Type I Diabetes Mellitus Flashcards

1
Q

What can cause type I DM?

A
  1. Autoimmune destruction of the pancreas gland - beta cells are attacked by the innate immune response
  2. Genetic predisposition - not all cases of monozygotic twins (30% concordance) - must be environmental element
  3. Virus infection - hypothesis, molecular mimicry
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2
Q

What are the differences between type I and II DM?

A

Type I = insulin deficiency

Type II = insulin resistance

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3
Q

What is the major treatment for type I diabetes?

A

Insulin

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4
Q

How was insulin manufactured before the 60s?

A

Dog and other animal pancreatic ducts where ligated

This destroyed the pancreatic gland and exocrine funciton

Islets were preserved - isolated islets and insulin

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5
Q

What is polyuria?

A

Large amount of urine produced by the body

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6
Q

What happens if sodium concentration is not correct in the body?

A

Cerebral oedema in hyposmolarity

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7
Q

What are the complications of type I diabetes?

A
  1. Microvascular complications - endothelial damage caused by hyperglycemia
  2. Macrovascular complications
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8
Q

What is the major target for type I diabetes?

A

Tight control of serum glucose concentration

Tight glucose control = risks associated with diabetes are reduced

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9
Q

What are the consequences of hypoglycemia?

A

Coma and brain damage

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10
Q

What are the microvascular complications of DM type I?

A

Diabetic retinopathy - vascular damage leads to angiogenesis causes retinal damage

Diabetic nephropathy - increases glomerular P and basement membrane thickens leading to loss of protein in the urine

Peripheral neuropathy - accumulation of sorbitol in cells (cannot leave via GLUT) and causes glycation of structural proteins like collagen

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11
Q

What are the treatments for diabetic nephropathy?

A

Control of blood pressure

Inhibition of renin-angiotensin system

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12
Q

What is a presentation of diabetic neuropathy in diabetic patients?

A

Foot ulcers

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13
Q

What are macrovascular complications in type I DM patients?

A

Stroke

Ischaemic heart disease

Peripheral vascular disease - atherosclerosis

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14
Q

What are preventative measures patients can undertake to prevent peripheral vascular disease?

A

Management of risk factors like

Blood pressure
Lipids
Cigarette smoking

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15
Q

What effect does strict control of glucose levels have on microvascular and macrovascular complications?

A

Microvascular complications decreased when glucose levels were strictly controlled

Macrovascular complications were not affected significantly when glucose levels were strictly controlled

If too controlled - hypoglycemia, pathogenesis worsened

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16
Q

What is the future of type I DM treatment?

A

Iselt cell transplantation

Stem cell transplantation

17
Q

How does islet cell transplantation take place?

A
  1. Receive pancreas from non-living donor
  2. Digested using collagenase
  3. Extract beta cells
  4. Radiological access to the portal vein of the recipient - locate via US
  5. Use a catheter to inject the solution - lodge and engraft in the liver
  6. B cells will start to produce insulin
18
Q

What are the risks of islet cell tranplantation?

A

Thrombosis of the portal vein

Bleeding

Immunosuppressants - cancer and metabolic syndrome

19
Q

Which sources can be used for stem cell transplantation?

A
  1. Human embryonic stem cells

2. Induced pluripotent stem cells

20
Q

What are induced pluripotent stem cells?

A

Fibroblasts that have been reprogrammed through transcription

21
Q

What are the steps to producing insulin in stem cell transplantation?

A

Have to differentiate the stem cells under the right circumstances to produce insulin

They express the reverse diabetic phenotype

22
Q

What is important to do in stem cell transplantation?

A

Make sure the stem cells are not susceptible to injury by the autoantibodies that caused injury in the first place

23
Q

What is a transcription factor in mature beta cells?

A

MAFA