PATHOPHYSIOLOGY

Question 1

What is the origin of type 1 diabetes

Answer 1

Environmental trigger on a genetically susceptible individual

Question 2

What is LADA

Answer 2

Type 1 diabetes presenting in adults

Question 3

Genes linked to type 1 diabetes

Answer 3

HLA antigens in chromosome 6
Insulin gene polymorphisms on chromosome 11
PTPN22
IL2RA
CTLA-4

Question 4

Environmental triggers for Type 1 diabetes

Answer 4

Early exposure to cow’s milk
Lack of breastfeeding
Gut bacteria
Certain viruses

Question 5

Viruses that can trigger pathogenesis of type 1 diabetes in a agenetically susceptible individual

Answer 5

Rotavirus
Enterovirus

Question 6

Which vitamin deficiency is more prevalent in type 1 DM

Answer 6

Vitamin D deficiency

Question 7

Most common autoantibodies in type 1 DM

Answer 7

ICA - Islet Cell Autoantibodies

Question 8

Other antibodies found in Type 1 DM apart from ICA

Answer 8

Antibodies formed to
Insulin
Glutamic acid decarboxylase 65 (GAD65)
Insulinoma-associated antigen 9 (IA-2)
Zinc transporter 8 (ZnT8)

Question 9

Autoimmune disorders common in type 1 DM

Answer 9

Hashimoto’s thyroiditis
Graves’ disease
Addison’s disease
Vitiligo
Celiac sprue

Question 10

Apart from insulin, which other hormone is deficient in type 1 DM

Answer 10

Amylin

Question 11

What causes type 2 DM

Answer 11

Beta cell dysfunction coupled with insulin resistance

Question 12

Why is type 2 diabetes polygenetic

Answer 12

many geenetic defects contribute to its pathogenesis

Question 13

Defects in type 2 DM that impair glucose regulation (7)

Answer 13

1. Deficiency and resistance to insulin
2. Deficiency and resistance to incretins
3. Excess glucagon secretion
4. Increased hepatic glucose production
5. Upregulation of SGLT2
6. Systemic inflammation
7. Diminished satiety

Question 14

People with type 2 DM lose approximately ……….. of
β-cell function per year.

Answer 14

5% to 7%

Question 15

Glucotoxicity occurs when glucose levels chronically exceed……………..

Answer 15

140
mg/dL (7.8 mmol/L)

Question 16

What is glucotoxicity

Answer 16

When β-cell is unable to maintain sufficient
insulin secretion and, paradoxically, releases less insulin as glucose
levels increase

Question 17

Causes of progressive beta cell loss in type 2 DM

Answer 17

(1) glucotoxicity
(2) lipotoxicity
(3) insulin resistance
(4) age
(5) genetics
(6) incretin deficiency.

Question 18

What causes impaired glucose tolerance in the early stages of beta cell dysfunction

Answer 18

Deficient first-phase insulin release

Question 19

Cause of decreased posprandial insulin secretion in type 2 DM

Answer 19

Impaired beta cell function
Diminished stimulus from gut hormones (mostly incretins)

Question 20

How is abdominal fat different from subcutaneous fat

Answer 20

Presence of o excess lipids in non-adipose tissue
Abdominal fat is resistant to antilipolytic effects of insulin

Question 21

Causes insulin resistance in type 2 DM

Answer 21

1.Release of excess free fatty acids by abdominal fat
2. Excess fat inhibits secretion of adiponectin
3. Oversecretion of inflammatory adipokines
4. Excess stored fatsalso causes adipocytes to become too large and inhibit further fat storage

Question 22

how adoes abdominal fat causes insulin resistance

Question 23

Which tissues or organs does insulin resistance affect

Answer 23

Muscle
Adipose tissue
Liver

Question 24

Function of adinopectin

Answer 24

Suppresses the attachment of monocytes to endothelial cells,
thereby protecting against vascular damage.

Question 25

Adipokines released in type 2 DM by Visceral adipose tissue

Answer 25

Plasminogen activator inhibitor-1 TNF-alpha Interleukin-6 Resistin Angiotensinogen

Question 26

Role of resistin in type 2 DM

Answer 26

Causes insulin resistance

Question 27

Surrogate market for visceral adipose tissue

Answer 27

Central obesity

Question 28

Renal threshold for glucose in normal people and diabetics

Answer 28

Normal - 10 mmol/l Diabetes- 12.2-13.3 mmol/l

Question 29

What accounts for increased reabsorption of glucose in the proximal renal tubules in diabetes

Answer 29

Upregulation of the SGLT-2 receptors

Question 30

What is type A insulin resistance

Answer 30

Clinical syndrome characterized by acanthosis nigricans, virilization in women, polycystic ovaries, and hyperinsulinemia.

Question 31

What is type B insulin resistance

Answer 31

When anti-insulin receptor antibodies block the binding of insulin

Question 32

Clinical presentation of type 1 DM

Answer 32

Polyuria Polydipsia Polyphagia Fatigue Lethargy Blurred vision

Question 33

Components metabolic syndrome

Answer 33

Abdominal Obesity Triglycerides High LDL or Low HDL cholesterol High blood pressure Hyperglycaemia

Question 34

Components metabolic syndrome

Answer 34

Abdominal Obesity Triglycerides High LDL or Low HDL cholesterol High blood pressure Hyperglycaemia

Question 35

Components metabolic syndrome

Answer 35

Abdominal Obesity Triglycerides High LDL or Low HDL cholesterol High blood pressure Hyperglycaemia

Question 36

Acute complications of diabetes or diabetic emergencies

Answer 36

Diabetic ketoacidosis in type 1 Hyperosmolar hyperglycaemic state for type 2 Hypoglycaemia

Question 37

Microvascular complications of diabetes

Answer 37

Nephropathy Neuropathy Retinopathy

Question 38

Macrovascular complications of diabetes

Answer 38

Cardiovascular disease Cerebrovascular disease Peripheral vascular disease

Question 39

Combined macrovascular and microvascular complication

Answer 39

Diabetic foot problems