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44 terms

Patho 4/30

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Islets
endocrine cells
Acini
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
Present
Type 1 treatment
Insulin
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
Absent
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
Ketoacidosis
Accumulation of acidic ketone bodies in blood due to lack of insulin stimulated fatty acid utilization
Normal range of Hb A1c levels
4-5.9%
Poorly controlled diabetes range of Hb A1c levels
8%<
Well controlled diabetes range of Hb A1c levels
7%
Fatty acid + insulin =
energy
Fatty acid - insulin =
ketone bodies and acidosis
Microangiopathy
thickening of basement membranes of small vessels, important morphological feature that is responsible for
Retinopathy
small hemorrhages, microaneurysms, proliferation of blood vessels
Nephropathy
Kimmelstiel-Wilson (K/S) change in glomerulus
Neuropathy
Peripheral (Charcot foot) and Autonomic
Inciting factors of Charcot food
Repeated unrecognized microtrauma or an unidentifiable injury
Metformin
improves glucose tolerance in patients w/ type 2 diabetes; Decreases intestinal absorption of glucose; Improves insulin sensitivity by increasing peripheral glucose uptake & utilization
Sulfonylurea
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)