Endocrinology

E-1 Pathogenetic classification of diabetes mellitus

DM type 1: autoimmune response, destruction of insulin-producing beta-cells of pancreas,

DM type 2: Insulin resistance or impaired insulin secretion due to progressive destruction and dysfunction of B-cells. Obesity and a sedentary lifestyle.

Gestational Diabetes: Impaired Glucose Tolerance during pregnancy

Specific types:
Genetic (B-cell function or insulin action)
pancreatic conditions
Endocrine conditions
Drug induced
infections

E-2 Diabetes diagnostic and metabolic compensation criteria

Diabetes Diagnostic Criteria

Hemoglobin A1c (HbA1c) ≥ 6,5%
Fasting plasma Glucose 7> mmol/L
Oral glucose tolerance test: ≥11.1 mmol/L
Random blood glucose level ≥ 200 mg/dL
symptoms: polyuria, polydipsia, weight loss

Metabolic compensation criteria (all in normal range)
no glucosurea
HbA1c
Blood glucose (oral and fasting)
TAG, Cholesterol, BMI, BP

E-3 Type 1 and type 2 DM differences

Pathogenesis

DM1: Genetic & environmental factors → Progressive autoimmune destruction of pancreatic beta cells → Absolute insulin deficiency → Hyperglycemia
DM2:Genetic & environmental factors: Obesity, Aging with glucotoxicity & lipotoxicity → Insulin Resistance & Secretion deficit. (increased insulin production maintain blood glucose levels initally)

Clinical picture:
General: Polyuria, Polydypsia, Unexplained Weight loss, Poor Wound Healing, Visual Disturbances
DM1: sudden onset <20y, ketoacidosis, thin body type
DM2: gradual onset >30y, initally asymptomatic, obese

Therapy:
DMI1: Lifelong (long or short) insulin injection/pump, Regular meals & glucose monitoring, Healhy diet and lifestyle
DM2: lifestyle changes & loose weight, metformin, insulin

E-4 Late complications of diabetes mellitus: pathogenesis, types, therapy principles.

Pathogenesis:Chronic hyperglycemia → glycation of proteins & lipids, sorbitol accumulation, PKC acitivation,oxidative stress → thickend Basal mem brane & endothelial dysfunction → microvascular & macrovascular damage

Types:

Macrovascular (atherosclerosis)
Coronary Artery Disease
Cerebrovascular Disease: Stroke, stenosis, vascular malformation
Peripheral Artery Disease

Microvascular
Diabetic retinopathy
Diabetic nephropathy
Diabetic neruopathy
Diabetic foot

Therapy:

glycemic control
BP control (ACE inhibitor)
lipid control (Statins)
lifestyle (smoking, exercise, diet, weight)
regular screening
pain medication (asprin)

E-5 Diabetic sensorimotor polyneuropathy symptoms, diagnosis, and therapy principles

symptoms:

Numbness & tingeling, Burning pain (feet & hands)
hypersensitivity
muscle weakness
foot  ulcers

diagnosis:

Clinical diagnosis & history
Vibration sensation & pressure test

Therapy principles:
Glucose/diabetes control
Foot carePain management
Treat risk factors/ healhty lifestyele (BP, smoking, dyslipedemia)
Education
pain management

E-6 Diabetic macroangiopathy symptoms and diagnostic principles

symptoms

Coronary Artery Disease (CAD): Angina, Shortness of breath & Fatigue
Cerebrovascular disease: Stroke symptoms — Weakness, One-sided Paralysis, Slurred speech.
Peripheral artery disease: Coldness or numbness in the legs or feet

diagnostic principles
Clinical history
Physical examination
Blood test: blood glucose, HbA1C,renal function, lipid profile
Imaging studies: ECG, Echocardiography, Carotid ultrasound, Ankle-brachial index (ABI), Coronary angiography, CT, MRI