Diabetes Type II
Terms
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- medical consequences of Obesity
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CV: CAD, MI, CHF, HTN, CV accidents. L vent hypertrophy
Cancer: Colon, Prostrate, breast, ovary, endometrail, cervical, gall bladder, bile ducts.
Metabolic: Insulin resistance, hyperlipidimai
Endocrine: PCOD, decreased tertosrone
Rhuematic, Joints
Liver: Cholestrol gallstones,
Pulmonary, Sleep apnea, snoring, incresed work to breathe, obesity hyperventilation syndrome. -
Metabolic syndrome
CHAOS -
Hyperlipidmia
Hypertriglycerdimia
Hypertension
Insulin resistance
artherosclerosis
Coronary Artery Disease
HTN
Adult
Onset diabetes
Stroke - Etiology of metabolic syndrome
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increased adipodicity-decreased adiponectin, increased resistan, increases insuline resistance
periphral resistance, post receptor problem,
excess fatty acid, affect insulin senstivity in other tissues, deposition of fat affects insulin sensititvty. - Viceral Fat vs subcutaineous fat
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Viceral fat: central fat, surrounding abdominal viscera, induces insulin resistance, MS
responsive to epinephrine, free fatty acid mobility, Apple shaped
Subcutanious fat-metabolically neutral, pear shaped - Causes of Insulin Resistance
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Primary defect in signaling: receptor muations, IAA, genetics
2 to endocrine: Cushings, Acromegaly, Pheo, Clucagonoma, Hyperthyroidism, Insulinoma
2 to other disorders: Viceral fat, stress, uremia, hyperglycermia, liver disease, AIDS, neuromuscular disorders
2 to normal states: Pregnancy, Puberty, Starvation
2 to medications: Glucocorticoids, Niacin, Thiazide Diuretics, Esotrogens, b-blockers - Consequences of Insuline Resistance
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Type II diabetes
Acanthosis nigricans--skin condition, dark, velvety skin thickening on back of neck and skin folds. TO MUCH IGF-1!!
Pseudoacromegaly
PCOD
HTN
HyperTG - Type II Diabetes etiology: Obesity, Insuline resistance, B-cell failure
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Obesity: adiponectin and resistin, decrease senstivty
Increased insuline resistance: need more insulin for same effects.
B-cell faliure: limits ability to produce or secrete insulin. genetic mutations. increased fatty acids have deletarious effects on b-cells. - Genetics of Diabetes: Type I and Type II
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Type I: Leptin, LeptinR, POMC, MC4R mutations
Type II: 50-90% concordance twin studies. - How is Mitochondrial genes inherited?
- Materially Inherited diabetes and deafness syndrome: mitochondra have DNA, exclusively from the mother. egg contains normal and abnormal DNA-heteroplamy, quite diffent syndromes depending on degree of heteroplasmy.
- How does mito DNA cause diabetes?
- MIDD, not obese, diabetes in middle age, relative insulin deficency, tRNA gene, defects in oxidative PO, impaired glucose sensing and insuline secreation.
- Maturity Onset Diabetes of the Young
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Inheritance: autosomal, heterozygous mutations cause disease
MODY2: Glucokinases genes decreases g-6PO, decreased insulin
MODY1-6: Beta-cell transciption factors, interfere with normal function or production and replacement of b-cells - Short Term complications of TII diabetes
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DKA-uncommon, insulin levels are still enough to suppress glucagon, inhibit b-oxidation
only in stress/infeection, underlying insulin definency
Hyperosmolarity-more later - Long term compliations of TII diabetes
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macrovascular complications, HTN, MI, stroke, amputation, caused by syndrome X. same as type one long term complications but less frequency.
protection: Diet management, Blood pressure and cholestrol managment, low saturated fat diet, aspirin therapy, stop smoking. - Hyperosmolarity in TII diabetes
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increase glucose, glucosuria, osmotic diresis. Free water loss causes hyperosmolarity. cognitive function, mental status declines, hyperosmolic coma!
fluid losses, fever burns, diarrehea, vomiting, lack of water intake, stress, surgey, elderly precipites risk
Tx: correct osmolarity slowly! - Steps to prevent adverse complications in pregnancy
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1st/3rd trimester problems.
1. optimal control before conception
2. monitor and control of glucose during pregnancy.
3. fetus is nutrient sink!
4. mom, increase insulin resistance, gluc mom-baby
5. Gestational diabetes