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28 Cards in this Set
- Front
- Back
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Actions of Insulin
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Increase glucose uptake into cells, Promotes formation of glycogen, decreases gluconeogenesis, stimulates fat deposition and inhibits lipolysis, Storage of AA ans protein
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Acute problems of Diabetes?
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From Hyperglycemia: diabetic Ketoacidosis, non-ketotic hyperosmolar state
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Long-Term complications of Hyperglycemia?
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Retinopathy, Neuropathy, Nephropathy, Vasculopathy: CVD, peripheral VD, stroke
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Classic presentation of type-1 Diabetes mellitus?
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Pplyuria, polydypsia, polyphagia.
Ketoacidosis, enuresis(bed wetting), growth retardation, fasting hyperglycemia |
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Diabetic Ketoacidosis
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Confusion, Lethargy, dehydration, tachypnia, Kussmal respirations, fruity breath
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Etiology of Type-1 Diabetes Mellitus?
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Familial, HLA associated
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Diagnosis of Type-1 Diabetes Mellitus?
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1 symptoms
2 causal plasma glucose > 200 3 FPG > 126 4 2 HR PG > 200 after oral glucose tolerance test |
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Etiology of Type-2 Diabetes Mellitus?
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Very strong genetic component, not HLA mediated, strong association with obesity
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Insulin Resistant Syndrome?
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Hyperlipidemia, increased triglycerides, decreased HDL, increased LDL, Hypertension, increase PAI1: deacreased fibrinolysis, increase risce of CV moridity, obesity, no ketoacidosis
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MODY
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Maturing onset diabetes of the young: Chromosomal mutation. Looks like Type 2 but at younger age
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Threatment of Type-2 Diabetes Mellitus?
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Diet, exercise, weight lose, pharmacology
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Screening for Diabetes Mellitus?
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Type 1 not recomended
Type 2: every three years after 45, younger if obese, primary relative with DM, high risk ethnic group... |
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IFG?
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Impaired fasting glucose
FPG = 100-126 |
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IGT?
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Impaired glucose tolerance
Post-prandial plasma glucose = 140-200 |
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Non-ketotic Hyperosmolar State (NKHS)?
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Hyperglycemia, hyperosmolarity, osmotic diuresis, mental status changes, seizures, coma
Seen in Type-2 especially in elderly Treat with fluid replacement |
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Cells in Islets of Langerhans and what they secrete?
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Beta: Insulin
Alpha: Glucagon delta: Somatastatin PP: polypeptide D1: VIP, WHDA Enterochromaffin: Serotonin |
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Preproinsulin Cleaved to form?
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Insulin and C-peptide(used as a marker for endogenous insulin formation)
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How does Glucose stimulates release of Insulin?
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Glucose enters GLUT-2, turned to ATP which blocks K+ channel, Membrane depolarizes, Opens Calcium channel, calcium influx causes insulin release and synthesis
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How does insulin cause its effects?
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Insulin binds Tyrosine Kinase receptor, activate PI-3K pathway , increase GLUT-4 expression, synth of lipids, pts, glycogen
Insulin binds Tyrosine Kinase receptor, activates MAPKinase pathway, cell growth and prolifeation |
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Obesity linked to Diabetes?
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Central Worse than gluteal and subcutaneous, FFA and TGI inhibit signalling, Cytokines from fat: leptin, resistin, adiponectin
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Mitochondrial Diabetes?
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Maternally inherited, Cannot make ATP and need ATP for insulin synthesis, rare
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causes of Type-1 diabetes(Beta cell destrubtion)?
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insulitis: CD4 and CD8 cells
Cytokines produced locally Auto-AB against islet cels or insulin Amyloid(Type 2) |
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Macrovescicular Complications of Diabetes?
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Accelerated Athersclerosis: MI, Renal artery athero, hypertension, gangrene of lower extremities
Hyaline arteriosclerosis:HTN |
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Microvescicular Complications of Diabetes-retinopathy?
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lens-cataracts
iris-glaucoma Retina, new vescels form on disk and retina and hemorrhage and cause vitrious death. |
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Microvescicular Complications of Diabetes-Nephropathy?
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Renal vascular lesions,
Glomerular lesions: capillary basement thickeninf, mesangial sclerosis, nodular glomerulosclerosis (Kimmelstiel-wilson lesion) |
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Microvescicular Complications of Diabetes-Peripheral neuropathy?
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Axial, autonomic, weakness, functional disability, predisposed to ulcers, infection, gangrene
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Insuloma?
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Beta cell, solitary, 90% benign,
Triad: glucose <50, CNS symptomes, attacks with fasts or exercise. |
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Gastrinoma?
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Found in Parncreas, duodenum, peripancreatic tissue.
Cause Zollinger-ellison syndrome:multiple peptic ulcers, usually invasion or mets |
