L1: Diabetes Mellitus Flashcards
(69 cards)
1
Q
Tips in DM
A
2
Q
Pathway of CHO in the body & its relation to insulin
A
3
Q
Effects of Insulin (In Brief)
A
4
Q
Effect of DM (In Brief)
A
5
Q
Insulin & Anti-Insulin Hormones
A
6
Q
Role of Incretins
A
7
Q
HLA in DM
A
8
Q
Def of DM
A
9
Q
Classification of DM
A
- Type 1 diabetes
- Type 2 diabetes
- Gestational DM
- Other Specific Types of DM
10
Q
Types of Type I DM
A
A : Immune mediated.
B : Idiopathic.
11
Q
what are other types of DM?
A
- Genetic defects of B-cell function.
- Genetic defects in insulin action.
- Exocrine pancreatic causes
- Endocrinal causes
- Infections
- Drugs
- Other genetic syndromes
- Uncommon forms of immune mediated diabetes
12
Q
what are secondary causes of DM?
A
13
Q
Exocrine pancreatic causes of DM
A
14
Q
Endocrinal causes of secondary DM
A
15
Q
Infections causing DM
A
- Congenital rubella.
- Cytomegalovirus.
16
Q
Drugs Causing DM
A
Interferon, Corticosteroids, CCP, Diuretics
17
Q
what are Genetic Syndromes that may Cause DM?
A
- Down’s syndrome.
- Klinefelter syndrome.
18
Q
Uncommon forms of immune mediated diabetes
A
Anti-insulin receptor Ab.
19
Q
Characters of MODY type of DM
A
Mature Onset Diabetes in the Young:
- Represent 15 % of cases.
- Autosomal dominant.
- In young obese people.
- Treated by oral antidiabetics.
- less liable for microangiopathy
20
Q
what is LADA short for?
A
Late onset Autoimmune Diabetes of Adult
21
Q
Pathaphysiology of DM I
A
22
Q
….. is considered the major factor in the pathophysiology of type 1 DM.
A
Autoimmunity
23
Q
Approximately 85% of type 1 DM patients have circulating ……. and the majority also has detectable …….. before receiving insulin therapy.
A
- islet cell antibodies,
- anti-insulin antibodies
24
Q
The most commonly found islet cell antibodies are those directed against ……
A
glutamic acid decarboxylase (GAD), an enzyme found within pancreatic beta cells
25
- Type 1 DM is the result of destruction of insulin secreting beta cells of the islets of Langerhans in the pancreas.
- As beta-cell mass declines, insulin secretion decreases until the available insulin no longer is adequate to maintain normal blood glucose levels
..
26
Antibodies in Type I DM
27
Disease Stages in Type I DM
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Paracrinopathy In DM
29
After ........ of the beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed.
80-90%
30
Patients need exogenous insulin to:
**NPRD**
1) Normalize lipid and protein metabolism.
2) Prevent ketosis.
3) Reverse this catabolic condition.
4) Decrease hyperglucagonemia.
31
Etiology of Type I DM
32
Type 1 DM results from ......
a. Autoimmune destruction of the beta cells of the pancreas
b. Genetic predisposition
c. Environmental component
33
From 90% to 95% of young children with type 1 DM carry ........
- HLA-DR 3
OR
- HLA-DR 4.
34
Carriage of both haplotypes (i.e. DR 3 / 4 heterozygotes) confers the ....... susceptibility.
Highest
35
Extragenetic factors in DM I
Extra genetic factors may contribute Potential triggers for immunologically
mediated destruction of the beta cells include :
- Viruses (e.g., enterovirus, mumps, rubella, and Coxsackie virus B4).
- Toxic chemicals.
- Exposure to cow’s milk in infancy.
- Cytotoxins.
36
Pathophysiology of DM II
37
Type 2 diabetes is characterized by a combination of ........
Type 2 diabetes is characterized by a combination of
- Peripheral insulin resistance.
- Inadequate insulin secretion by pancreatic beta cells
38
For type 2 diabetes mellitus to occur, both insulin resistance and inadequate insulin secretion **must** exist.
For example, all overweight individuals have insulin resistance, but diabetes develops only in those who cannot increase insulin secretion sufficiently to compensate for their insulin resistance.
39
what is IR Attributed to?
elevated levels of free fatty acids and pro inflammatory cytokines in plasma
40
what does IR Lead to?
41
- In the progression from normal to abnormal glucose tolerance, ......... increase first.
- Eventually, ......... develops as suppression of hepatic gluconeogenesis fails.
- postprandial blood glucose levels
- fasting hyperglycemia
42
..
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Pathophysiology & Etiology of Type II DM (PPT)
44
Natural History of Type II DM
45
Sequence of PP Hyperglycemia & Fasting Hyperglycemia in Type II DM
46
Etiology of Type II DM
47
Major risk factors for type 2 DM
48
CP of DM
- Asymptomatic
- Classic symptoms
- Symptoms of complications
49
Asymptomatic DM
in 1/3 of cases.
50
Classic Symptoms of DM
51
Complications of DM
Acute & Chronic
52
Acute Complications of DM
- Diabetic comas
- Infections
- Complication related to systems ( on top of atherosclerosis )
1) Acute Myocardial Infarction ( painless )
2) Cerebral Stroke & Acute neuropathy
3) Acute Renal Failure
4) Intermittent Claudication
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Chronic Complications of DM
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DDx of DM
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DDx of reducing substance in urine
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DDx of loss of weight inspite of good appetite
* Malabsorption syndrome
* Parasitic infestation
* Thyrotoxicosis
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Compare Between Type I & II DM
58
Investigations in DM
**Investigations**
- To Diagnose DM
- To Diagnose type of DM
- To monitor diabetic Complication
- To monitor diabetic patients
59
Investigations to Diagnose DM
60
Prognosis of IGT
- 1/3 remain IGT
- 1/3 develop frank DM
- 1/3 return to normal plasma glucose
61
Investiations to Diagnose type of DM
62
Investigations To monitor diabetic Complication
- Retinopathy: Fundus Exam.
- Nephropathy : urine analysis for microalbuminuria
- ECG
- Lipid profile
63
Investigations to monitor diabetic patients
Glycosylated proteins
64
what are Examples of Glycosylated proteins?
- HBA1C **(3 Months)**
- Fructosamine (Glycosylated albumin) **(3 Weeks)**
65
Target of Hb A1C in diabeteics
< 7 %
66
How is Hb A1C Formed?
Formed due to non-enzymatic glycosylation of amino acid valine & lysine in β chain of HbA
67
Uses of Hb A1C
It gives an estimate of diabetic control for the preceding 3 months.
68
Factors interfering with measurement of A1C
69
what is Fructosamine? and what is it used for?
- Fructosamine ( glycosylated albumin)
- It gives an estimate of diabetic control for the preceding 3 Weeks.
