Pathology Chapter 3: Carbohydrate & Lipid Disorders

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Questions and Answers

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?

  • ≥200 mg/dL
  • ≥126 mg/dL (correct)
  • ≥100 mg/dL
  • ≥150 mg/dL

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?

<p>Impaired glucose tolerance (D)</p> Signup and view all the answers

Which of the following best describes the cause of Type 2 diabetes mellitus?

<p>Insulin resistance coupled with inadequate insulin production (C)</p> Signup and view all the answers

What is one of the main characteristics of Type 1 Diabetes Mellitus?

<p>Autoimmune destruction of beta cells (D)</p> Signup and view all the answers

Which of the following is a consequence of high levels of C-peptide?

<p>More fat accumulation around the heart (C)</p> Signup and view all the answers

How is insulin secretion affected when glucose is administered intravenously compared to orally?

<p>IV glucose results in lower insulin secretion initially. (C)</p> Signup and view all the answers

The natural history of type 2 diabetes often involves which of the following scenarios?

<p>Excessive insulin secretion in the early stages. (B)</p> Signup and view all the answers

What role does incretin play in insulin regulation?

<p>Stimulates the release of insulin. (D)</p> Signup and view all the answers

What is often a key difference between Type 1 and Type 2 diabetes in terms of insulin production?

<p>Type 1 has an absence of insulin production. (B)</p> Signup and view all the answers

What can considerably elevate the risk of cardiovascular disease in individuals with obesity-related diabetes?

<p>Increased lipid storage. (B)</p> Signup and view all the answers

Which of the following tests is primarily used to assess long-term glucose control in diabetes management?

<p>Glycated hemoglobin (HbA1c). (C)</p> Signup and view all the answers

Which condition can lead to glucocorticoid-induced diabetes?

<p>Both Type 1 and Type 2 diabetes (C)</p> Signup and view all the answers

What happens to glucose reabsorption in the kidneys during diabetes?

<p>Excess glucose may appear in urine. (A)</p> Signup and view all the answers

What is a potential consequence of metabolic acidosis in type 1 diabetes?

<p>Excess fat breakdown for energy. (A)</p> Signup and view all the answers

How does an increase in blood ketones affect a diabetic patient?

<p>It increases the risk of metabolic acidosis. (D)</p> Signup and view all the answers

What type of deficits are responsible for maturity-onset diabetes of the young (MODY)?

<p>Defects in insulin production due to beta cell function. (D)</p> Signup and view all the answers

Which hormone's actions are primarily lipogenic?

<p>Insulin (A)</p> Signup and view all the answers

What characterizes the distinct insulin-related issue in Type 2 diabetes mellitus?

<p>Insulin resistance with insufficient insulin production (D)</p> Signup and view all the answers

What is the significance of the fasting plasma glucose level of ≥126 mg/dL in diagnosing diabetes mellitus?

<p>Identifies hyperglycaemia with risk of microvascular disease (A)</p> Signup and view all the answers

Which of the following is a likely effect of chronic hyperglycaemia due to diabetes mellitus?

<p>Development of microvascular complications such as retinopathy (D)</p> Signup and view all the answers

What does 'impaired glucose tolerance' indicate about a patient's condition?

<p>Higher than normal glucose but not qualifying for diabetes diagnosis (D)</p> Signup and view all the answers

What type of diabetic emergency can arise from high glucose levels combined with insufficient insulin?

<p>Diabetic ketoacidosis (C)</p> Signup and view all the answers

Which of the following best describes the mechanism by which incretin influences insulin secretion?

<p>Incretin stimulates beta cells to secrete insulin in response to food intake. (D)</p> Signup and view all the answers

What occurs to the levels of C-peptide in a patient with Type 1 diabetes?

<p>Almost zero due to lack of insulin production. (D)</p> Signup and view all the answers

In type 2 diabetes, what effect does prolonged high insulin secretion have on the beta-cells?

<p>Leads to beta-cell destruction and possible insulin deficiency. (C)</p> Signup and view all the answers

Which metabolic pathway is primarily affected by insulin's action as a lipogenic hormone?

<p>Fatty acid and triglyceride synthesis. (C)</p> Signup and view all the answers

Which test provides insight into long-term glucose control in diabetic patients?

<p>Glycated hemoglobin (HbA1c) test. (A)</p> Signup and view all the answers

What happens to glucose reabsorption in the kidneys when diabetes is present?

<p>Glucose reabsorption is impaired, leading to glucose in urine. (D)</p> Signup and view all the answers

What could lead to glucocorticoid-induced diabetes?

<p>Elevated blood glucose from glucocorticoid therapy. (B)</p> Signup and view all the answers

What is a common characteristic of patients with metabolic acidosis in type 1 diabetes?

<p>Breakdown of fatty acids for energy. (B)</p> Signup and view all the answers

How does an acute phase of insulin secretion differ from a later phase in response to oral glucose intake?

<p>The acute phase occurs first, followed by a more sustained but lower insulin release. (D)</p> Signup and view all the answers

Which of the following conditions occurs due to significantly elevated ketones in diabetic patients?

<p>Diabetic ketoacidosis. (C)</p> Signup and view all the answers

What is a significant risk factor for cardiovascular disease associated with obesity-related diabetes?

<p>Increased levels of C-peptide. (D)</p> Signup and view all the answers

What is an autoimmune marker commonly associated with Type 1 diabetes?

<p>Islet autoantibodies. (B)</p> Signup and view all the answers

Which condition is characterized by a failure of insulin to promote glucose entry into cells?

<p>Type 2 diabetes due to insulin resistance. (C)</p> Signup and view all the answers

Flashcards

Diabetes Mellitus

A group of metabolic disorders characterized by high blood sugar levels (hyperglycemia) and lack of insulin.

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)

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)

A type of diabetes characterized by the body's resistance to insulin's action, leading to high blood sugar.

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Microvascular Complications

Complication of diabetes affecting small blood vessels in the eyes, kidneys, and feet.

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What is Diabetes Mellitus?

A group of disorders that affect the body's ability to use glucose (sugar) for energy, resulting in high blood sugar levels.

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What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disorder where the immune system mistakenly attacks and destroys beta cells in the pancreas, which are responsible for producing insulin.

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What is Type 2 Diabetes?

Type 2 diabetes is characterized by insulin resistance, where the body doesn't respond properly to insulin, and eventually, the pancreas may not be able to produce enough insulin.

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What is Insulin?

Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels by allowing glucose to enter cells for energy.

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What are Incretins?

Incretins are hormones released by the gut in response to eating, stimulating insulin secretion from the pancreas. Some medication mimics the effects of incretins to boost insulin release.

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What are the Two Phases of Insulin Secretion?

The first phase of insulin secretion is a rapid and short-lived response to the intake of glucose, while the second phase is a slower and more sustained response.

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What is C-peptide?

C-peptide is a fragment of the pro-insulin molecule that is released into the bloodstream along with insulin. It is a good indicator of insulin production.

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What is Glycated Hemoglobin (HbA1c)?

Glycated hemoglobin (HbA1c) reflects the average blood sugar level over the past 2-3 months, providing a long-term picture of blood sugar control.

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What is Pro-insulin Processing?

The process of converting pro-insulin into active insulin and C-peptide occurs in the pancreas before release into the bloodstream.

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What are the Metabolic Actions of Insulin?

Insulin's primary metabolic function is to facilitate glucose uptake into cells for energy, promote glycogen synthesis, and suppress glucose production by the liver. It also promotes fat storage and protein synthesis.

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What are Ketone Bodies?

Ketone bodies are alternative sources of energy for the brain and body during prolonged periods of fasting or inadequate glucose availability.

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What happens in Insulin Deficiency (Type 1 Diabetes)?

Type 1 diabetes is characterized by a complete absence of insulin production due to the destruction of beta cells in the pancreas. Ketoacidosis can occur with high ketones in the blood.

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What is Hyperinsulinemia?

Hyperinsulinemia is a condition characterized by excessively high levels of insulin in the blood, which can happen in the early stages of type 2 diabetes.

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What is Insulin Resistance?

Insulin resistance is a condition where the body's cells don't respond properly to insulin, leading to high blood sugar levels.

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What is the Natural History of Type 2 Diabetes?

The natural history of type 2 diabetes involves a gradual progression from insulin resistance to beta cell dysfunction, ultimately leading to insulin deficiency.

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What is hyperglycemia?

Hyperglycemia is a condition characterized by high blood sugar levels, often due to insufficient insulin production or impaired insulin action. It's a key feature of diabetes mellitus.

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Describe Type 1 diabetes

Type 1 diabetes results from the autoimmune destruction of insulin-producing beta cells in the pancreas, leading to severe insulin deficiency.

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Describe Type 2 diabetes

Type 2 diabetes is characterized by reduced sensitivity to insulin (insulin resistance) and eventual decline in insulin production. It often develops gradually.

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What are microvascular complications?

Chronic hyperglycemia can damage small blood vessels in the eyes (retinopathy), kidneys (nephropathy), and feet (neuropathy), leading to long-term complications in those with diabetes.

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Define impaired glucose tolerance

Impaired glucose tolerance refers to a milder form of hyperglycemia, and it can often precede the diagnosis of diabetes. It signifies an increased risk for developing diabetes.

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Type 1 Diabetes

Type 1 diabetes is an autoimmune disorder where the body's immune system mistakenly attacks and destroys beta cells in the pancreas, leading to a complete lack of insulin production.

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Type 2 Diabetes

Type 2 diabetes is characterized by insulin resistance, where the body's cells don't respond properly to insulin, leading to high blood sugar levels. Over time, the pancreas may not be able to produce enough insulin.

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Insulin

Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels by allowing glucose to enter cells for energy.

Signup and view all the flashcards

Incretins

Incretins are hormones released by the gut in response to eating, stimulating insulin secretion from the pancreas. Some medications mimic the effects of incretins to boost insulin release.

Signup and view all the flashcards

Phases of Insulin Secretion

The first phase of insulin secretion is a rapid and short-lived response to the intake of glucose, while the second phase is a slower and more sustained response.

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C-peptide

C-peptide is a fragment of the pro-insulin molecule that is released into the bloodstream along with insulin. It is a good indicator of insulin production.

Signup and view all the flashcards

Glycated Hemoglobin (HbA1c)

Glycated hemoglobin (HbA1c) reflects the average blood sugar level over the past 2-3 months, providing a long-term picture of blood sugar control.

Signup and view all the flashcards

Pro-insulin Processing

The process of converting pro-insulin into active insulin and C-peptide occurs in the pancreas before release into the bloodstream.

Signup and view all the flashcards

Metabolic Actions of Insulin

Insulin's primary metabolic function is to facilitate glucose uptake into cells for energy, promote glycogen synthesis, and suppress glucose production by the liver. It also promotes fat storage and protein synthesis.

Signup and view all the flashcards

Ketone Bodies

Ketone bodies are alternative sources of energy for the brain and body during prolonged periods of fasting or inadequate glucose availability.

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Insulin Deficiency (Type 1 Diabetes)

Type 1 diabetes is characterized by a complete absence of insulin production due to the destruction of beta cells in the pancreas. Ketoacidosis can occur with high ketones in the blood.

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Hyperinsulinemia

Hyperinsulinemia is a condition characterized by excessively high levels of insulin in the blood, which can happen in the early stages of type 2 diabetes.

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Insulin Resistance

Insulin resistance is a condition where the body's cells don't respond properly to insulin, leading to high blood sugar levels.

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Natural History of Type 2 Diabetes

The natural history of type 2 diabetes involves a gradual progression from insulin resistance to beta cell dysfunction, ultimately leading to insulin deficiency.

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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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