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Endo II > DM and hypoglycemia darrow > Flashcards

DM and hypoglycemia darrow Flashcards

1
Q

skin issues in DM

A 
diabetic dermopathy
finer peples 
acanthrosis nigricans
bullous diabeticorum
vitiligo
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2
Q

metabolic syndrome

A 
waist circumference >40" men >35" women 
TGs >150
HDL 130/85
glucose >100
apple or Tasmanian devil shape
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3
Q

what are the mediators of metabolic syndrome?

A 
leptin
abnormal adiponectin
resistin
visfatin
TNF-alpha
IL-6
thrombospondin
plasminogen activator-1
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4
Q

TSP1

A

expressed by adipose tissue -> activates TGF-beta -> activated PAI-1 which is procoagulant
TPS1 is inhibited PPARy agonists (TZDs)

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5
Q

lean people adipose tissue

A

few macros
secretes high levels of adiponectin
low levels of inflammatory cytokines

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6
Q

obese people adipose tissue

A

lots of macros

tissue secretes high levels of many adipokines and low levels of adiponectin

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7
Q

is omental or sub-Q fat healthier

A

sub-Q

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8
Q

what happens to uric acid levels in metabolic syndrome

A

increased

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9
Q

what type of cholesterol is increased in metabolic syndrome

A

small dense LDLs

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10
Q

what happens to plasminogen activator levels in metabolic syndrome?

A

increased

this is bad b/c increases coagulation

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11
Q

what happens to platelet aggregation in metabolic syndrome

A

increased

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12
Q

what happens to homocysteine levels in metabolic syndrome?

A

increased

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13
Q

what is the initial step in both micro and macrovascular damage

A

tissue damage by hyperglycemia-mediated mitochrondrial superoxide production

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14
Q

Criteria to Dx DM

A

random glucose >200 with symptoms
FBS >126
2 hour post meal >=200 (2x)
HbA1C>=6.5% (2x)

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15
Q

what TF is associated with type II

A

TCF7L2

part of WNT pathway which activates frizzled which controls beta cell development and fnx

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16
Q

what ion imbalances can cause polyuria

A

hypercalcemia
hypokalemia
both of these affect distal tubule

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17
Q

Abs in DMI

A 
zinc transporter Abs
glutamic acid decarboxylase 65 (GAD65) Abs
insulin Abs
tyrosine phosphatase Abs
islet cell Abs
insulinoma-associated Abs
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18
Q

what HLA is associated with DMI

A

HLA-DR3

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19
Q

MODY defect

A

TFHNF 1-> decreased apoM -> decreased clearance of HDL which in this case is not cardioprotective

20
Q

inheritance of DMII vs MODY

A

DMII- polygenic

MODY- monogenic, autosomal dominant

21
Q

age of onset of DMII vs MODY

A

DMII- >40

MODY <25

22
Q

penetrance of DMII vs MODY

A

DMII- variable (10-40%)

MODY 80-90%

23
Q

obesity of DMII vs MODY

A

DMII usually obese

MODY not usually obese

24
Q

MODY 3

A

HNF1alpha mutation
TF
most common
responds to SUs

25
Q

Medications which can cause DM

A 
cyclosporine
tacrolimus
steroids
thiazides
beta-blockers
olanzopine
26
Q

reasons for insulin resistance

A 
AEIOU Has Poorly Controlled Diabetes
Aging
Endorcinre
Infections
Obesity
Uremia
Hyperglycemia
Acanthrosis nigricans
Stress
Pregnancy, pancreatic disorders, polygalndular failure syndrome
Cortisone 
Disorders of insulin, myotonic Dystrophy
27
Q

Drugs that cause hyperglycemia

A 
beta-blockers
glucocorticoids
Oral contraceptives
Pentamidine
Niacin 
Olanzapine (anti-psychotic)
cyclosporin
28
Q

obesity with mm

A

excess calories -> increased lipogenesis -> excess malonyl CoA -> blocks fatty acyl CoA oxidation -> TG and LP synthesis -> increased DAG and ceramide -> activate PKA pathways -> inhibit insulin R

29
Q

obesity and liver

A

visercal fat -> TNF-apha and resistin -> block insulin R

30
Q

obesity and pancreas

A

TNF-alpha effects -> kills B cells

31
Q

Type IV

A

XANTHOMAS
hepatic overproduction of VLDL
may be acquired in DM

32
Q

cheriopathy

A

glycate your collagen can’t bring fingers together

33
Q

what are CAD equivalents

A 
DM
cerebral aa disease
AA
PVD
should be on a statin
34
Q

IIb hyperlipidemia

A

most common in DM
HTN and obese
NO xanthomas
lactescent plasma

35
Q

III hyperlipidemia

A

equal elevation of TGs and chol

36
Q

Whipple’s triad

A

-symptoms and signs of hypoglycemia (confusion, sweating, tachy)
-low glucose at time of event
-reversal with glucose
MUST check for insulinoma

37
Q

sympathoadrenal signs

A 
glucose <60
sweating
tachy
anxiety
tremulous
nausous
most common in post prandial hypoglycemia
38
Q

neuroglycopenic signs

A 
glucose <50
blurred vision
fatigue
dizziness
HA
confusion
seizures
coma
death
most common in fasting hypoglycemia
39
Q

Dx insulinoma

A
  • serum glucose
  • serum insulin and C-peptide (when glucose in <5
  • fast up to 72 hours with glucose and insulin
  • serum B-hydroxybutyrate
40
Q

Tests for insulinomas

A

endoscopic US

Ca stimulated angiography

41
Q

Tx for insulinoma

A 
Surgery
Frequent food
Diazoxide
Verapamil
Octreotide
42
Q

nesidioblastosis

A

hyperplasia of beta cells

causes hypoglycemia after eating

43
Q

Causes of hypoglycemia

A

Re-ExPLAINS
renal disease
exogenous drugs, exercise
pit insufficiency, pregnancy, post gastrectomy
liver failure
adrenal insufficiency, acidosis, alcohol, artifactual
islet cell tumors, infection, immune mediated
neoplasms
sepsis, spurious

44
Q

drugs causing hypoglycemia

A

SAP
SUs
alcohol, ASAs, antidysrrhymics, abx, acetaminophen overdose
pentamidide

45
Q

how does hypoglycemia precipitate CV events

A
  • triggers inflammation via CRP, IL6, VEGF
  • induces increased platelet and neutrophil activation
  • increases adrenaline -> increased cardiac work load
  • underlying endothelial dysfunction -> vasodilation

Endo II (15 decks)

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