3.4.2 Diabetes Mellitus and Treatment

Question 2

Which medical student had pre-diabetes before doing an lifestyle overhaul?

Answer 2

Miles Sanderson

Question 3

What are some of the possible causes of Type I DM?

Answer 3

Definitive: Congential Rubella

Putative: enteroviruses, rotaviruses, componets of infant’s diet, association with certain genotypes

Question 4

What are some factors that can cause islet beta cells to be lost or become dysfunctional in Type II DM?

Answer 4

Glucotoxicity, Lipotoxicity, Inflammation, Genetic Factors, Insulin resistance, “pancreatic exhaustion”

Question 5

What could lead to a better prognosis in patients with Type I DM?

Answer 5

The preservation of a small number of islet beta cells

Question 6

How can the adipocyte act as an endocrine organ leading to hyperglycemia and against hyperglycemia?

Answer 6

Question 7

Which type of diabetes is highly associated with obesity?

Answer 7

Type II DM

Question 8

What are some of the characteristics of the younger children that are being diagnosed with Type II DM?

Answer 8

Minority children (AA, H, AI)

Girls

Mean age: 13 y/o

Family history of DM

Obese (BMI >30)

Question 9

What is the WHO definition of diabetes?

Answer 9

A chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Question 10

What type of diabetes is characterized by AI destruction of islet cells later in life?

Answer 10

Latent Autoimmune Diabetes of Adults (LADA)

Question 11

Describe the natural history of Type I DM and its stages.

Answer 11

Question 12

Describe the increase in DM worldwide?

Answer 12

EXPLOSIVE (similar to taking a dump after a late night taco bell run after a night of heavy drinking)

Question 13

How does insulin secretion, insulin resistance, postprandial glucose, and fasting glucose changing during the three stages of Type II DM?

Answer 13

Question 14

What is the functional model of pancreatic development in Type I DM?

Answer 14

Islet cell neogenesis -> functional islet cell mass -> islet cell apoptosis/loss (due to AI destruction)

Question 15

What are some of the potential sites for the original defect leading to type II DM?

Answer 15

pancreas, liver, muscle, fat

Question 16

What are some of the abnormalities that arise from a (relative) lack of insulin?

Answer 16

Glucose, lipid, protein, and electrolyte metabolism

Question 17

What are the prevelances of Type I DM, Type II DM, undiagnosed DM, and IGT in the US?

Answer 17

Question 18

What type of diabetes has an “absolute” lack of insulin? “Relative” lack?

Answer 18

Absolute: Type I DM

Relative: Type II DM

Question 19

Describe the nature inheritabilty of type II DM

Answer 19

Polygenetic with strong environmental factors

(complex genetic susceptibility with weak penetrance)

Question 20

Who are at the greatest risk for developing DM?

Answer 20

Lower socioeconomic class

Minorities

Question 21

What is the major characteristic of Type I DM?

Answer 21

Chacterized by near-total or complete loss of beta islet cells

Question 22

What are the three phases in the natural history of Type II DM?

Answer 22

IGT, undiagnosed diabetes, known diabetes

Question 23

Describe each of these phases of islet cells during the progression of Type I DM.

Answer 23

Question 24

What type of DM is becoming more and more prevalent in the US?

Answer 24

Type II DM in young adults and children

Question 25

How has the mortality of diabetes changed over time?

Answer 25

Increasing

Question 26

Over time, what factors can play a role in the progressive loss of islet cell capacity?

Answer 26

inflammatory, glucose, and lipid toxicity

Question 27

Insulin resistance leads to what complications associated with Type II DM?

Answer 27

Question 28

What two conditions involving insulin lead to Type II DM?

Answer 28

Insulin deficiency and insulin resistance

Question 29

What are some of the key triggers of Type II DM?

Answer 29

Obesity and Age