# 11 Diabetes

## Overview

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetes%20mellitus%20vs%20insipidus/README.md)

* Diabetes: meaning polydipsis/polyuria..

![](https://f001.backblazeb2.com/file/wikiFiles/NIxcyvh.jpg)

### Diabetes Symptoms

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetes%20symptoms/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/VnpehgK.jpg)

Complications:

![](https://f001.backblazeb2.com/file/wikiFiles/hOXcOrq.jpg)

### Diabetes Diagnosis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetes%20diagnosis%20methods/README.md)Diagnosis:..

![](https://f001.backblazeb2.com/file/wikiFiles/DN1Frbm.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetes%20symptoms%20vs%20asymptomatic%20diagnosis/README.md)

* Asymptomatic as in no polyuria/polydipsia..

![](https://f001.backblazeb2.com/file/wikiFiles/jwVZfHz.jpg)

### Glucose Tolerance Test

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Glucose%20tolerance%20test%20MOA%20and%20use/README.md)

* Just measuring glucose level is not helpful because elevated in pregnancy
* Measuring glucose load response more helpful..

![](https://f001.backblazeb2.com/file/wikiFiles/j1swEH2.jpg)

### Hemoglobin A1C

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Hemoglobin%20A1C%20molecular%20MOA/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/R1pVUkf.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/A1C%20diagnosis%20values/README.md)

* 3 months because RBC lives for 3 months..

![](https://f001.backblazeb2.com/file/wikiFiles/Q3rhsiT.jpg)

## Type 1 Diabetes

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%201%20diabetes%20pathogenesis%20and%20what%20antibodies/README.md)

* aka insulitis

![](https://f001.backblazeb2.com/file/wikiFiles/TXX6VAU.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/zO9mrDf.jpg)

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).**

.,

![](https://f001.backblazeb2.com/file/wikiFiles/mukCyWV.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%201%20diabetes%20HLA%20association/README.md)Association with HLA-DR3 and DR4.,

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%201%20Diabetes%20demographics/README.md).,

![](https://f001.backblazeb2.com/file/wikiFiles/gDO6qeE.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%201%20diabetes%20symptoms%20and%20treatment/README.md)

* lifelong insulin

![](https://f001.backblazeb2.com/file/wikiFiles/9KihH4Q.jpg)

* **weight loss, low muscle mass, always wanting to eat**

..

### Diabetic Ketoacidosis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20ketoacidosis,%20DKA,%20is,%20happens%20when/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/O6ucvsn.jpg).,

* Type 2 still has insulin, thus less common

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/DKA%20pathogenesis/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/sR68qRt.jpg).,

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/zE3sc2L.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/rlP6tUL.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Acidosis/alkalosis%20and%20potassium%20levels/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/ccxEWUr.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Hypophosphatemia%20with%20DKA,%20type%201%20diabetes,%20MOA%20and%20symptoms/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/vMSajHY.jpg)

.,

* Patients with DKA and respiratory failure, always ckeck phosphate

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/DKA%20Symptoms/README.md)Symptoms:

![](https://f001.backblazeb2.com/file/wikiFiles/8fujhdp.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/1UJYE8T.jpg)

.,

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Cerebral%20edema%20pathogenesis%20and%20treatment%20in%20DKA/README.md)..

* 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

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/DKA%20fungal%20association/README.md)Associated with mucormycosis:.,

* classic case: DKA patient in recovery with new onset fever/headache/eye pain

![](https://f001.backblazeb2.com/file/wikiFiles/NJoDqgG.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/WTOtq7W.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/wknQ2ol.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/DKA%20treatment/README.md)Treatment:

![](https://f001.backblazeb2.com/file/wikiFiles/U4xCVlt.jpg)

* K lost in urine. Add K after a few hours of insulin

![](https://f001.backblazeb2.com/file/wikiFiles/mw4jM4b.jpg)

.,

## Type 2 Diabetes

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%202%20diabetes%20pathogenesis/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/tHqzU0m.jpg)

.,

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%202%20diabetes%20demographics/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/hB4RL6m.jpg)

.,

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%202%20diabetes%20risks/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/bgIBy5V.jpg)

* more free FA bad because used for fuel instead of glucose
* Left: apple shape. Right: pear shape..

![](https://f001.backblazeb2.com/file/wikiFiles/yFdQ7mJ.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Family%20history%20and%20gene%20in%20Type%202%20diabetes/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/W2n8yX8.jpg)

### Insulin Resistance

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%202%20diabetes%20insulin%20resistance%20MOA/README.md)..

* 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**

![](https://f001.backblazeb2.com/file/wikiFiles/FBDTdPT.jpg)

### Amyloid

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%202%20Diabetes%20histology/README.md)Histology

![](https://f001.backblazeb2.com/file/wikiFiles/iRZaLLM.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/ChjZsck.jpg)

.,

![](https://f001.backblazeb2.com/file/wikiFiles/mukCyWV.jpg)

* accumultates in type 2 diabetes islets

### Acanthosis Nigerians

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Acanthosis%20nigricans%20is,%20demographics,%20location,%20cancer%20association/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/LseTSzK.jpg)

* Insulin tells keratinocytes to grow

### Hyperglycemic Hyperosmolar Syndrome, HHS

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Hyperglycemic%20hyperosmolar%20syndrome,%20HHS%20is,%20demographics/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/E493ZUb.jpg)

.,

* Similar to DKA of type 

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/HHS%20symptoms%20and%20treatment/README.md)

![](https://f001.backblazeb2.com/file/wikiFiles/F2jhyGB.jpg)

* high serum osm from glucose

![](https://f001.backblazeb2.com/file/wikiFiles/5aDcmCN.jpg)

.,

## Diabetic Complications

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20complications%202%20main%20MOA/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Vq5xudC.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/hOXcOrq.jpg)

### Nonenzymatic Glycation

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Nonenzymatic%20glycation%20and%20AGEs/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/axyBxwP.jpg)

* AGE cause problems

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/AGE%20causes%20what%20problems/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/hOXcOrq.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/AGE%20and%20Atherosclerosis/README.md)

* Macroangiopathy:..

![](https://f001.backblazeb2.com/file/wikiFiles/m7z8onH.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/AGE%20and%20kidney%20pathogenesis/README.md)

* Microangiopathy:..

![](https://f001.backblazeb2.com/file/wikiFiles/eAeelxZ.jpg)

* put on dialysis

![](https://f001.backblazeb2.com/file/wikiFiles/nCFzJJS.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/fMu5bYi.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/Td8bUAi.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Proteinuria%20and%20diabetes,%20treatment/README.md)

* Caused by AGE and hyperfiltration..

![](https://f001.backblazeb2.com/file/wikiFiles/GTxHaiU.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/AGE%20and%20GBM/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/gzo6yNF.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/2%20types%20of%20Glomerulosclerosis%20resulting%20from%20AGE/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/3uUgTzd.jpg)

Sclerosis of entire kidney:

![](https://f001.backblazeb2.com/file/wikiFiles/KP2ofSu.jpg)

* pyelonephritis and scarring with infection. Atrophic and smaller:

![](https://f001.backblazeb2.com/file/wikiFiles/dQpbz3i.jpg)

papillary necrosis, triangular necrosis:

![](https://f001.backblazeb2.com/file/wikiFiles/H8WyK8Z.jpg)

Diffuse:

![](https://f001.backblazeb2.com/file/wikiFiles/OeG8PNm.jpg)

Nodular:

![](https://f001.backblazeb2.com/file/wikiFiles/1XfdtGL.jpg)

#### Kimmelstiel-Wilson Nodules

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Kimmelstiel-Wilson%20Nodules%20are/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/BNcKIv0.jpg)

### Sorbitol

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Sorbitol%20accumulation%20causes%20what%20problems/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/hOXcOrq.jpg)

#### Polyol pathway

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Polyol%20pathway%20what%20happens/README.md)Alternative glucose pathway:..

![](https://f001.backblazeb2.com/file/wikiFiles/Cj9nXUv.jpg)

* Little activity at normal glucose level but increased activity at chronic hyperglycemia
* End result is increased sorbitol because second step is slow

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Sorbitol%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/DT5c6ot.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Sorbitol%20and%20cataracts%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/kT0URAH.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/qka6cTt.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Sorbitol%20and%20neuropathy%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/KdHjlPS.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20sorbitol%20neuropathy%20symptoms/README.md).,

![](https://f001.backblazeb2.com/file/wikiFiles/n9X9oLp.jpg)

* sensory loss more than motor
* distal more than proximal
* B12: equally proximal and distal
* diarhea

#### Diabetic Foot Disease

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20foot%20disease%20cause%20and%20results/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/6SZJgB7.jpg)

* PVD: peripheral vascular disease

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20foot%20disease%20prevention%20and%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/jYjmUo9.jpg)

* O2 chamber drives O2 into ulcer for healing

### Diabetic Retinopathy

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20retinopathy%20pathogenesis,%20prevention/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/27jRmwW.jpg)

* Both AGE and sorbitol involvement

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Diabetic%20retinopathy%20findings%20on%20eye%20exam/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/NQg5yyO.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/QhlGR6C.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/L6lIJQS.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Endocrinology/Type%201%20and%20type%202%20diabetes%20differences%20in%20pathophysiology,%20insulin,%20biopsy,%20age,%20genetic,%20complications/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/ReNWJ2n.jpg)