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Flashcards in Pathogenesis of diabetes mellitus Deck (30)
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1

What does diabetes insipidus mean?

Passing lots of insipid urine - ADH insufficiency

2

List the diagnostic criteria for DM (all types)

- Fasting blood glucose (>126mg/dl- Fasting, >Need 2 abnormal tests )
- OGTT
- HbA1c

3

Fasting blood glucose results

5.7% and 6.4%.: Likely prediabetes
≥ 6.5% diabetes

4

OGTT results

Oral glucose tolerance test
- 2-hour glucose
<200mg/dl: normal

5

What are the symptoms of diabetes

P3- Polyphagia, Polydipsia, and Poluria

6

Define HbA1c and explain results

AGE (Hemoglobin+ Sugar complex)

7

Define gestational diabetes

women become very resistant to their own insulin, hyperglycemia by the end of 2nd trimester (1% to 3% of all pregnancy). Resolve spontaneously after delivery.

8

Which types of diabetes are insulin resistant?

Type 2
Gestational
Steroid-induced
Acromegaly

NB: patients often have very high levels of insulin in circulation

9

What auto-antibodies can be found in T1DM?

Islet cell autoantigen (ICA) 512
IAA (insulin auto-antibody)
GAD (glutamic acid decarboxylase)

10

What is the typical presenting history for T1DM

Child/adolescent
history of weight loss, thirst, polyuria, nocturia, and fatigue
HLA DR3 and 4
Viral illness recently
High blood glucose level
High blood ketones

11

Why does weight loss occur in T1DM

Glucose is not absorbed into muscles/fat cells from the blood
Results in both fat and muscle bulk

12

Which genes are likely to increase susceptibility to T1DM?

CTLA4 (Cytotoxic T-Lymphocyte Associated Protein 4), and PTPN22 (Protein tyrosine phosphatase, non-receptor type 22 ), and insulin gene VNTRs(variable number of tandem repeats).

13

Which other autoimmune diseases are associated with T1DM?

> Thyroid disease (hyper and hypo) V. strongly associated
> Coeliac disease - strongly associated
> Addison's disease = primary adrenal insufficiency (hypocortisolism)
> Pernicious anaemia
> Inflammatory bowel disease (UC/Crohn's)
> Premature ovarian failure

14

Genes for DM 2

Transcription factor 7-like 2=TCF7L2
Peroxisome proliferator-activated receptor gamma=PPAR-γ or PPARG

15

Insulitis=

DM1

16

Amyloid in islets

DM2

17

RAGE=

AGE: bind to a specific receptor (RAGE)- expressed macrophages and T cells

18

Macroangiopathy- mechanism

AGE: Col 4 + Sugar- non-enzymatic glycosylation

19

Atheroma in DM patients is an example of ______

Macroangiopathy

20

Micro-angiopathy- mechanism

AGE and Sorbitol induced pericyte injury

21

Cataract- in DM - mechanism____

Sorbitol-induced lens injury (osmotic injury)

22

Neuropathy in DM mechanism

Sorbitol-induced Schwan cell injury (osmotic injury)

23

Organopathy in DM is most likely due to______

Microangiopathy

24

diffuse thickening of glomerular basement membranes in DM is due to______

Microangiopathy

25

VGEF production is DM is due to________

PKC and RAGE

26

Secondary DM causes______

Drugs (corticosteroid, Thyroid hormone, Thiazides, Phenytoin )
Disease of exocrine pancreas: chronic pancreatitis.
Genetic syndrome: Downs syndrome
Endocrinopathes : Acromegaly, Cushing's syndrome.

27

Baby of a DM 2 mother= Possible complications

NRDS and pancreatic beta- cell hyperplasia

28

Pathogenesis of Gestational DM

Insuline resistance due to placental hormones/cytoines

29

Suger level of the baby after deliver in a DM2 mother

Low

30

Suger level of the baby after deliver in a DM1 mother

High- due to presence of antibody against the beta cells (IgG) in the baby's blood. It came from DM1 mother