SECRETS Endo - Pancreas Flashcards
DM 1 sx
polyuria
polydipsia
weight loss
polyphagia
hyperglycemia
may present as DKA
DM 1 cause
autoimmune destruction of beta cella
DM 2 cause & hyperglycemia cause
insulin resistance
beta cell dysfunction
lipolysis, reduced glucose uptake –> hyperglycemia
c peptide - insulinoma vs exogenous insulin
high in insulinoma
low in exogenous insulin
proinsulin = c peptide + insulin
weight loss in DM 1
insulin deficiency = hypercatabolic state
stimulate gluconeogenesis, glycogenolysis, fatty acid catabolism
DKA mechanism
w/o insulin, fatty acids delivered to liver instead of taken up by adipocytes
metabolized in liver –> ketoacids
hyperglycemia –> dehydration –> kidneys cannot excrete acid
hyperglycemia ADR - short and long term
short = prevent DKA long = reduce microvascular, macrovascular complications
HbA1C
represents glycosylated Hb
associated with levels of plasma glucose
effective measure of long term diabetes b/c RBC lifespan is 120 days
diabetes + HTN tx
ACEi
reduce incidence of nephropathy and MI
BB in diabetics
contraindicated
mask signs of hypotension
inhibit epinephrine response to hypotension
overdose nighttime insulin
elevated morning plasma glucose due to ++ sympa response to hypoglycemia
DM 2 sx
overweight sedentary strong family history polydipsia polyuria
which GLUT is insulin dependent
GLUT4
in skeletal muscle and adipose tissue
glucose & K cotransporter
primary metabolic fuel in fasting state
fatty acids
glucose, ketones in brain
metformin
inhibit hepatic glucose production
stimulate adipose/skeletal muscle uptake of glucose
beneficial to lipid profile
anorexic effect
Metformin ADR
lactic acidosis
esp in pts with CHF, liver disease, renal disease
DM 2 tx
sulfonylureas
a-glucosidase inhibitors
PPAR-y agonists
a-glucosidase inhibitors
acarbose
miglitol
inhibit intestinal enzymes that break down disaccharides
undigested sugars cannot be absorbed
metabolized by colonic bacteria –> flatulence
sulfonylureas
tolbutamide
glyburide
stimulate insulin secretion
depolarize cell –> open Ca channels –>influx Ca
sulfonylureas ADR
weight gain
hypoglycemia
disulfiram like rxn in 1st gen
foot ulcers in diabetics
microvascular disease = poor perfusion
neuropathy (stocking-glove) = can’t feel feet
PPAR-y agonists
glitazones
pioglitazone
diabetic nephropathy
nodular glomerulosclerosis
Kimmelstein-Wilson lesio
expansion of mesangium by intensely PAS-positive material without thickening of glomerular capillary walls
DM 2 poor glycemic control complications
OD on sulfonylureas = hypoglycemic coma
hyperglycemia = hyperosmolar nonketotic coma, DKA
gestational diabetes
diabetes dx in pregnancy, resolves 6 weeks after birth
increased risk of DM 2
maternal insulin resistance mechanism
placental secretion of hPL = antagonize maternal insulin
facilitate delivery of glucose to fetus via passive diffusion
gestational diabetes –> fetus
macrosomia birth injury increased fetal insulin hypoglycemia at birth respiratory distress syndrome
hypoglycemia in neonate
maternal diabetes
elevated fetal glucose –> chronic fetal hyperinsulinemia
tx give baby glucose
respiratory syndrome in neonate of maternal diabetes
respiratory distress syndrome
lack of surfactant
surfactant synthesis decreased by insulin
increased by cortisol, T4
reactive hypoglycemia causes
functional* = excessive insulin secretion
alimentary = rapid glucose absorption –> surge of insulin secretion (gastric resection)
occult diabetes = exaggerated late phase insulin secretion
Whipple’s triad
hypoglycemia
sx of hypoglycemia
resolution with food
insulinoma
insulinoma tx
surgery
nesidioblastosis
beta islet cell hyperplasia
excess insulin secretion
hypoglycemia
