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40 Cards in this Set
- Front
- Back
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Definition of diabetes?
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A group of metabolic disorders sharing the common underlying feature of HYPERGLYCEMIA
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Scope of diabetes?
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Affects 16 million in the USA
Each year 54,000 die from the disease Leading cause of end stage renal disease, blindness, lower extremity amputations Lifetime risk of 1 in 3 for males and 2 in 5 for females |
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How is diabetes Diagnosed?
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A random blood glucose level > 200 mg/dL
A fasting glucose >126 mg/dL An abnormal oral glucose tolerance test |
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How is diabetes Classified?
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Type I Deficiency of Insulin
Type II Insulin resistance Other types |
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Normal Insulin Physiology
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Tightly regulated
Formed in the beta cells of the pancreatic islets Most potent anabolic hormone known Principal function is to increase the rate of glucose transport into skeletal muscle and adipocytes. Receptor-mediated MAP-kinase and PI-3K signaling pathways effect cell growth and proliferation and anabolic functions. |
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Principle function of insulin?
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Increase the rate of glucose transport into skeletal musc and adipocytes
Most potent anabolic hormone |
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Type I DM?
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Autoimmune
T lymphocytes destroy islets Lack of insulin Lower genetic susceptibility |
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Whats the genetic susceptibility of type I DM?
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Lower than Type II (concordance rate of 38% if onset at less than 24 years of age and 6% if onset at 25 years of age or older)
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Type II DM?
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Genetic more important than type I
Insulin resistance: abnormalities of the insulin signaling pathway and Role of obesity Beta cell dysfunction |
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Other forms of diabetes?
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Maturity onset diabetes of the young
Primary defect in the beta cell function Gestational diabetes mellitus Glucokinase gene mutations Mitochondrial diabetes Diabetes associated with Insulin gene or insulin receptor mutations |
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What causes insulin resistance?
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Due to quantitative and qualitative abnormalities of the insulin signaling pathway
Role of obesity |
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How is obesity involved in type II DM?
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Free fatty acids
Adipokines PPR gamma and thiazolidinediones |
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What’s the genetic link w/ Type II DM?
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Higher: Concordance rate of 50-90% in identical twins
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Pathogenesis of the complications of Diabetes Mellitus?
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Macro- and microvascular disease lead to the complications of diabetes
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What kind of Macrovascular dz does DM cause?
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Accelerated atherosclerosis:
MI Stroke Lower extremity Gangrene |
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What kind of Microvascular dz does DM cause?
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Retinopathy
Nephropathy Neuropathy |
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What are 3 pathways involved in the pathogenesis of DM?
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Advanced Glycosylation end products formed
Protein Kinase C activation Intracellular Hyperglycemia w/ polyol pathway disturbances |
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What are some diabetic complications in the Pancreas?
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Lesions inconstant; rarely of diagnostic value
Autoimmune insulitis in Type I (T lymphocytes) Amyloid deposits in islets Type II diabetes |
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What are some Macrovascular complications of DM?
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Accelerated atherosclerosis
MI=most common cause of death in diabetics Gangrene of the lower extremities (100x more than nondiabetics) Hyaline arteriolosclerosis—assoc. w/ hypertension |
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What’s the most common cause of death in diabetics?
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Hypertension
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What are some Microvascular complications of DM?
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Consistent feature=thickening of the BM of the capillary (Skin, skeletal muscle, retina, renal glomeruli, renal medulla, renal tubules, peripheral nerves, placenta)
Type IV collagen deposits Leads to leaky capillaries |
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What do microvascular complications such as thickening of the BM cause in DM?
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Type IV collagen deposits
Leaky capillaries |
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What are 3 lesions seen w/ diabetic nephropathy?
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1. Glomerular lesions: thick BM, mesangial sclerosis and nodular glomerulosclerosis
2. Vascular lesions: arteriolosclerosis 3. Pyelonephritis: including necrotizing papillitis |
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What kind of glomerular lesions are seen in diabetic nephropathy?
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1. Thickened BM
2. Mesangial sclerosis 3. Nodular glomerulosclerosis (KW nodules)=pathognomonic |
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Whats a pathognomic lesion of the glomeruli seen in diabetic nephropathy?
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Nodular glomerulosclerosis (KW nodules)
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What pathogenic process is associated w/ diabetic nephropathy?
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arteriolosclerosis
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What kind of ocular complications do diabetics have?
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Cataracts due to:
Thickening of the epithelium of ciliary body Diabetic retinopathy |
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What are the two types of diabetic retinopathy?
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Background (preproliferative)
Proliferative |
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What are the characteristics of background (preproliferative) diabetic retinopathy?
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Microaneurysms, macular edema, hemorrhagic exudates
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What are the characteristics of Proliferative diabetic retinopathy?
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Neovascularization: retinal hemorrhage, detachment, blindness
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what are three types of diabetic neuropathy?
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1. distal symmetric
2. autonomic 3. focal or multifocal assymetric |
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what age gets type 1 DM?
what precipitates it? The three P's? |
usually <18 yo, can be any age
abrupt precipitation w/ infection Polyuria, Polydipsia, Polyphagia |
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what are the three P's of type 1 DM?
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Polyuria
Polydipsia Polyphagia |
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what kind of state is seen with the acute onset of type 1 DM
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catabolic state
"polyphagia w/ weight loss" diabetic ketoacidosis |
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who gets type II DM?
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older ppl, but now epidemic in overweight kids/teens
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how is type II DM diagnosed?
how is this different than for type I? |
routine blood or urine test
rather than Sx |
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what can happen to an elderly person who has acute uncontrolled type II DM?
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hyperosmolar nonketotic diabetic coma
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prevalence of diabetes in the US?
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top 10 killer in the US
markedly reduces QOL |
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3 things to help the dz course of DM?
do they prevent complications? |
strict glycemic control
lifestyle dietary alterations no, but decrease incidence |
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is there a cure on the horizon for DM?
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Islet cell transplant
Stem cells |
