1.
Classic symptoms of diabetes: Polyuria Polydipsia Weight Loss Polyphagia Blurred Vision Impaired Growth Susceptibility to infection Ketoacidosis Nonketotic hyperosmolar coma Death
2.
Define diabetes mellitus: A group of metabolic disorders characterized by impaired glucose utilization, resulting in hyperglycemia
3.
Describe the hyaline arteriosclerosis seen in diabetes: Caused by the leakage of plasma components into the wall and excessive production of ECM by the smooth muscle cells with loss of cellular detail. It looks like pink homogenously staining material in the wall of blood vessels that have a narrow lumen
4.
Diagnostic criteria for diabetes mellitus: Glucose > 200mg/dL, Fastin glucose > 126 mg/dl (must be repeated for confirmation in order to make diagnosis)
5.
Genetics of Type 1 diabetes?: HLA-DR4: 7 fold risk HLA-DR3: 5 fold risk HLA-DR4/HLA-DR3: 14 fold risk, HLA-DR2: protective
6.
Latest classification of diabetes: Type 1, Type 2, Gestational diabetes, other
7.
Normal islet cell population: 70% beta cells that produce insulin, 20% alpha cells that produce glucagon, 5-7% delta cells that produce somatostatin
8.
Possible candidates for the environmental trigger of type 1: viral (coxsackie, mumps, rubella, measles, CMV, EBV), chemical (rat poison)
9.
Prevalence of diabetes in the US: ~16 million Americans (~9% of the population)
10.
Risk factors for Type 2 diabetes: 1. Race- American Indians have higher risk 2. Obesity 3. Hypertension 4. High LDL low HDL 5. Age >45
11.
Trace the clinical course of type 1 diabetes: Distal environmental trigger followed by a proximal stress which causes a precipitous drop in blood glucose and initial diagnosis. After initial diagnosis there may bea 1-5 year of honeymoon period with a recovery of beta cell activity but then the insulin levels decline into frank diabetes again
12.
True/False: there are autoantibodies that can be seen in the first year of Type 1 diabetes and that disappear after a while: True- although the significance of these antibodies in the etiology is not certain
13.
Type 1 diabetes: Brittle diabetes, Age <25, 50% concordance in MZ twins, HLA-D association, autoimmune islet destruction, diabetic ketoacidosis, total lack of insulin which makes the body very sensitive to exogenous insulin, to exercise, to infection, to changes in food intake
14.
Type 2 diabetes: >35, overweight, 100% concordance in MZ twins, peripheral resistance to insulin, normal or slightly low for body weight insulin, ketoacidosis resistant but prone to hyperosmolar, nonketotic, diabetic coma
15.
What % of type 1 diabetics have a positive family history of the disease?: <20%
16.
What % of type 2 diabetic have a +ve family history?: 25%
17.
What pathological changes are seen in the islets of Type 2 diabetics?: Amyloid deposition in the beta cells (10-70% of patients; the amyloid is composed of amylin a polypepetide made and cosecreted with insulin; large amounts of amylin appear to inhibit insulin), no insulinitis, mild beta cell hyperplasia
