Patho E4: Endocrine & Pancreas

Does not include the A/P review

What are the 4 different ways to dx DM?

• fasting plasma glucose 126+

• sx of DM + random glucose 200+

• plasma glucose level 200+ after an oral dose of 75g of glucose

• Hb A1C 6.5+%

DM is due to a deficiency of insulin action. What causes this?

• dec insulin secretion by Beta cells

• insulin resistance at target tissues

• inc in counterregulatory hormones that oppose insulin

A1C provides an estimation of blood glucose concentration over the past ____

120 days (3 months)

What microvascular diseases can DM cause?

Retinopathy, Nephropathy, Neuropathy

What macrovascular disease can DM cause?

CAD, PVD, CVA; major cause of death in DMT2

DM is the leading cause of what?

• blindness in working age adults

• ESRD

• nontraumatic LE amputations

What can help prevent DM?

healthy diet, regular exercise, maintaining healthy weight, avoid tobacco use

What is DM Type 1?

Insulin-dependent diabetes

What causes DMT1?

autoimmune destruction of pancreatic B cells

What age group does DMT1 typically affect?

bimodal peak of incidence: 5-7 yrs & again at puberty

What S/sx are associated w/ DMT1?

polyuria, polydipsia, wt loss, markedly inc serum glucose levels, polyphagia, inc ketone bodies, DKA

What is the tx for DMT1?

lifelong insulin therapy

What is the pathophysiology behind DMT1?

selective destruction of B cells by T lymph or AI destruction occurs gradually → Sx of insulin deficiency appear

What are found in 50% of newly dx T1 diabetics?

islet cell antibodies (ICA) and insulin autoantibodies (IAA)

What lab findings would you see in a pt w/ DMT1?

• hyperglycemia

• ketonuria

• low/undetectable serum insulin and C peptide

• Auto-antibodies against components of the islet B cells

How are ketones made?

dec glucose uptake by tissues → lipolysis & ketosis → free ketones

What are signs of DKA?

inc ketones, polyuria, edema, glucose avg >500, coma (due to hyperosmolality)

Which form of DM is more common?

Type 2

What age group is most affect by DMT2?

adults, inc prevalence w/ age

DMT2 is more prevalent in what race?

Native Americans, Mexican Americans, African Americans

What is the hallmark of DMT2?

insulin resistance

What is DMT2 associated with?

obesity

What do normal adipocytes secrete?

“healthy” adipokines → inc insulin sensitivity

What do hypertrophied adipocytes seen in obese pts secrete?

other adipokines (TNF, IL-6) → contribute to insulin resistance; adiponectin release dec → insulin resistance

How soon is DMT2 dx after onset?

often 5-7 yrs later

The increase in the prevalance and epidemic of DMT2 is associated with what?

heavily associated w/ obesity

It is estimated that ___ children born after 2000 will develop diabetes in their lifetime.

1/3

What lab findings would you see in a pt w/ DMT2?

hyperglycemia, HLD, high serum insulin/C peptide, defective insulin secretion, insulin resistance, inc glucagon levels, high glucagon-insulin ratio

What S/sx are associated w/ DMT2?

Glucosuria, polyuria, nocturia, polydipsia, polyphagia, wt loss, dehydration, obesity

What is the etio of DMT2?

insulin resistance → inc in insulin secretion → pancreas burns out → ineffective insulin secretion; also due to B cell defect

What is the primary source of mediators of insulin resistance?

adipose tissue, particularly central (abd) obesity

What is the tx of DMT2?

lifestyle modification, medication therapy, insulin is NOT required but may be used to achieve optimal glucose control

What is the role of medications in DMT2?

enhance insulin secretion, dec insulin resistance in hepatic or peripheral tissue, interfere w/ intestinal absorption of carbs

What are complications of DMT2?

Hyperosmolar Coma (HHNK/HHNS), DKA, hypoglycemia

What are signs of a Hyperosmolar coma?

ketosis absent, glucose 800-2400, inc osmolarity, dehydration

What triggers DKA in DMT2?

inc stress that inc levels of counter regulatory hormones (MI, infections, trauma)

What can cause hypoglycemia in DMT2?

meds, exercise, fasting

What is seen in Latent Autoimmune DM?

autoantibodies, some insulin resistance; adult onset

Pts w/ LADA often become insulin dependent w/in how many yrs?

6 yrs

As age of mother goes up, the incidence of Gestational diabetes ____

increases

What are complications of Gestational Diabetes?

high birth wt & fetal complications (inc risk for DM, cancer, schizophrenia, cardiac disease, obesity)

Gestational diabetes typically occurs during the ___ half of pregnancy.

2nd

What is the tx for Gestational diabetes?

typically resolves w/ delivery

About ___ of women w/ gestational diabetes develop DMT2 later in life.

50%