..cause fever. need to be incised to drain

Question 17

EXTERNAL OTITIS

Answer 17

Pseudomonas Aeruginosa!!!

Question 18

Mucormycosis, the rhinocereral form, starts in the nose, spreads into the paranasal sinus, orbit, skull and base of brain

Answer 18

Need amphtericin and surgery

Question 19

Diabetes predisposes to UTI that can spread into the kidney and cause pyelonephritis

Answer 19

KNOW

Question 20

Pyelonephritis + Ischemia

Answer 20

renal papillary necrosis

Question 21

Infection + Ischemia + Neurpathy

Answer 21

Ulceration and gangrene

Question 22

What is the metabolic syndrome

Answer 22

Diabetes + Hypertension + Dyslipidemia + Abdominal Obesity

Also called teh deadly quartet…..diabetes, high blood pressure, high cholesterol, obesity

Question 23

Deadly quartet characterized by what

Answer 23

pro-thrombotic, pro-inflammatory

- Associated with high levels of C-reactive protein, IL-6, and Plasminogen activator 1

Question 24

What medication is associated with the metabolic syndrome

Answer 24

Clozapine

Question 25

What are the five major risk factors for atherosclerosis

Answer 25

SHODDY
S- smoking
H- HTN
O- obesity
D-Diabetes
DY- Dyslipidemia

Question 26

MEtabolic syndrome respondes to diet, some good diets are the mediterranean diet, DASH diet (no salt), low glycemic index

Gotta exercise too

Answer 26

ok

Question 27

Two forms of diabetic neuropathy

Answer 27

peripheral and autonomic

Question 28

Autonomic Neuropathy comes later

Answer 28

It is manifested by:

• resting tachycardia
• exercise intolerance
• GI dysmotility
• Impotence
• Orthostatic hypotension

Question 29

Retinopathy is acually a type of

Answer 29

microangiopathy

Question 30

2 forms of retinopathy

Answer 30

Background and proliferative

Question 31

Background retinoipathy

Answer 31

capillary thickening, microaneurysms, venous dilation, hemorrhages.

Question 32

Prliferative

Answer 32

neovascularization and fibrosis

Question 33

The three major types of diabetic nephropathy are

Answer 33

Glomerular (diffuse) also called kimmelstiel wilson

Papillary- pyelonephritis and papillary necrosis

Tubulointerstitial- BM thickening and intersitial fibrosis

Question 34

Nodular type of diabetic glomerulopathy

Answer 34

usually only after more than 10 years of diabetes

much more characteristic of diabetes superimposed on diffuse glomerulopathy

Question 35

kimmelstiel wilson nodules

Answer 35

ovoid or spherical nodules.. squeeze capillary shut…again, the kidneys have been damaged for a long time.