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Flashcards in Nichols Diabetes Deck (35):
1

The essence of diabetes is hyperglycemia. The bad thing about hyperglycemia is that it causes excess glucose to stick to everything. ESPECIALLY BASEMENT Membranes

.

2

What's the bad thing about Sorbitol Pathway?

It eventually turns things into FRUCTOSE which is an even STRONGER glycosylator than glucose is.

3

KNOW the BIG THREE...mechanisms of long term complications

1) AGEs
- Glucose binds to peptides, this complex interacts with collagen to trap albumin in BM, LDL in arterial atheromas (atherosclerosis), and interactes with AGE receptors (RAGE) to form ROS like superoxide

2) Protein Kinase C:
- Forms profibrogenic TGF-beta (BM thickening)
- forms pro-angiogenic (VEGF) ....retinopathy

Polyol
- glucose-----sorbitol via aldose reductase-----fructose using NADPH. This NADPH was suppusoed to be used to reduce glutathione which you need to break down ROS. But not its used to make fructose, a terrible glycosylator.

4

Insulinitis with T cells.....what type of D

D1

5

Amyloidosis of islets

D2

6

Hyperglycemia impairs immune system? How?

Neutrophil function is impaired.

7

How does Hyperglycemia disable neutrophil function

Excess glucose causes upregulation of CD11 on neutrophils and upregulation of ICAM, VCAM, and E selectin on endothelial surfaces. All of this leads to sticky vessels and disables the neutrophils from geting to the site of infection.

8

C3 and hyperglycemia

hyperglycemia causes unactivated complement (C3) to bind to staph. This inhibits the activation of active forms of complement like C5

9

KNOW..TOO MUCH SUGAR IMPAIRS BACTERIAL KILLING by reducing oxidative burst.

Blame it on the sorbitol. Overactive sorbitol pathway steals NADPH which is needed to make the superoxide in phagosomes.

10

TEST>>>>

Too much ROS is a characteristic of the BIG 3, too little ROS (superoxide) is a mechanism of diabetic infection

11

Resistin

hormone that makes cells resistant to nsulin.
Also inhibits neutrophil chemotaxis

12

Constitutive activation of Neutrophil extracellular trap formation..

Reduces response to pathogens

13

ALL this leads to greater rate of infection in:

skin, feet, lungs, urinary tract

14

Furuncle

Follicle that is infected. Breaks through the BM and into the subcutaneous fat.

15

Furuncle cause

staph

16

Carbuncle

Coalescence of furuncles.....cause fever. need to be incised to drain

17

EXTERNAL OTITIS

Pseudomonas Aeruginosa!!!

18

Mucormycosis, the rhinocereral form, starts in the nose, spreads into the paranasal sinus, orbit, skull and base of brain

Need amphtericin and surgery

19

Diabetes predisposes to UTI that can spread into the kidney and cause pyelonephritis

KNOW

20

Pyelonephritis + Ischemia

renal papillary necrosis

21

Infection + Ischemia + Neurpathy

Ulceration and gangrene

22

What is the metabolic syndrome

Diabetes + Hypertension + Dyslipidemia + Abdominal Obesity

Also called teh deadly quartet.....diabetes, high blood pressure, high cholesterol, obesity

23

Deadly quartet characterized by what

pro-thrombotic, pro-inflammatory
- Associated with high levels of C-reactive protein, IL-6, and Plasminogen activator 1

24

What medication is associated with the metabolic syndrome

Clozapine

25

What are the five major risk factors for atherosclerosis

SHODDY
S- smoking
H- HTN
O- obesity
D-Diabetes
DY- Dyslipidemia

26

MEtabolic syndrome respondes to diet, some good diets are the mediterranean diet, DASH diet (no salt), low glycemic index

Gotta exercise too

ok

27

Two forms of diabetic neuropathy

peripheral and autonomic

28

Autonomic Neuropathy comes later

It is manifested by:
- resting tachycardia
- exercise intolerance
- GI dysmotility
- Impotence
-Orthostatic hypotension

29

Retinopathy is acually a type of

microangiopathy

30

2 forms of retinopathy

Background and proliferative

31

Background retinoipathy

capillary thickening, microaneurysms, venous dilation, hemorrhages.

32

Prliferative

neovascularization and fibrosis

33

The three major types of diabetic nephropathy are

Glomerular (diffuse) also called kimmelstiel wilson

Papillary- pyelonephritis and papillary necrosis

Tubulointerstitial- BM thickening and intersitial fibrosis

34

Nodular type of diabetic glomerulopathy

usually only after more than 10 years of diabetes
much more characteristic of diabetes superimposed on diffuse glomerulopathy

35

kimmelstiel wilson nodules

ovoid or spherical nodules.. squeeze capillary shut...again, the kidneys have been damaged for a long time.