11 Diabetes
Last updated
Last updated
Diabetes: meaning polydipsis/polyuria..
_..
Complications:
_Diagnosis:..
Asymptomatic as in no polyuria/polydipsia..
Just measuring glucose level is not helpful because elevated in pregnancy
Measuring glucose load response more helpful..
_..
3 months because RBC lives for 3 months..
aka insulitis
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).
.,
_Association with HLA-DR3 and DR4.,
_.,
lifelong insulin
weight loss, low muscle mass, always wanting to eat
..
Type 2 still has insulin, thus less common
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
_..
.,
Patients with DKA and respiratory failure, always ckeck phosphate
_Symptoms:
.,
_..
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
.,
.,
.,
more free FA bad because used for fuel instead of glucose
Left: apple shape. Right: pear shape..
_..
_..
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
_Histology
.,
accumultates in type 2 diabetes islets
_..
Insulin tells keratinocytes to grow
.,
Similar to DKA of type
high serum osm from glucose
.,
_..
_..
AGE cause problems
_..
Macroangiopathy:..
Microangiopathy:..
put on dialysis
Caused by AGE and hyperfiltration..
_..
_..
Sclerosis of entire kidney:
pyelonephritis and scarring with infection. Atrophic and smaller:
papillary necrosis, triangular necrosis:
Diffuse:
Nodular:
_..
_..
_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
_..
_..
_..
_.,
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
_..
Both AGE and sorbitol involvement
_..
_..
.,
.,