Pathology of DM complications

Question 1

How much of pancreatic islet cells are B cells?

Answer 1

2/3rds

Question 2

Pathology of T2DM is a combination of….

Answer 2

1. reduced tissue sensitivity to insulin (insulin resistance)
2. inability to secrete very high levels of insulin

Question 3

Increase in FFA effect on insulin

Answer 3

Leads to decreased insulin receptor sensitivity

Question 4

What does central adiposity lead to and why?

Answer 4

Hyperinsulinaemia
More insulin needs to be produced to make glucose go back to normal levels as decreased removal of glucose from the blood

Question 5

Annual mortality % of diabetics compared to non diabetics

Answer 5

5.4%

double the rate of non diabetics

Question 6

How much is life expectancy decreased by in DM?

Answer 6

5 - 10 years

Question 7

What does DM accelerate in large vessels and therefore they are at a higher risk of what?

Answer 7

Atherosclerosis so at a higher risk of

• CHD
• MI
• atherothrombotic stroke

Question 8

How does DM accelerate atherosclerosis?

Answer 8

Glucose attaches to low density lipoprotein
Glucose molecules stop low density lipoprotein from binding its receptor (on liver cells) tightly
Low density lipoprotein is not removed by liver cells -> lipoprotein and lipid stay in blood -> hyperlipidaemia
Hyperlipidaemia leads to atherosclerosis

Question 9

How does DM cause arteriolar disease?

Answer 9

Molecules flux into subendothelial but find it hard to flux back to the blood.
Build up of ‘trapped’ molecules under endothelial cell
Basal lamina also becomes thickened
Narrow arteriole - poor blood flow - ischaemia

Question 10

Risk of amputation in DM

Answer 10

40x

Question 11

`Risk of end stage renal disease in DM

Answer 11

25x

Question 12

Risk of blindness in DM

Answer 12

20x

Question 13

Pathology of small vessel disease in DM

Answer 13

Increase connective tissue around capillaries e.g. glomerulus in kidney
Collagen is glycosylated which binds to albumin (doesn’t bind usually) and albumin accumulates in subendothelial spaces of arterioles

Question 14

Protein structure in DM small vessels and what does this mean?

Answer 14

Proteins are cross linked
Rigid, cross-linked proteins cannot easily be removed
They persistent even if return to normoglycaemia

Question 15

2 results of glycosation

Answer 15

Accumulation of trapped plasma proteins

Accumulation of cross linked basal lamina proteins

Question 16

Treatment of sensory neuropathy

Answer 16

Painkillers
Gabapentin 
Duloxetine
Acupunture
More

Question 17

What type of pulse tends to be bounding? Why do we have to beware of this?

Answer 17

Neuropathic pulse

As can have good pulse but poor perfusion

Question 18

How are calluses related to ulcers?

Answer 18

Pressure causes callus formation

If the callus gets too hard then can break down the tissues underneath it

Question 19

What are involuted nails?

Answer 19

Gentle curves to a pincer shape

Question 20

When is there a big ulcer risk under calluses?

Answer 20

Neuropathic

Question 21

Presentation of Charcots

Answer 21

Rockerbottoms foot
Clawing of toes
Bounding pulses
Possible 3C temperature difference between the feet
Look for infection

Question 22

What is charcots a combination of?

Answer 22

Osteopenia
Sensory neuropathy
Trauma

Question 23

What type of condition is charcots?

Answer 23

Inflammatory

Question 24

Examples of GI autonomic neuropathies

Answer 24

Chronic diarrhoea
GORD
Gastroporesis

Question 25

What is GORD caused by?

Answer 25

Reduced LOS pressure

Question 26

When does chronic diarrhoea as a result of autonomic neuropathy often occur?

Answer 26

At night

Question 27

Features of gastroparesis

Answer 27

Erratic BG control
Bloating
Vomiting

Question 28

Treatment of gastroporesis and what kind of drugs are these?

Answer 28

Metoclopramide
Domperidone
Erythromycin
PROKINETIC DRUGS