Pathogenesis of diabetes mellitus Flashcards

1
Q

What does diabetes insipidus mean?

A

Passing lots of insipid urine - ADH insufficiency

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2
Q

List the diagnostic criteria for DM (all types)

A
  • Fasting blood glucose (>126mg/dl- Fasting, >Need 2 abnormal tests )
  • OGTT
  • HbA1c
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3
Q

Fasting blood glucose results

A

5.7% and 6.4%.: Likely prediabetes

≥ 6.5% diabetes

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4
Q

OGTT results

A

Oral glucose tolerance test
- 2-hour glucose
<200mg/dl: normal

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5
Q

What are the symptoms of diabetes

A

P3- Polyphagia, Polydipsia, and Poluria

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6
Q

Define HbA1c and explain results

A

AGE (Hemoglobin+ Sugar complex)

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7
Q

Define gestational diabetes

A

women become very resistant to their own insulin, hyperglycemia by the end of 2nd trimester (1% to 3% of all pregnancy). Resolve spontaneously after delivery.

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8
Q

Which types of diabetes are insulin resistant?

A

Type 2
Gestational
Steroid-induced
Acromegaly

NB: patients often have very high levels of insulin in circulation

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9
Q

What auto-antibodies can be found in T1DM?

A

Islet cell autoantigen (ICA) 512
IAA (insulin auto-antibody)
GAD (glutamic acid decarboxylase)

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10
Q

What is the typical presenting history for T1DM

A
Child/adolescent
history of weight loss, thirst, polyuria, nocturia, and fatigue
HLA DR3 and 4
Viral illness recently
High blood glucose level
High blood ketones
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11
Q

Why does weight loss occur in T1DM

A

Glucose is not absorbed into muscles/fat cells from the blood
Results in both fat and muscle bulk

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12
Q

Which genes are likely to increase susceptibility to T1DM?

A

CTLA4 (Cytotoxic T-Lymphocyte Associated Protein 4), and PTPN22 (Protein tyrosine phosphatase, non-receptor type 22 ), and insulin gene VNTRs(variable number of tandem repeats).

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13
Q

Which other autoimmune diseases are associated with T1DM?

A

> Thyroid disease (hyper and hypo) V. strongly associated
Coeliac disease - strongly associated
Addison’s disease = primary adrenal insufficiency (hypocortisolism)
Pernicious anaemia
Inflammatory bowel disease (UC/Crohn’s)
Premature ovarian failure

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14
Q

Genes for DM 2

A

Transcription factor 7-like 2=TCF7L2

Peroxisome proliferator-activated receptor gamma=PPAR-γ or PPARG

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15
Q

Insulitis=

A

DM1

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16
Q

Amyloid in islets

A

DM2

17
Q

RAGE=

A

AGE: bind to a specific receptor (RAGE)- expressed macrophages and T cells

18
Q

Macroangiopathy- mechanism

A

AGE: Col 4 + Sugar- non-enzymatic glycosylation

19
Q

Atheroma in DM patients is an example of ______

A

Macroangiopathy

20
Q

Micro-angiopathy- mechanism

A

AGE and Sorbitol induced pericyte injury

21
Q

Cataract- in DM - mechanism____

A

Sorbitol-induced lens injury (osmotic injury)

22
Q

Neuropathy in DM mechanism

A

Sorbitol-induced Schwan cell injury (osmotic injury)

23
Q

Organopathy in DM is most likely due to______

A

Microangiopathy

24
Q

diffuse thickening of glomerular basement membranes in DM is due to______

A

Microangiopathy

25
Q

VGEF production is DM is due to________

A

PKC and RAGE

26
Q

Secondary DM causes______

A

Drugs (corticosteroid, Thyroid hormone, Thiazides, Phenytoin )
Disease of exocrine pancreas: chronic pancreatitis.
Genetic syndrome: Downs syndrome
Endocrinopathes : Acromegaly, Cushing’s syndrome.

27
Q

Baby of a DM 2 mother= Possible complications

A

NRDS and pancreatic beta- cell hyperplasia

28
Q

Pathogenesis of Gestational DM

A

Insuline resistance due to placental hormones/cytoines

29
Q

Suger level of the baby after deliver in a DM2 mother

A

Low

30
Q

Suger level of the baby after deliver in a DM1 mother

A

High- due to presence of antibody against the beta cells (IgG) in the baby’s blood. It came from DM1 mother