37. Diabetes mellitus Flashcards Preview

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Flashcards in 37. Diabetes mellitus Deck (46):
1

acute manifestation

polydipsia, polyuria, polyphagia, weight loss ( type 1)
hyperosmolar coma ( type 2)

2

diabetes mellitus is caused by

1. insulin deficiency or insensitivity ( and glucagon exceess )
2. unpposed secretion of epinephrine
3. unpposed secretion of GH
4. glucorcorticicoid therapy ( steroid diabetes )

3

diabetes mellitus - MCC

insulin deficiency or insensitivity ( and glucagon excess)

4

rare cause of diabetes melitus

2. unpposed secretion of epinephrine
3. unpposed secretion of GH
4. glucorcorticicoid therapy ( steroid diabetes )

5

Diabetes mellitus - insulin deficiency or insensitivity causes ( biochemistry )

1. decreased serum glucose uptake
2. inreased proterolysis
3. increased lipolysis ( insulin deficiency only)
4. increased glycogenolysis
5. increased gluconeogenesis

6

diabetes mellitus - insulin deficiency vs insensitivity ( according biochemistry)

increased lipolysis is caused only by insulin deficiency ( endogenous insulin in DM2 prevents lipolysis)

7

diabetes mellitus - diagnosis

1. fasting serum glucose
2. 2h oral glucose tolerance test
3. HbA 1C

8

HbA 1c test - chatacteristic and values

-reflects average blood glucose over prior 3 months
-more than 6.5%

9

normal glucose level

70-120 mg/dl

10

fasting serum glucose test - positive / procedure

> 126 mg / dL
fasting for more than 8h

11

random glucose test - positive / procedure

>200 mg/dL
2h after consumption of 75g in water

12

complications are divided to

1. Non enzymatic glyation ( NEG) of vascular basement membranes
2. osmotic damage

13

complications - osmotic damage pathophysiology

sorbitol accumulation in organs with aldosterone reductase and decreased or absent sorbitol dehydrogenase

14

osmotic damage ---> sorbitol accumulation in organs with

aldosterone reductase and decreased or absent sorbitol dehydrogenase

15

aldosterone reductase function

glucose + NADPH --> sorbitol

16

sorbitol dehydrogenase function

sorbitol + NAD+ --> fructose

17

Cells sorbitol ith aldosterone reductase and decreased or absent sorbitol dehydrogenase

1. Schwann cells
2. retina
3. kidneys
4. Lens has primarily aldose reductase

18

osmotic damage - consewuences

1. neuropathy
2. cataracts

19

neurpathy degeneration

motor , sensory ( glove and stocking distribution ) autonomic degeneration

20

MCC of death in diabetics

MI

21

complications - non enzymatic glycation is divided to

1. small vessel
2. large vessel

22

NEG of large vessels - lessions

atherosclerosis

23

NEG of large vessels - clinically

1. CAD
2. peripheral vascular occlusive disease --> gangrene --> limb loss

24

NEG of small vessels causes --> histology

diffuse thickening of basement membrane ( hyaline arteriolosclerosis

25

complications - NEG of small vessels - clinically ?

1. retinopathy 2. glaucoma 3. neuropathy 4. nephropathy

26

retinopathy of diabetes mellitus - findings

1. hemorrhages
2. exudates
3. microaneurysms
4. vessel proliferation

27

diabetes mellitus and hypertension against renal

both causes chronic renal failure

28

nephropathy - findings ( pathways

nodular glomerulosclerosis ( AKA Kimmelstiel - Wilson nodules ) --> progressive proteinuria and arteriolosclerosis --> hypertension --> both to chronic renal failure

29

nodular glomerulosclerosis - also known as

Kimmelstiel - Wilson nodules

30

MCC of nontraumatic amputation

peripheral vascular ocllusive disease

31

MCC of blindness in developed world

diabetes

32

insulin deficiency or insensitivity - decreased serum glucose uptake / increased glycogenolysis, increased gluconeogenesis
----> .....--->

hyperglycemia, glycosuria --> 1. high plasma osm --> thirsty 2. osmotic diuresis --> loss of water , Na+, K+ --> hypovolemia --> circulation failure and decreased tissue perfusion --> coma / death and high serum lactate ( anion gap met acidosis)

33

insulin deficiency or insensitivity - increased lipolysis ----> .....--->

increased plasam free fatty acids --> ketogenesis, ketonuria, ketonemia --> a. anion gap met acidosis --> hyperventilation b. vomiting --> loss of water Na/K --> hypovolemia ...

34

insulin deficiency or insensitivity - increased protein catabolism ----> .....---> .....--->

decreased protein , weight loss --> gluconeogenesis --> hyperglycemia, glycosuria ---> ...

35

Name some acute manifestations that may be seen in type 1 and type 2 diabetes mellitus. Name two other causes of these symptoms.

Polyphagia, polydipsia, polyuria, weight loss; glucocorticoids (steroid diabetes), unopposed secretion of GH or epinephrine (rare)

36

• Classically, diabetic ketoacidosis is an acute sign of type __ (1/2) diabetes. Hyperosmolar coma is an acute sign of type __ (1/2) diabetes.

1; 2

37

• What three direct effects on cellular metabolism can a diabetic insulin deficiency create?

Decreased glucose uptake, increased protein catabolism, and increased lipolysis

38

• A diabetic patient is severely volume depleted and has a low serum pH (acidosis). What will happen if the condition is not treated?

Coma and death

39

• A patient has chronic insulin insensitivity. List three pathologic processes caused by small vessel disease in patients with this condition.

Retinopathy, glaucoma, nephropathy (proteinuria, chronic renal failure, arteriosclerosis, Kimmelstiel-Wilson nodules)

40

• A woman with poorly controlled diabetes has hypertension. What two diabetes-related pathologic processes contribute to her hypertension?

Nonenzymatic glycation causing small vessel arteriosclerosis in the kidney, and large vessel atherosclerosis

41

• What two disease states can osmotic damage cause in patients with chronic diabetes? What is the pathophysiology?

Neuropathy and cataracts; sorbitol builds up in organs with aldose reductase and low/absent sorbitol dehydrogenase, causing osmotic damage

42

• Does diabetic neuropathy affect the motor, sensory, and/or autonomic nervous systems?

Can affect all three systems

43

• What three glucose-related tests are diagnostically useful for diabetes?

Oral glucose tolerance test, fasting serum glucose, glycosylated hemoglobin (HbA1c) test (reflecting average blood glucose over 3 months

44

• A patient with hyperglycemia and metabolic acidosis has ketones in her urine and blood. What causes this ketonemia and ketonuria?

Increased lipolysis with insulin deficiency

45

• A patient has had poorly controlled diabetes for 20 years. For what large vessel disease is he at risk? What is the pathophysiology?

Atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene (limb loss), cerebrovascular disease; nonenzymatic vessel glycation

46

• A patient has diabetes. What is the most common cause of death among people with this condition?

Myocardial infarction