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endocrine cells


exocrine cells

Insulin (Islet β cell)

Decreases serum glucose level; Promotes utilization of glucose & lipid synthesis

Glucagon (Islet α cell)

Increases serum glucose levels; Promotes utilization of glycogen & lipid

Random blood glucose

200 mg/dl

Fasting blood glucose

126 mg/dl on more than 1 occasion

Abnormal oral glucose tolerance test

200 mg/dl 2 hr after glucose load

Type 1 age

Juvenile onset

Type 1 % of cases

5-10% of cases

Type 1 aka

Insulin-dependent diabetes mellitus (IDDM)

Type 1 pathophysiology

Autoimmune destruction of β cell; Idiopathic

Type 1 onset

Abrupt, often triggered by infection or stress

Type 1 islet of cell antibody

Present, decreased insulin synthesis

Type 1 ketosis


Type 1 treatment


Type 1 complication

Occur early and severe

Type 2 age

Usually >25 years

Type 2 % of cases

80% of cases

Type 2 aka

non-insulin-dependent diabetes mellitus (NIDDM) or Adult Onset Diabetes Mellitus (AODM)

Type 2 islet of cell antibody

Absent, insulin resistance

Type 2 onset

More often insidious

Type 2 ketosis


Type 2 treatment

Diet or diet + insulin

Type 2 complication

Develop more slowly and less severe

HLA linked genes

genes that are involved in immune tolerance and regulation; leads to development of autoimmunity

Environmental factors for Type 2

Inactivity, poor diet, overweight, advancing age, heredity


Accumulation of acidic ketone bodies in blood due to lack of insulin stimulated fatty acid utilization

Normal range of Hb A1c levels


Poorly controlled diabetes range of Hb A1c levels


Well controlled diabetes range of Hb A1c levels


Fatty acid + insulin =


Fatty acid - insulin =

ketone bodies and acidosis


thickening of basement membranes of small vessels, important morphological feature that is responsible for


small hemorrhages, microaneurysms, proliferation of blood vessels


Kimmelstiel-Wilson (K/S) change in glomerulus


Peripheral (Charcot foot) and Autonomic

Inciting factors of Charcot food

Repeated unrecognized microtrauma or an unidentifiable injury


improves glucose tolerance in patients w/ type 2 diabetes; Decreases intestinal absorption of glucose; Improves insulin sensitivity by increasing peripheral glucose uptake & utilization


augment insulin secretion from β cells in the islets of Langerhans

Secondary DM due to

Diseases that destroy pancreatic islet cells; Endocrine disorders where effect of insulin is antagonized; Drugs

Diseases that destroy pancreatic islet cells

pancreatitis, cystic fibrosis, iron overload (hemochromatosis), surgical removal of pancreas

Endocrine disorders where effect of insulin is antagonized

GH excess (acromegaly), Cushing syndrome, exogenous CS intake

Drugs that cause secondary DM

β adrenergic agonists, thiazide diuretics

Reduce risk of gestational diabetes

Monitoring blood & urine glucose levels; Specific dietary guidelines; Exercising; Monitoring your weight gain; Taking insulin; Watching for complications in fetus & mother (e.g., controlling HTN in mother)

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