W27-L3: The pathology of Diabetes Flashcards
Where are most insulin receptors expressed?
only on a few tissues, skeletal muscle, liver and fat
What are the acute complications of T1D and T2D?
Type 1: Diabetic ketoacidosis
Type 2: Hyperosmolar coma
What are the macrovascular effects of diabtetes?
Atheroma: accelerated and more severe
What are the microvascular effects of diabtetes?
nephropathy
Diabetic retinopathy
Delayed wound healing
neuropathy
What are the underlying causes of microvascular complications?
Relate to the long term effects of hyperglycaemia on cells and extracellular matrix, Particularly glycosylation of proteins
How does diabetes effect immune cells?
impairs neutrophil function which predisposes them to infections eg pyelonephritis
What are the causes of diabetic nephropathy?
Atheroma in larger arteries, often with foci of renal infarction
What is the histology of diabetic nephropathy?
Kimmelstiel- Wilson nodules: spherical nodules arising in mesangium and eventually becoming balls of collagen
hyaline arteriolosclerosis: Arteriolar wall thickening by acellular proteinaceous material
What is the cause of impaired wound healing in diabetes?
impaired perfusion in the setting of microvascular injury
Why is chronic hyperglycaemia damaging to tissue?
3 pathways:
– Advanced Glycation End products (AGEs)
– Activation of Protein Kinase C
– Intracellular hyperglycaemia and abnormal Polyol pathways
What are Advanced Glycation End products?
Result of reactions between molecules derived from glucose and the amino groups of various proteins inside and outside cells
How do Advanced Glycation End products cause damage?
The AGEs bind to a specific receptor (RAGE) on inflammatory cells including macrophages and T cells, endothelial cells, and vascular smooth muscle
How can diabetes effect the liver?
Non-alcoholic steatoheapatitis
