Pathophysiology Of Type 2 Diabetes

Question 1

Name 3 pathophysiology of type 2 diabetes ( hint : 3 “I”)

Answer 1

1) insulin resistance
2) increases glucose output from the liver
3) impaired beta cell function

Question 2

What is the Ominous Octet to Hyperglycemia

Answer 2

1) neurotransmitter dysfunction (brain)
2) increased lipolysis (fat cells)
3) increased glucose reabsorption ( kidneys)
4) decreased glucose uptake ( muscles)
5) decreased incretin effect (intestines)
6) increased hepatic glucose production (liver)
7) increased glucagon secretion (pancreas)
8) impaired insulin secretion (Pancreas)

Question 3

What does SGLT-2 stand for, where is it located and what is it’s function?

Answer 3

SGLT-2 is located in the proximal convoluted tubule in the kidney and responsible for reabsorption of glucose back into the blood

Question 4

What is the average glucose resorptive capacity of the kidney in healthy people without diabetes?

Answer 4

375mg/min

Question 5

What concentration exceeds the plasma glucose level and what happens ?

Answer 5

180-200mg/dL, the reabsorptive capacity of the proximal tubule is exceeded and excess glucose is excreted in the urine

Question 6

What does it mean that the kidney’s reabsorptive capacity is exceeded?

Answer 6

The SGLT receptors are saturated, therefore SGLT receptors can’t pick up glucose and reabsorb glucose back into the blood so excess glucose is excreted into the urine

Question 7

What happens with SGLT-2 in diabetic kidney?

Answer 7

Diabetic kidney upregulates the SGLT receptors increasing SGLT activity causing an increase of glucose reabsorption leading to hyperglycemia.

Question 8

What is the threshold concentration at which the diabetic kidney can maximally reabsorb glucose?

Answer 8

Above 180 to 200mg/dL up to 240mg/ dL

Question 9

What is familial glycosuria?

Answer 9

An autosomal genetic disorder that leads to impaired SGLT-2 , so instead of glucose being reabsorbed into blood , it is excreted into the urine as much as 50 grams of urinary glucose per day, BUT KIDNEY FUNCTION REMAINS NORMAL

Question 10

Name 12 drug classes to treat diabetes:

Answer 10

1) biguanides
2) GLP-1 agonists (glucagon like peptide)
3) SGLT-2 inhibitor ( sodium glucose transport)
4) DDP-4 inhibitor ( dipeptidyl peptidase)
5) alpha- glucosidase inhibitor
6) thiazolidinedione
7) sulfonylurea
8) meglitinide (glinide)
9) insulin
10) bile acid sequestrants ( colesevelam)
11) dopamine agonist ( bromocriptine)
12) Amylinomimetics