Podcast
Questions and Answers
What is the primary difference between Type 1 and Type 2 diabetes mellitus?
What is the primary difference between Type 1 and Type 2 diabetes mellitus?
- Type 1 diabetes results in marked insulin deficiency, unlike Type 2 which involves insulin resistance. (correct)
- Type 1 diabetes is more common in obese individuals than Type 2 diabetes.
- Type 1 diabetes occurs predominantly in adults, while Type 2 occurs in children.
- Type 1 diabetes is due to insulin resistance, while Type 2 is due to autoimmune destruction.
What is the fasting plasma glucose level that is considered diagnostic for diabetes mellitus?
What is the fasting plasma glucose level that is considered diagnostic for diabetes mellitus?
- ≥200 mg/dL
- ≥126 mg/dL (correct)
- ≥100 mg/dL
- ≥150 mg/dL
What complications arise due to chronic hyperglycaemia in diabetes mellitus?
What complications arise due to chronic hyperglycaemia in diabetes mellitus?
- Muscle atrophy and joint pain
- Microvascular complications such as retinopathy, nephropathy, and neuropathy (correct)
- Increased appetite and weight gain
- Hypoglycaemia and hypertension
Which condition is characterized by a fasting plasma glucose level lower than typical diabetes levels but higher than normal?
Which condition is characterized by a fasting plasma glucose level lower than typical diabetes levels but higher than normal?
Which of the following best describes the cause of Type 2 diabetes mellitus?
Which of the following best describes the cause of Type 2 diabetes mellitus?
What is one of the main characteristics of Type 1 Diabetes Mellitus?
What is one of the main characteristics of Type 1 Diabetes Mellitus?
Which of the following is a consequence of high levels of C-peptide?
Which of the following is a consequence of high levels of C-peptide?
How is insulin secretion affected when glucose is administered intravenously compared to orally?
How is insulin secretion affected when glucose is administered intravenously compared to orally?
The natural history of type 2 diabetes often involves which of the following scenarios?
The natural history of type 2 diabetes often involves which of the following scenarios?
What role does incretin play in insulin regulation?
What role does incretin play in insulin regulation?
What is often a key difference between Type 1 and Type 2 diabetes in terms of insulin production?
What is often a key difference between Type 1 and Type 2 diabetes in terms of insulin production?
What can considerably elevate the risk of cardiovascular disease in individuals with obesity-related diabetes?
What can considerably elevate the risk of cardiovascular disease in individuals with obesity-related diabetes?
Which of the following tests is primarily used to assess long-term glucose control in diabetes management?
Which of the following tests is primarily used to assess long-term glucose control in diabetes management?
Which condition can lead to glucocorticoid-induced diabetes?
Which condition can lead to glucocorticoid-induced diabetes?
What happens to glucose reabsorption in the kidneys during diabetes?
What happens to glucose reabsorption in the kidneys during diabetes?
What is a potential consequence of metabolic acidosis in type 1 diabetes?
What is a potential consequence of metabolic acidosis in type 1 diabetes?
How does an increase in blood ketones affect a diabetic patient?
How does an increase in blood ketones affect a diabetic patient?
What type of deficits are responsible for maturity-onset diabetes of the young (MODY)?
What type of deficits are responsible for maturity-onset diabetes of the young (MODY)?
Which hormone's actions are primarily lipogenic?
Which hormone's actions are primarily lipogenic?
What characterizes the distinct insulin-related issue in Type 2 diabetes mellitus?
What characterizes the distinct insulin-related issue in Type 2 diabetes mellitus?
What is the significance of the fasting plasma glucose level of ≥126 mg/dL in diagnosing diabetes mellitus?
What is the significance of the fasting plasma glucose level of ≥126 mg/dL in diagnosing diabetes mellitus?
Which of the following is a likely effect of chronic hyperglycaemia due to diabetes mellitus?
Which of the following is a likely effect of chronic hyperglycaemia due to diabetes mellitus?
What does 'impaired glucose tolerance' indicate about a patient's condition?
What does 'impaired glucose tolerance' indicate about a patient's condition?
What type of diabetic emergency can arise from high glucose levels combined with insufficient insulin?
What type of diabetic emergency can arise from high glucose levels combined with insufficient insulin?
Which of the following best describes the mechanism by which incretin influences insulin secretion?
Which of the following best describes the mechanism by which incretin influences insulin secretion?
What occurs to the levels of C-peptide in a patient with Type 1 diabetes?
What occurs to the levels of C-peptide in a patient with Type 1 diabetes?
In type 2 diabetes, what effect does prolonged high insulin secretion have on the beta-cells?
In type 2 diabetes, what effect does prolonged high insulin secretion have on the beta-cells?
Which metabolic pathway is primarily affected by insulin's action as a lipogenic hormone?
Which metabolic pathway is primarily affected by insulin's action as a lipogenic hormone?
Which test provides insight into long-term glucose control in diabetic patients?
Which test provides insight into long-term glucose control in diabetic patients?
What happens to glucose reabsorption in the kidneys when diabetes is present?
What happens to glucose reabsorption in the kidneys when diabetes is present?
What could lead to glucocorticoid-induced diabetes?
What could lead to glucocorticoid-induced diabetes?
What is a common characteristic of patients with metabolic acidosis in type 1 diabetes?
What is a common characteristic of patients with metabolic acidosis in type 1 diabetes?
How does an acute phase of insulin secretion differ from a later phase in response to oral glucose intake?
How does an acute phase of insulin secretion differ from a later phase in response to oral glucose intake?
Which of the following conditions occurs due to significantly elevated ketones in diabetic patients?
Which of the following conditions occurs due to significantly elevated ketones in diabetic patients?
What is a significant risk factor for cardiovascular disease associated with obesity-related diabetes?
What is a significant risk factor for cardiovascular disease associated with obesity-related diabetes?
What is an autoimmune marker commonly associated with Type 1 diabetes?
What is an autoimmune marker commonly associated with Type 1 diabetes?
Which condition is characterized by a failure of insulin to promote glucose entry into cells?
Which condition is characterized by a failure of insulin to promote glucose entry into cells?
Flashcards
Diabetes Mellitus
Diabetes Mellitus
A group of metabolic disorders characterized by high blood sugar levels (hyperglycemia) and lack of insulin.
Diabetes
Diabetes
A condition where the body does not produce enough insulin or cannot use insulin effectively, resulting in high blood sugar.
Type 1 Diabetes (T1DM)
Type 1 Diabetes (T1DM)
A type of diabetes where the body completely stops producing insulin due to the destruction of beta cells in the pancreas.
Type 2 Diabetes (T2DM)
Type 2 Diabetes (T2DM)
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Microvascular Complications
Microvascular Complications
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What is Diabetes Mellitus?
What is Diabetes Mellitus?
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What is Type 1 Diabetes?
What is Type 1 Diabetes?
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What is Type 2 Diabetes?
What is Type 2 Diabetes?
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What is Insulin?
What is Insulin?
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What are Incretins?
What are Incretins?
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What are the Two Phases of Insulin Secretion?
What are the Two Phases of Insulin Secretion?
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What is C-peptide?
What is C-peptide?
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What is Glycated Hemoglobin (HbA1c)?
What is Glycated Hemoglobin (HbA1c)?
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What is Pro-insulin Processing?
What is Pro-insulin Processing?
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What are the Metabolic Actions of Insulin?
What are the Metabolic Actions of Insulin?
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What are Ketone Bodies?
What are Ketone Bodies?
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What happens in Insulin Deficiency (Type 1 Diabetes)?
What happens in Insulin Deficiency (Type 1 Diabetes)?
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What is Hyperinsulinemia?
What is Hyperinsulinemia?
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What is Insulin Resistance?
What is Insulin Resistance?
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What is the Natural History of Type 2 Diabetes?
What is the Natural History of Type 2 Diabetes?
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What is hyperglycemia?
What is hyperglycemia?
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Describe Type 1 diabetes
Describe Type 1 diabetes
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Describe Type 2 diabetes
Describe Type 2 diabetes
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What are microvascular complications?
What are microvascular complications?
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Define impaired glucose tolerance
Define impaired glucose tolerance
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Type 1 Diabetes
Type 1 Diabetes
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Type 2 Diabetes
Type 2 Diabetes
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Insulin
Insulin
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Incretins
Incretins
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Phases of Insulin Secretion
Phases of Insulin Secretion
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C-peptide
C-peptide
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Glycated Hemoglobin (HbA1c)
Glycated Hemoglobin (HbA1c)
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Pro-insulin Processing
Pro-insulin Processing
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Metabolic Actions of Insulin
Metabolic Actions of Insulin
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Ketone Bodies
Ketone Bodies
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Insulin Deficiency (Type 1 Diabetes)
Insulin Deficiency (Type 1 Diabetes)
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Hyperinsulinemia
Hyperinsulinemia
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Insulin Resistance
Insulin Resistance
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Natural History of Type 2 Diabetes
Natural History of Type 2 Diabetes
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Study Notes
Carbohydrate & Lipid Metabolism Disorders
- This presentation covers the approach to patients with disorders of carbohydrate and lipid metabolism.
- It is part of a third-year General Pathology course.
Roadmap
- The roadmap outlines a sequence of topics:
- Diabetes management
- Diabetes emergencies (diabetic ketoacidosis, hyperglycemic hyperosmolar state, hypoglycemia)
- Lipid metabolism
- Mixed hyperlipidaemia
- Hypercholesterolaemia and hypertriglyceridemia
Diabetes Mellitus
- Diabetes mellitus is a clinical syndrome characterized by elevated plasma blood glucose (hyperglycemia).
- Type 1 diabetes mellitus (T1DM) is typically caused by autoimmune destruction of insulin-producing beta cells in the pancreas, leading to significant insulin deficiency.
- Type 2 diabetes mellitus (T2DM) is characterized by reduced sensitivity to insulin and an inadequate insulin secretion to overcome 'insulin resistance'.
Diabetes Mellitus (Detailed)
- High glucose and lack of insulin cause acute symptoms, metabolic decompensation, and hospitalization. These acute issues are particularly prevalent in type 1 diabetes.
- Chronic hyperglycemia leads to diabetes-related microvascular complications affecting eyes (retinopathy), kidneys (nephropathy), and feet (neuropathy).
- Blood glucose levels are continuously distributed, without a clear division between normal and abnormal values.
- Diagnostic criteria for diabetes mellitus involve a fasting plasma glucose of ≥126 mg/dL or glucose of ≥200 mg/dL two hours after an oral glucose challenge.
- Less severe hyperglycemia is called "impaired glucose tolerance."
Diabetes Mellitus (Mechanisms - Diagrams)
- Healthy cells efficiently take up glucose from the bloodstream using insulin receptors.
- In Type 1 diabetes, the pancreas fails to produce insulin, resulting in reduced glucose uptake.
- In Type 2 diabetes, cells do not respond properly to insulin, making glucose uptake inefficient.
Diabetic Ketoacidosis (DKA)
- DKA is an acute, life-threatening complication of diabetes, primarily in type 1 diabetes, which is characterized by insufficient insulin.
- DKA is characterized by hyperglycemia, ketogenesis, metabolic acidosis (low bicarbonate, pH below 7.3), and dehydration.
- Underlying causes include infection, stress response, and missed/inadequate insulin doses. Infections can heavily exacerbate the condition.
Hyperglycemic Hyperosmolar State (HHS)
- HHS is an acute complication in type 2 diabetic patients characterized by severe hyperglycemia, hyperosmolarity (high serum osmolarity, often above 320 mOsmol/kg), and dehydration without significant ketoacidosis. There is little to no ketone body production.
Hypoglycemia
- Hypoglycemia is a potentially dangerous condition with abnormally low blood glucose (below 70 mg/dL).
- Symptoms include sweating, trembling, and rapid heart rate, and the condition is potentially serious, especially if left untreated.
Chronic Complications of Diabetes
- Chronic complications include:
- Microvascular problems: retinopathy, nephropathy, neuropathy.
- Macrovascular problems: CVD, stroke, PAD.
- Foot complications: neuropathies, ulcers. Charcot foot is a serious complication from the loss of sensation in the feet.
Lipoproteins
- Lipids, such as fatty acids, cholesterol, and triglycerides, are hydrophobic molecules that bind to proteins for transport.
- These lipids are transported as lipoproteins, which have a hydrophobic core and an amphiphilic surface monolayer.
- The different types of lipoproteins include chylomicrons, VLDL, IDL, LDL, and HDL.
Disorders of Lipid Metabolism
- Proteins and receptors on lipoproteins guide lipid metabolism.
- Dyslipidemia is a common disorder characterized by defects in lipoprotein synthesis and catabolism, affecting lipoprotein levels.
- Treatment of dyslipidemia can improve cardiovascular health.
Hypercholesterolemia
- Hypercholesterolemia is a common condition characterized by elevated LDL cholesterol.
- Physical signs like corneal arcus and xanthelasma may indicate hypercholesterolemia.
- The risk of CVD is linked to the severity of LDL cholesterol rise.
Hypertriglyceridemia
- Hypertriglyceridemia is often linked to genetic factors, high alcohol consumption, medications, diabetes, impaired glucose tolerance, and other factors including obesity.
- Increased triglycerides can correlate with postprandial hyperlipidemia, decreased HDL cholesterol, and thus higher CVD risk.
Mixed Hyperlipidaemia
- Mixed hyperlipidemia involves higher levels of both triglycerides and LDL cholesterol.
- Treatment of extreme triglyceride elevation may temporarily disguise it as a mixed hyperlipidemia.
- The condition frequently develops with diabetes, impaired glucose intolerance, high BMI, and other insulin resistance problems.
Evolution of Atherosclerotic Plaque
- Atherosclerotic plaque development involves multiple steps including LDL accumulation, inflammation, and smooth muscle proliferation. Cells adhering to the vascular endothelium, macrophages picking up oxidized LDL, and other inflammatory responses are part of the progression.
Life History of Atheroma
- Atheroma formation progresses from normal artery, early atheroma and vulnerable plaque, to stabilized plaque, and ruptured plaque/thrombosis.
Non-pharmacological Management of Lipid Disorders
- Dietary changes including reducing saturated fat and cholesterol, incorporating unsaturated fats, controlling carbohydrate consumption, increasing physical activity and increasing fruit and vegetable intake are critical.
Pharmacological Management of Lipid Disorders
- Treatment choices vary based on the predominant lipid abnormality.
- Statins, fibrates, and other drugs are frequently utilized.
Diabetic Foot Disease
- Peripheral neuropathy and vascular disease are major factors in development of diabetic foot issues. Poor blood flow and reduced sensation greatly increase risk.
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