DM and DMT2 and DMT1

Question 1

overt DMT1 presentation

Answer 1

increase thrist, urination

weight loss

bed wetting

hunge

Question 1

treatment for emergent severe hypoglycemia

Answer 1

glucagon injections

Question 2

long term microvascular complications of DM

Answer 2

retinopathy

nephropathy

neuropathy

Question 3

pathogenesis of DM complications (pathways impacted)

Answer 3

accumulation of advanced glycosylation end products

accumulation of sorbitol

disrupt of hexosamine pathway

disrupt of protein kinase C pathway

activation of poly ADP-Ribose polymerase pathway

increased oxidative stress

Question 3

2 defects of DM2

2 outcomes

Answer 3

Insulin resistance (imp glucose production and uptake)

inadequate insulin secretion

outcomes:
inability to suppress glucose from liver and kidney during fast
inability to appropriately take up glucose

Question 4

dehydration in ketoacidosis due to

Answer 4

vomiting (due to ketoacids)

anion gap metabolic acidosis > compensatory tachypnea

severe hyperglycemia > glycosuria > water follows

Question 5

most common insulin regimen

Answer 5

MDI - multiple daily injections

long acting (glargine or detemir) + short acting with meals (lispro or aspart)

Question 6

electrolyte changes in untreated T1DM

Answer 6

hyponatremia

hypokalemia

low CO2 (bicarb) ketoacidosis

decreased phosphate intake and phosphaturia

Question 7

Dx of DM

Answer 7

HbA1c >6.5%

OR

fasting plasma glucose >126mg/dL

OR

2 hour plasma glucose >200 ueing 75g oral glucose tolerance test

OR

Random glucose >200

Question 7

fluid and electrolyte abnormalities in DM due to

Answer 7

osmotic diuresis that results from hyperglycemia

Question 7

Adipose tissue inflammation pathogenesis in DMT2

Answer 7

changes in stromovascular cells to phenotypic activation of pro-inflammatory state.

adaptive immune cells interact+activate adipose macrophages>

> macrophages and Tcells shift from anti- to pro-inflammatory state

> CD8, Th1, Th17 cells stimulate M1 macrophage poalrization

>chemokines and cytokines promote inflammation and insulin resistance

Question 7

moderate hypoglycemia in insulin overdose symptoms

treatment

Answer 7

**neurogenic symptoms: **

confusion, combativeness

poor coordination

slurred speech

treat with fast acting carbs

Question 8

Dx of pre-diabetes

Answer 8

Fasting plasma glucose = 100-125

OR

2 hour plasma glucose 140-199 during 75g oral glucose tolerance test

OR

A1C 5.7-6.4%

Question 10

patients present DMT1 when

Answer 10

80-90% of beta cells are lost

Question 12

Dx of T1DM

Answer 12

random blood glucose >200

or

two fasting blood >126

or

positive oral glucose tolerance test

Question 13

T1DM in adults pathogenesis

Answer 13

5-15% with DM express anti-islet autoantibodies

rapid 3 year progression to T1

HLA alleles associated

Question 15

eitologic classification of DM

Type1

Type 2

gestational

Answer 15

1 - autoimmune B cell destruction with lack of insulin

2 - insulin resistance with relative insulin deficiency

Gestational - insulin resistance with B-cell dysfunction

Question 16

long term macrovascular complications of DM

Answer 16

coronary artery disease

peripheral vascular disease

Question 18

impaired consciousness in ketoacidosis due to

Answer 18

intracellular dehydration due to severe hyperglycemia

Question 19

2 ketone bodies typically elevated in DKA

Answer 19

Acetoacetate

B-hydroxybuturate

Question 21

Pathophys DMT1

Answer 21

molecular mimicry > APCs > CD4 differentiation to CD4Th1 cells

>CD4 Th1 INFg and IL 2 > CD8 CTls >

>CD8 attack beta cells > release more contents = more antigen

Question 22

insulin overdose causes hypoglycemia, which causes mil adrenergic sympoms…

Answer 22

shakiness,

headaches

dizziness

sweating

tachycardia

hunger + fatigue

(due to increased sympathetic tone)

Question 23

locations and actions of glucagon like peptide 1 GLP-1

Answer 23

liver: reduces hepatic glucose output by inhibiting glucagon release

Stomach - slows gastric emptying

alpha cell - inhibits glucagon secretion

Beta cell - stimulates glucose-dependent insulin secretion and B-cell differentition and proliferation