Path 8 Diabetes

Question 1

Type 2 diabetes definition

Answer 1

Progressive insulin secretory defect

Question 2

Diabetes Dx

Answer 2

Fasting plasma glucose > 126
HbA1C > 6.5%
Random glucose > 200

Question 3

Prediabetes

Answer 3

Increased risk of CV disease

Question 4

Proinsulin

Answer 4

Cleaved into insulin and c-peptide

Question 5

Insulin anabolic functions

Answer 5

• Promote lipogenesis, inhibit lipolysis
• Promote AA uptake and protein synthesis
• Inhibit protein degradation

Question 6

Glucose receptors

Answer 6

GLUT-2 on B cells for insulin production

GLUT-4 on normal cells stimulated by insulin

Question 7

DM type I genetics

Answer 7

HLA-DR3 or DR4

-less genetic influence than in Type II

Question 8

Insulin resistance

Answer 8

• Found 10-20 years before onset of DM

- Universal in obese diabetics

Question 9

4 ways obesity contributes to Insulin Resistance

Answer 9

• FFA inhibit insulin signaling
• FFA engage inflammation
• Adipocytokinins (resistin)
• PPARy

Question 10

B-cell dysfunction

Answer 10

Amylin deposition

Islet degeneration

Question 11

Monogenetic DM

Answer 11

MODY (maturity-onset diabetes of the young) caused by many individual mutations

Question 12

3 DM complication mechanisms

Answer 12

• Non-enzymatic glycosylation
• Protein Kinase C activation
• Intracellular hyperglycemia & polyol disturbance

Question 13

AGEs

Answer 13

Advanced Glycosylation End Products

-Damage long lived proteins

Question 14

PKC mechanism

Answer 14

Neovascularization (retinopathy)

-Intracellular hyperglycemia activates DAG -> PKC -> VEGF

Question 15

Intracellular hyperglycemia & polyols mechanism

Answer 15

Lens, kidneys, blood vessels, nerves don’t require insulin for glucose transport
-Hyperglycemia -> Sorbitol (polyol via Aldose Reductase) -> Fructose -> Water influx, oxidative stress

Question 16

Diabetes islet infiltration

Answer 16

Type I - T lymphocytes (insulitis)

Type II - Amyloid

Question 17

Alpha cells

Answer 17

Glucagon

Question 18

Beta cells

Answer 18

Insulin

Question 19

Delta cells

Answer 19

Somatostatin

Question 20

Type I island histo

Answer 20

T lymphocytes

• No beta cells
• Normal alpha and delta

Question 21

Diabetic atherosclerosis

Answer 21

Same as regular atherosclerosis

-MI is most common cause of death

Question 22

Diabetic microangiopathy

Answer 22

Diffuse thickening of basement membranes

Question 23

Diabetic glomeruli (3)

Answer 23

-Capsular drops, fibrin caps, K-W lesions (mesangial matrix)

Question 24

Diabetic renal damage (3)

Answer 24

• Hyalinization (mucopolysaccharides), thickening of aff/eff arterioles
• Renal papillary necrosis
• Recurrent pyelonephritis

Question 25

Diabetic nephrotic syndrome cause

Answer 25

``` Diffuse glomerulosclerosis (diffuse mesangial sclerosis) -DIffuse BM thickening and mesangial matrix deposition ```

Question 26

Chronic pyelonephritis histo

Answer 26

Thyroidization of the kidney tubules

Question 27

Diabetic comas

Answer 27

Type I - ketoacidosis | Type II - hyperosmolar nonketotic coma (dehydration from sustained osmotic diuresis)