Pancreas Pathology Flashcards
what are the causes of electrolyte disturbance in DKA?
- osmotic diuresis (↑ glucose)
- vomiting (ketosis irritates area prostrema)
- dehydration
results in metabolic acidosis
in the absence of insulin the anabolic/catabolic hormones predominate
catabolic: breakdown protein, fat and carbs ;
insulin is a anabolic hormone
advanced glycosylation end products (AGE) have been implicated in some diabetic complications such as______
diabetic retinopathy
diabetic ketoacidosis is more common in type __ DM
type 1; due to lack of insulin so it is rare in type 2 DM
plasma glucose levels are: 260-600 mg/dL
fasting plasma glucose level greater than ______ is required for DM diagnosis
126 mg/dL
what is given to restore metabolic control in DKA?
- insulin IV
- potassium supplements
- bicarbonate (sometimes)
what is a the prediabetic result in the OGTT after 2 hours
140-200 mg/dL
fruity scented breath is seen in ____
DKA
in someone with DKA, you will see:
↑/ ↓ K
↑/ ↓ Na
↑ K
↓ Na
what cells are involved in β cell damage
- CD4 and CD8
why is type ___ diabetes more prone to ketosis?
- type 1 diabetes = more prone to ketosis
- lack of insulin → lipolysis → ketosis
which one has higher glucose level: HSS (hwperosomlar hyperglycemic state) or DKA?
HSS: 600-1200 mg/dL
what is the main cause of DKA?
severe deficiency of insulin leading to severe dehydration
________ causes the characteristic osmotic diuresis and dehydration in DKA → cell starvation and hypovolemia → ketosis
hyperglycemia
the first functional change in diabetic nephropathy is _________
the first biochemical sign is ________
- hyperfiltration
- microalbuminuria: 30-300mg/day
why do you give someone with DKA potassium supplements when their lab values show ↑ K ?
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
amyloid deposits are more commonly seen in type ___ diabetes
type 2
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
myoinositol
microangiopathic complications of DM are characterized by ____________ causing leakiness
thickening of basement membranes → leakiness
nephropathy, retinopathy, neuropathy
what are the three lesions of diabetic nephropathy?
- glomerular lesions: BM thickening and mesangial expansion and later get Kimmelsteil Wilson nodules
- arteriolosclerosis
- papillary necrosis
viral/chiemcal attacks on β cells lead to ________ or _______ that then cause activation of T cells in the peripancreatic lymph nodes
exposure of new β cell antigens or can cause molecular mimicry between the virus and β cell structures
low/normal/high anion gap metabolic acidosis is seen in DM
high anion gap metabolic acidosis
(low bicarbonate)
anion gap = Na+ - (Cl- + HCO3-)
normal: 8-16
prediabetic range of HBA1c is _______
5.7-6.4%
describe the glomerular lesions seen in diabetic nephropathy
basement membrane thickening and mesangial expansion. subsequent nodular despots (KM nodules)
what is the random blood glucose level required for diagnosis of DM?
> 200 mg/dL (11.1 mmol/L)
what type of patients does hyperosmolar hyperglycemic state (HSS) aka hyperosmolar non ketotic coma occur in?
elderly patients with type 2 DM
the storage form of insulin is _______
proinsulin;
it is later cleaved to insulin + C peptide
type ____ diabetes has a HLA link
type 1
explain the mechanism of ketosis in diabetes
- 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
both hyperosmolar hyperglycemic state and DKA are due to insulin deficiency. what is the difference?
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
what is the benefit of measuring glycosylated hb?
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
glycated hemoglobin (HBA1c) level. > ____ % is sufficient to diagnose someone with DM
> 6.5%
how do you know a person is diabetic based on the OGTT (oral glucose tolerance test)
if their blood glucose does not return back to normal after 2 hours (diabetic patients will be > 200 mg/dL after 2 hours)
how does diabetic neuropathy present?
- paraesthesia of the limbs, pain (sensory)
- muscle atrophy and weakness (motor)
- impotence orthostatic hypotension (autonomic)
the HLA system in type 1 diabetes is involved in _____
antigen presentation and they alter the immune response against normal or altered β cells
