Diabetes

Question 0

2 hr after 75g carb load= 150-200

Answer 0

impaired glucose tolerance- big vessel damage

Question 1

three criteria for diabetes

Answer 1

symptoms + random >200

fasting glucose >125 2 xs

after a 75 g glucose load, a plasma glucose at or above 200 after 2 hrs (need to be low carb for two days before)

Question 2

2 hrs after 75 g glycose load =>200

Answer 2

DM- small BV damage

Question 3

predisone

Answer 3

increases risk for diabetes

Question 4

percentage of people that develop DM overtime who have IGT?

Answer 4

25%

Question 5

Metabolic syndrome must have greater than 3 of

Answer 5

obesity (increase waist circumference)
lipids (increase TG, decrease HDL)
BP >130/85
glucose >100

Question 6

DM 1 type 1a

Answer 6

autoimmune

Question 7

DM1 type 1B

Answer 7

idiopathic

Question 8

HLA association type 1 DM

Answer 8

HLA-DR, HLA-DQ

Question 9

Autoimmune Polyglandular Syndrome

Answer 9

dm type 1
hashimotos
addisons
premature ovarian failure
SLE, RA, pernicious anemia, etc

Question 10

DR+Q vs DR3/4+DQ

Answer 10

Dr+Q is protective

DR3/4+DQ are at a high risk

Question 11

DR and DQ are on chromsome

Answer 11

6

Question 12

IDDM-2 insulin gene is on

Answer 12

chromsome 11

Question 13

IDDM2 insulin gene

Answer 13

class of variable number of tandem repeats at that locus (class III protective, class I predisposing)

Question 14

PTPN22 and CTLA4

Answer 14

genes associated with cytotoxic T cell function

Question 15

breast feeding and DM1

Answer 15

protective

Question 16

cytokine mechanism of DM

Answer 16

activation of TH1 is bad vs Th2 tell cells

Question 17

what is the most predicative of DM1 development risk?

Answer 17

insulin antibodies in children

glutamic a decarboxylase (GAD) autoAb are most pesistent are thus the only ones tested in adulthood

Question 18

only primary prevention that was successful in diabetes

Answer 18

oral insult- delayed onset (but still occured)

Question 19

promising secondary preventiont rials

Answer 19

heat-shocked protein 60 and CTLA 4 IG

Question 20

quantitatively most important for stimualted glucose uptake

Answer 20

muscle

Question 21

insulin increases and increases with glucose until

Answer 21

insulin maxes out and falls

Question 22

the heavier you are per height

Answer 22

the more insulin resistant you are

Question 23

Rare AD diseases that produce DM2

Answer 23

MODY- maturity onset diabetes of the young

Question 24

most common MODY

Answer 24

MODY3

Question 25

MODY easily treated with

Answer 25

sulfonylurea (insulin ineffective)

Question 26

MODY2

Answer 26

mutation of glucokinase- glucose sensor; islet enzyme which converts G-->G6P, which increases insulin release

Question 27

normal fasting insulin level

Answer 27

<10 uU/L

Question 28

exercising vs resting muscle

Answer 28

exercisign muscle can take glucose up without needing insulin but resting muscle is under control of insulin

Question 29

insulin does not do this with liver

Answer 29

regulate how much the liver can take up

Question 30

insulin does do this with liver

Answer 30

tells it to stop gluconeogenesis and glycogenolysis | during fastign, resting glucose is also higher

Question 31

insulin and fat

Answer 31

regulates glucose uptake | regulates FFA output

Question 32

adiponectin is equal to

Answer 32

1/BMI

Question 33

adiponectin

Answer 33

decreases insulin resistance and is LOW in type2 DM

Question 34

leptin

Answer 34

signals satiety and increase with increasing fat mass, so obese individuals must have some resistance to it

Question 35

functions of glucagon like peptide

Answer 35

decreases glucagon realse, increases insulin release and responsiveness decreases appetite

Question 36

why is GLP1 released

Answer 36

neural reflex (via enteroendocrine cells) in jejunum in response to eating

Question 37

T2DM & GLP1

Answer 37

decreased levels

Question 38

acanthosis

Answer 38

skin rash common sign of insulin resistance

Question 39

three major complications of uncontrolled DM

Answer 39

microangiopathy accelerated atherosclerosis opportunistic infections

Question 40

kid target for opportunistic infections

Answer 40

kidney

Question 41

kidneys transplanted frm diabetic to normal patient

Answer 41

will be normal

Question 42

types of infections common in diabetics

Answer 42

fungal (candida, mucormycosis) | bacteria (pyelonephritis)

Question 43

mechanisms of retinal injury

Answer 43

fluid retention by glucose (can be reversed with good control) microangiopathy-->occlusion-->thickened endothelial cell prolif-->angiogensis eventual ischemia and infacrts

Question 44

early changes Type 1 DM

Answer 44

autoimmune attack on B cells with lymphocyte infiltration

Question 45

late changes Type 1 DM

Answer 45

islet atrophy- absence of B cells, seen with IHC stain for insulin

Question 46

Type II early changes

Answer 46

no changes in islets

Question 47

mid course Type II

Answer 47

b cell malfunction

Question 48

later type II

Answer 48

b cell depletion/atrophy, but not absent

Question 49

late changes Type II DM

Answer 49

amyloid deposition in islets, which is not specific to, but is very common in end stage DM2

Question 50

Malliard Reaction

Answer 50

browning in cells glucose becomes reactive-->interacts with lipids-->bicarb structures not stable-->less function-->AGEs accumulate inside and outside cell **cannot be cleared and effects are worse with aging

Question 51

how do AGEs interaact with blood vessel

Answer 51

get put out in the extravascular space (basement membrane)--Bind stable proteins (collagen IV, laminin)-->ECM no longer degraded properly-->increase BM that is stiffer and less permeable this causes INTRACELLULAR TF, TGFB inflam, NO gen and endothelial cell swells-->looses fx-->dies

Question 52

pyelonephritis is

Answer 52

more common in DM | more severe in DM

Question 53

ischemia serves as a ___for infection

Answer 53

nidus