11 Diabetes
- Diabetes: meaning polydipsis/polyuria..
Diabetes Symptoms
Complications:
Diabetes Diagnosis
Diagnosis:..
- Asymptomatic as in no polyuria/polydipsia..
Glucose Tolerance Test
- Just measuring glucose level is not helpful because elevated in pregnancy
- Measuring glucose load response more helpful..
Hemoglobin A1C
- 3 months because RBC lives for 3 months..
Type 1 Diabetes
Islet cell antibodies are found in the vast majority of T1DM patients, as well as asymptomatic family members. Islet antigens that are the targets of autoimmune attack may include insulin and the β-cell enzyme glutamic acid decarboxylase (GAD).
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Association with HLA-DR3 and DR4.
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- weight loss, low muscle mass, always wanting to eat
Diabetic Ketoacidosis
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- Type 2 still has insulin, thus less common
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- Trauma/infection increases epinephrine
- Fruity breath from acetone
- Dehydration -> hypotension
- Ketones made from lipolysis
- Oxaloacetate depletion from high NADH pushing towards malate
- can get mild hyponatremia from loss of Na in urine
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- Patients with DKA and respiratory failure, always ckeck phosphate
Symptoms:
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- Hyperglycemia long term > brain makes taurine molecules to match osmolarity (doesn't happen in type 2)
- Give fluid too fast > blood osmolarity drop
- Water goes to brain, brain edema
- Use IV mannitol to treat
Associated with mucormycosis:.
- classic case: DKA patient in recovery with new onset fever/headache/eye pain
Treatment:
- K lost in urine. Add K after a few hours of insulin
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Type 2 Diabetes
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- more free FA bad because used for fuel instead of glucose
- Left: apple shape. Right: pear shape..
Insulin Resistance
- Type 2 associated with obesity
- Adipocytes make TNF-a and FA
- TNF-a and FA activates serine-threonine kinase
- serine-threonine kinase phosphorylates beta chain, inhibits tyrosine phosphorylation
- result is decreased number of available insulin receptors
Amyloid
Histology
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- accumultates in type 2 diabetes islets
Acanthosis Nigerians
- Insulin tells keratinocytes to grow
Hyperglycemic Hyperosmolar Syndrome, HHS
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- high serum osm from glucose
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Diabetic Complications
Nonenzymatic Glycation
- Caused by AGE and hyperfiltration..
Sclerosis of entire kidney:
- pyelonephritis and scarring with infection. Atrophic and smaller:
papillary necrosis, triangular necrosis:
Diffuse:
Nodular:
Kimmelstiel-Wilson Nodules
Sorbitol
Polyol pathway
Alternative glucose pathway:..
- Little activity at normal glucose level but increased activity at chronic hyperglycemia
- End result is increased sorbitol because second step is slow
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- sensory loss more than motor
- distal more than proximal
- B12: equally proximal and distal
- diarhea
- PVD: peripheral vascular disease
- O2 chamber drives O2 into ulcer for healing
Diabetic Retinopathy
- Both AGE and sorbitol involvement