Pathophysiology of DM // AI Generated!!

Dr. Sando

metabolic, blood glucose

Diabetes mellitus is a group of _____ diseases characterized by an elevated ________ concentration.

Hyperglycemia, secrete

___________ in DM results from defects in the inability to USE and/or _____ insulin.

catabolism

In muscle tissue, insulin suppresses protein _____.

ketone

In the liver, low insulin levels result in decreased gluconeogenesis and _____ body production.

Juvenile Onset"

The outdated name for Type 1 DM is "__________” or insulin-dependent diabetes.

thirst, urination, hunger

In Type 1 DM, three classic symptoms include increased ______, frequent ______, and extreme _____.

overdrive

In Type 2 DM, beta cells are initially in _____, then stop producing insulin after getting burned out.

Type 2 DM i

Two classes of oral medications for __________ include biguanides (e.g., metformin) and sulfonylureas

urine

SGLT2 inhibitors help treat Type 2 DM by getting rid of glucose via the _____

Adult Onset

The outdated name for Type 2 DM is "_________" or non-insulin-dependent diabetes.

absent, minimal

In Type 1 DM, endogenous insulin is either ______ or _____

30

The age of onset for Type 2 DM is usually greater than _____ years old

4-6, 10-14

Type 1 DM typically presents in childhood, with common ages being _______ and _____ years.

Prediabetes

________ is diagnosed when fasting blood glucose is between 100-125 mg/dL, or 5.6 to 7.0 mmol/L

glucose

Gestational diabetes is diagnosed through an oral _____ tolerance test

digestive enzymes

In secondary diabetes caused by necrotizing pancreatitis, both insulin and __________ must be supplemented

9

A non-modifiable risk factor for Type 2 DM is having given birth to a baby who weighed over _____ pounds.

3

A modifiable risk factor for Type 2 DM is being physically active less than _____ times a week

modifiable risk factor

Non-alcoholic fatty liver disease (NAFLD) is a __________ for Type 2 DM

hypertension

The primary complication of DM is _____, followed by CVD, nephropathy, and neuropathy.

retinopathy

PT can screen for neuropathy, HTN, CVD, and PVD, but should refer out for _____.

hyperglycemic

AGEs are produced at a moderate rate in healthy individuals but reaction rates are greatly increased in _____ conditions.

fatty acids, ketone bodies

Polyunsaturated _______ and ________ are endogenous sources of AGEs

Western diet

The __________ is high in AGEs due to thermal processing such as frying, grilling/BBQ, and baking

elastic

Changes in collagen from AGEs alter biomechanical properties, making tendons less _____.

stiffer

Decreased collagen sliding results in more connected, _____ tendons with reduced ROM.

outer surface, proximal/distal ends

In diabetic tendons, primary ECM changes occur at the _________ + _________

inflammation, degradation

Increased ECM stiffness in diabetic tendons is accompanied by increased _________ and _________ of ECM.

tenocytes

• decreased

• decreased

• increased

In a high glucose environment, tenocytes show:

• (increased/decreased) proliferation

• (increased/decreased) migration

• (increased/decreased) apoptosis

Tendinopathy, Post. tib. tendonitis

_________ and ________ are common tendon problems in DM

blunted

DM may cause a _____ pain response, making patients asymptomatic during tendon injury.

enthesis

Diagnostic imaging of DM tendons shows thickening, collagen disorganization, and calcific changes at the bone-tendon junction called the _____

atherosclerosis

DM increases __________ through glycation of LDL and HDL in blood

vascular dysfunction

AGEs decrease endothelial nitric oxide (NO), contributing to __________.

afterload

Arterial stiffness from AGEs contributes to HTN and increased cardiac _____, making the heart pump harder

• coronary artery disease

• peripheral arterial disease

• cerebrovascular disease

Three macrovascular complications of DM include: (3)

limb loss

Increased peripheral arterial disease in DM increases arterial insufficiency and risk of ________

basement membrane thickening

Microvascular effects of AGEs include ______________, which decreases filtration and diffusion of metabolites

Endothelial dysfunction

_________ from AGEs decreases the non-thrombogenic surface of blood vessels.

actin, intermediate

The cytoskeleton proteins damaged by AGEs include _____ and _____ filaments.

atrophy

Reduced axon transport due to AGE damage leads to axon _____ and loss of nerve function.

proprioception

A patient with sensory neuropathy loses protective sensation and _____.

Xerosis, Anhidrosis

_______ (dry skin) and _____ (issues with sweat production) are skin changes seen in autonomic neuropathy.

sympathetic vascular tone

Autonomic neuropathy results in loss of _____________.

intrinsic mm atrophy

Motor neuropathy causes ___________, leading to hammer toe and claw toe deformities

terminal stance

Limited ankle dorsiflexion reduces tibial progression in __________, increasing forefoot pressures

amitriptyline

Two antidepressant medications used for neuropathic pain are Duloxetine (Cymbalta) and _____.

motor neuropathy

Migration or diminished fat pads is a consequence of _____________ that alters pressure on the foot

FALSE —Insulin is produced by the BETA (β) cells of the Islet of Langerhans.

T/F: Insulin is produced by the alpha cells of the Islet of Langerhans.

FALSE — Insulin resistance primarily occurs in Type 1 DM.Type 1 DM is characterized by absolute insulin deficiency due to autoimmune destruction of β cells, meaning NO insulin is produced at all

T/F: Insulin resistance primarily occurs in Type 1 DM.

TRUE

T/F: Type 2 DM often presents with no symptoms until a serious complication develops

FALSE — Gestational diabetes is primarily managed by diet and exercise. It typically resolves postpartum, though it increases the risk of Type 2 DM later in life.

T/F: Gestational diabetes is primarily managed with oral hypoglycemics as the first-line treatment.

TRUE

T/F: Pain is often an early sign of sensory neuropathy

TRUE

T/F: During a diabetic foot check, if both dorsalis pedis and posterior tibial pulses are palpable, there is no need to check more proximal pulses.

FALSE — Patients with diabetes should AVOID heating pads and hot water bottles.

T/F: Patients with diabetes should use a heating pad or hot water bottle to warm cold feet.

TRUE

T/F: During remission, a plantar foot temperature increase of ≥4° indicates tissue tolerance has been reached and activity should be modified.

FALSE — Venous ulcers are typically WET, while arterial ulcers are typically DRY

T/F: Venous ulcers are typically dry, while arterial ulcers are typically wet.

FALSE — The ablation of nerve endings from Capsaicin is REVERSIBLE. Neurons grow back in approximately 3 months

T/F: After nerve ablation from 8% topical Capsaicin (Qutenza), the damage to the nerve endings is permanent.