Diabetes Darrow

Question 1

granuloma annulare

Answer 1

type IV rxn

associated with diabetes, thyroid disease, infection, malignancy, drugs

Question 2

metabolic syndrome

Answer 2

2 physical findings
-waist circumference and HTN

3 lab findings
-triglycerides, HDL-C, and glucose

Question 3

apple

Answer 3

bad body shape

-want to be a pear

Question 4

adipose tissue

Answer 4

secretes inflammatory and immune mediators

-adipokines

Question 5

abdominal fat

Answer 5

vs. subQ

causal factor mediating insulin resistance, increased diabetes risk, and cardiovascular disease in metabolic syndrome

dysregulated adipokine secretion, FFA toxicity, macrophage infiltration

Question 6

obese inflamed fat

Answer 6

release of adipokines

low levels of adiponectin

has lots of macrophages

with obesity and insulin resistance

this can promote ectopic lipid accumulation

Question 7

lean person adipose tissue

Answer 7

few macrophages, high adiponectin, low inflammatory cytokines

Question 8

TZD

Answer 8

thiazolinediones

activate PPAR

cause insulin resistance, VEGF angiogenesis inhibiton, increased leptin

Question 9

TSP1

Answer 9

to TGF-beta
to PAI-1 (procoagulant)
to atherosclerosis

Question 10

with metabolic syndrome

Answer 10

hyperuricemia
larger hyperdense LDL
increased PAI - atherosclerosis
increased platelet adhesion
decreased homocysteine

Question 11

diagnosis of type II DM

Answer 11

random >200 with sx

FBS >126 x2 (pre 100-125)

post meal >200 x2 (pre 140-199)

HBA1C >6.5% x2 (pre 5.7-6.4)

Question 12

causes of DM II

Answer 12

genetic - beta cell fatigue and death
-TCF7L2 - transcription factor in beta cell development

environmental - visceral obesity - insulin resistance

Question 13

TCF7L2

Answer 13

genetic mutation in DM II

Wnt signaling pathway - for beta cell development

Question 14

vitiligo in DM I?

Answer 14

autoimmune - so see mix of sx

Question 15

polyuria

Answer 15

C-DRIPPED

cortisol excess
DM
recovery from renal failure
ions (hyper Ca, hypo K)
parkinsons - nocturnal nocturia
psychogenic polydipsia
enzyme
drugs

Question 16

Abs in DM I

Answer 16

GAD 65
insulin Abs
islet cell cytoplasmic Abs
insulinoma associated 2
zinc transporter Abs
tyrosine phosphatase Abs

Question 17

HLA in DM I

Answer 17

DR3 and DR4

Question 18

MODY

Answer 18

maturity onset diabetes of youth

defect in TFHNF1
-results in decreased apoM**

decreased clearance of HDL

Question 19

acanthosis nigricans

Answer 19

sign of insulin resistance

-DM II

Question 20

TFHNF1

Answer 20

with MODY

no apoM - so HDL is high

Question 21

most common MODY

Answer 21

type 3

do respond to sulfonylureas

Question 22

MODY syndromes

Answer 22

involve impaired glucose induced secretion of insulin

Question 23

high E and NE

Answer 23

decrease insulin secretion

• due to alpha2 adrenergic activation
• result in hyperglycemia

Question 24

cause of insulin resistance

Answer 24

obesity and hyperglycemia

all proteins get glycated

Question 25

drugs causing hyperglycemia

Answer 25

``` beta blockers glucocorticoids antipsychotic - olanzapine statins oral contraceptives pentamidine cyclosporine niacin ```

Question 26

TNF alpha

Answer 26

blocks effects of insulin -muscle, liver, fat problem of obesity in DM II

Question 27

muscle insulin resistance

Answer 27

excess calories - lipogenesis with excess malonyl CoA - blockage of fatty acyl CoA oxiation byproducts - DAG and ceramide ceramide activates PKC pathways - inhibit insulin receptor activity

Question 28

eruptive xanthoma

Answer 28

hepatic overproduction of VLDL (type 4) associated with diabetes

Question 29

cheiropathy

Answer 29

limited joint mobility can't prayer sign hands with diabetes

Question 30

coronary artery disease equivalents

Answer 30

DM cerebral arterial disease aortic aneurysm PVD

Question 31

most diabetics

Answer 31

on statins - coronary artery disease equivalent

Question 32

type IIb hyperlipidemia

Answer 32

increased heaptic secretion of apoB100 and VLDL no xanthomas

Question 33

hypoglycemia

Answer 33

insulinoma

Question 34

whipples triad

Answer 34

insulinoma if: 1 signs and sx of hypoglycemia 2 low glucose at time of event (<50) 3 reversal with correction of hypoglycemia

Question 35

sympathoadrenal signs

Answer 35

glucose <60 sweating, tachycardia, tachypnea, anxiety, tremors, nausea more with post-prandial

Question 36

neuroglycopenic signs

Answer 36

glucose <50 blurry vision, fatigue, dizzy, HA, seizure, confused, coma, death more with fasting

Question 37

diagnosis of insulinoma

Answer 37

72 hour fast with insulin and glucose measure

Question 38

insulinomas

Answer 38

80% are benign pancreatic adenoma tx - surgery

Question 39

diazoxide

Answer 39

opens K channels - to stop insulin secretion in insulinoma

Question 40

in hypoglycemia

Answer 40

should see low glucose and low insulin

Question 41

C-peptide present in hypoglycemia

Answer 41

taken sulfonylurea drug**

Question 42

C peptide absent

Answer 42

taken too much insulin**

Question 43

nesidioblastoma

Answer 43

noninsulinoma pancreatogenous hypoglycemia syndrome pancreatic cell hyperplasia post prandial hypoglycemia