Pancreas Pathology

Question 1

what are the causes of electrolyte disturbance in DKA?

Answer 1

• osmotic diuresis (↑ glucose)
• vomiting (ketosis irritates area prostrema)
• dehydration

results in metabolic acidosis

Question 2

in the absence of insulin the anabolic/catabolic hormones predominate

Answer 2

catabolic: breakdown protein, fat and carbs ;

insulin is a anabolic hormone

Question 3

advanced glycosylation end products (AGE) have been implicated in some diabetic complications such as______

Answer 3

diabetic retinopathy

Question 4

diabetic ketoacidosis is more common in type __ DM

Answer 4

type 1; due to lack of insulin so it is rare in type 2 DM

plasma glucose levels are: 260-600 mg/dL

Question 5

fasting plasma glucose level greater than ______ is required for DM diagnosis

Answer 5

126 mg/dL

Question 6

what is given to restore metabolic control in DKA?

Answer 6

• insulin IV
• potassium supplements
• bicarbonate (sometimes)

Question 7

what is a the prediabetic result in the OGTT after 2 hours

Answer 7

140-200 mg/dL

Question 8

fruity scented breath is seen in ____

Answer 8

DKA

Question 9

in someone with DKA, you will see:
↑/ ↓ K
↑/ ↓ Na

Answer 9

↑ K

↓ Na

Question 10

what cells are involved in β cell damage

Answer 10

• CD4 and CD8

Question 11

why is type ___ diabetes more prone to ketosis?

Answer 11

• type 1 diabetes = more prone to ketosis

- lack of insulin → lipolysis → ketosis

Question 12

which one has higher glucose level: HSS (hwperosomlar hyperglycemic state) or DKA?

Answer 12

HSS: 600-1200 mg/dL

Question 13

what is the main cause of DKA?

Answer 13

severe deficiency of insulin leading to severe dehydration

Question 14

________ causes the characteristic osmotic diuresis and dehydration in DKA → cell starvation and hypovolemia → ketosis

Answer 14

hyperglycemia

Question 15

the first functional change in diabetic nephropathy is _________
the first biochemical sign is ________

Answer 15

• hyperfiltration

- microalbuminuria: 30-300mg/day

Question 16

why do you give someone with DKA potassium supplements when their lab values show ↑ K ?

Answer 16

there is only ↑ K because the potassium from inside the cell (where it is the highest) is shunted to the outside to compensate for the loss in Na so its not really a ↑ K

Question 17

amyloid deposits are more commonly seen in type ___ diabetes

Answer 17

type 2

Question 18

the accumulation of sugar alcohols in tissues which do not require insulin for glucose uptake will cause an accumulation of sorbitol. leading to osmotic effects and depletion of ______, amino acids, and potassium

Answer 18

myoinositol

Question 19

microangiopathic complications of DM are characterized by ____________ causing leakiness

Answer 19

thickening of basement membranes → leakiness

nephropathy, retinopathy, neuropathy

Question 20

what are the three lesions of diabetic nephropathy?

Answer 20

• glomerular lesions: BM thickening and mesangial expansion and later get Kimmelsteil Wilson nodules
• arteriolosclerosis
• papillary necrosis

Question 21

viral/chiemcal attacks on β cells lead to ________ or _______ that then cause activation of T cells in the peripancreatic lymph nodes

Answer 21

exposure of new β cell antigens or can cause molecular mimicry between the virus and β cell structures

Question 22

low/normal/high anion gap metabolic acidosis is seen in DM

Answer 22

high anion gap metabolic acidosis
(low bicarbonate)

anion gap = Na+ - (Cl- + HCO3-)
normal: 8-16

Question 23

prediabetic range of HBA1c is _______

Answer 23

5.7-6.4%

Question 24

describe the glomerular lesions seen in diabetic nephropathy

Answer 24

basement membrane thickening and mesangial expansion. subsequent nodular despots (KM nodules)

Question 25

what is the random blood glucose level required for diagnosis of DM?

Answer 25

> 200 mg/dL (11.1 mmol/L)

Question 26

what type of patients does hyperosmolar hyperglycemic state (HSS) aka hyperosmolar non ketotic coma occur in?

Answer 26

elderly patients with type 2 DM

Question 27

the storage form of insulin is _______

Answer 27

proinsulin;

it is later cleaved to insulin + C peptide

Question 28

type ____ diabetes has a HLA link

Answer 28

type 1

Question 29

explain the mechanism of ketosis in diabetes

Answer 29

• lack of insulin will cause fat break down → ↑ acetyl CoA
• acetyl CoA cannot be utilized in the citric acid cycle because the citric acid cycle is depressed when there is low insulin
• acetyl CoA cannot be utilized in the citric acid cycle so it is converted to ketone bodies

Question 30

both hyperosmolar hyperglycemic state and DKA are due to insulin deficiency. what is the difference?

Answer 30

HSS does NOT have ketosis because in that condition, there is a relative insulin sufficiency but it is sufficient enough to prevent ketosis but cannot suppress the hyperglycemia

Question 31

what is the benefit of measuring glycosylated hb?

Answer 31

levels give an integrated measure of glucose concentrations over the past 2-3 months (RBC average lifespan is 100 days)

not used to diagnose DM in third world countries where there are Hb abnormalities

Question 32

glycated hemoglobin (HBA1c) level. > ____ % is sufficient to diagnose someone with DM

Answer 32

> 6.5%

Question 33

how do you know a person is diabetic based on the OGTT (oral glucose tolerance test)

Answer 33

if their blood glucose does not return back to normal after 2 hours (diabetic patients will be > 200 mg/dL after 2 hours)

Question 34

how does diabetic neuropathy present?

Answer 34

• paraesthesia of the limbs, pain (sensory)
• muscle atrophy and weakness (motor)
• impotence orthostatic hypotension (autonomic)

Question 35

the HLA system in type 1 diabetes is involved in _____

Answer 35

antigen presentation and they alter the immune response against normal or altered β cells