Diabetes Mellitus

Question 1

Is Diabetes just one disease?

Answer 1

No; heterogeneous group of multifactorial, polygenic syndromes characterized by elevated fasting blood glucose

Question 2

How many people in US have diabetes?

Answer 2

28 million (8 mil undiagnosed)

Question 3

What is diabetes a leading cause of?

Answer 3

• Adult blindness + amputation
• Renal failure
• Nerve damage (neuropathy)
• Heart attacks
• Strokes

Question 4

Age of onset in Type 1 vs 2?

Answer 4

1- childhood/puberty

2- after 35

Question 5

Nutritional status at time of disease onset in type 1 vs 2?

Answer 5

1- undernourished

2- obesity

Question 6

Prevalence of type 1 vs 2?

Answer 6

1- <10% diagnosed diabetics

2- >90% diagnosed diabetics

Question 7

Genetic disposition in type 1 vs 2?

Answer 7

1- moderate

2- very strong

Question 8

Defect/deficiency in type 1 vs 2?

Answer 8

1- beta cell destruction -> no insulin production

2- insulin resistance + inability of beta cells to produce appropriate amount of insulin

Question 9

Frequency of ketosis in type 1 vs 2?

Answer 9

1- common

2- rare

Question 10

Plasma insulin in type 1 vs 2?

Answer 10

1- low-absent

2- high early in disease; low-absent later

Question 11

Acute complications in type 1 vs 2?

Answer 11

1- ketoacidosis

2- hyperosmolar hyperglycemic state

Question 12

Response to oral hypoglycemic drugs in type 1 vs 2?

Answer 12

1- unresponsive

2- responsive

Question 13

Treatment in type 1 vs 2?

Answer 13

1- insulin necessary

2- diet, exercise, oral hypoglyemic drugs, insulin (maybe), reduce risk factors (essential)

Question 14

What is essential for type 1 diabetes to occur?

Answer 14

Initiating event (virus/toxin) -> autoimmune attack on beta-cell of pancreas
-in individuals w/ genetic predisp

Question 15

What are the sx of type 1?

Answer 15

1) Polyuria
2) Polydipsia
3) Polyphagia
- all develop suddenly

Question 16

What is the diagnosis of type 1 confirmed by?

Answer 16

1) HbA1c (> or = 6.5 mg/dl)

2) Fasting blood glucose (FBG > or = 126 mg/dl, normal = 70-99)

Question 17

What is the biochemical diff between type 1 and 2?

Answer 17

1 has ketonemia (high blood KBs)

-body doesn’t have insulin -> TAG -> lipolysis -> FAs -> liver -> KBs

Question 18

What is increased metabolically in type 1?

Answer 18

1) Hyperglycemia (increased gluconeogenesis)
2) Ketonemia
3) Extra FAs in liver -> VLDLs accumulation
4) Extra FAs in intestine -> chylomicrons accumulate
5) Glucagon (b/c no insulin)

Question 19

What are the 2 treatments of type 1?

Answer 19

1) Standard: 1-2 daily injections

2) Intensive: 3+/day

Question 20

What does intensive therapy result in?

Answer 20

3-fold increase in freq. of hypoglycemia (>90% of patients)

-Caused by excess insulin

Question 21

Highest prevalance of type 2 is in what people?

Answer 21

A. Indians, Alaskan natives, hispanics, african amer, asian amer

Question 22

What sx are common in type 2?

Answer 22

1) Polyuria
2) Polydipsia
3) Polphagia
- May be asymptomatic

Question 23

What does insulin resistance cause in target tissues (liver, adipose, muscle)?

Answer 23

• Increased adipose lipolysis
• Decreased FA oxidation
• Increased gluconeogenesis
• Decreased glucose uptake by GLUT-4

Question 24

What is key in the development of insulin resistance?

Answer 24

Excess adipose tissue

-IR increases w/ weight gain, decreases w/ weight loss

Question 25

Up to 10 years as an obese individual, before diagnosis of diabetes what happens?

Answer 25

Develop insulin resistance w/ compensatory hyperinsulinemia | -Pancreas initially retains beta-cell capacity

Question 26

With time what happens in type 2?

Answer 26

Beta cell dysfunction w/ declining insulin secretion + worsening hyperglycemia

Question 27

What are microvascular complications of type 2?

Answer 27

Retinopathy, neuropathy, nephropathy

Question 28

What are macrovascular complications of type 2?

Answer 28

Cardiovascular disease + stroke

Question 29

What is increased metabolically in type 2?

Answer 29

All the same as in type 1 (hyperglycemia + dyslipidemia), but ketonemia is not nearly as high as in type 1

Question 30

What are the hypoglyemic agents used in treatment of type 2?

Answer 30

1) Metformin - decreases hepatic output of glucose 2) Sulfonylureas - increase insulin secretion 3) Thiazolidinediones - increase peripheral insulin sensitivity 4) Alpha-glucosidase inhibitors - decrease dietary carb absorption 5) Later on insulin therapy

Question 31

What can often correct type 2?

Answer 31

Weigh reduction, exercise and medical nutrition therapy

Question 32

Increased HbA1c is linked to?

Answer 32

Higher chance of microdisease

Question 33

What are chronic complications of type 2?

Answer 33

Premature atherosclerosis, cardiovascular disease + stroke, retinopathy, nephropathy/neuropathy

Question 34

What is directly correlated to incidence of type 2?

Answer 34

Obesity and exercise