Type II DM

Question 1

Diabetes results from…

Answer 1

defects in insulin secretion, insulin action, or both

Question 2

what is the common theme in diabetes

Answer 2

hyperglycemia

Question 3

what is the prevalence of diabetes

Answer 3

25 millions in US

Question 4

what are the classification of diabetes

Answer 4

• type I diabetes (5-10%)
• type II diabetes (90-95%)

Question 5

type 1 diabetes is an ?

Answer 5

autoimmune disease

Question 6

what happens in type 1 diabetes

Answer 6

pancreatic beta cell destruction

Question 7

what happens in type 2 diabetes

Answer 7

combination of peripheral resistance to insulin action and an inadequate secretory response by beta cells

Question 8

type II diabetes has a twin concordance rate between ?

Answer 8

70 and 90%

Question 9

what are the 3 notable genes implicated in type II DM

Answer 9

• TCF7L2 gene
• PPAR receptor
• IRS genes

Question 10

what is the most important environmental risk factor for type II DM

Answer 10

obesity

Question 11

what happens first in type II DM and then followed by what?

Answer 11

first, impaired insulin action and then impaired insulin secretion

Question 12

what is the pathophysiologic pearl for type II DM

Answer 12

it seems like to progress to overt T2DM, you need impaired insulin secretion, which seems to arise after a long history of insulin resistance

Question 13

what are the factors for the development of insulin resistance

Answer 13

• increased free fatty acids and adipocyte endocrine dysfunction
• reduced incretin release
• insulin receptor desensitization due to chronically high levels of serum glucose

Question 14

what does incretins do?

Answer 14

• decrease gastric emptying
• increase insulin release
• reduce glucagon secretion

Question 15

non-esterified fatty acids increase ?

Answer 15

insulin resistance

Question 16

persistent hyperglycemia leads to what?

Answer 16

advanced glycation end products (AGEs)

Question 17

what are advanced glycation end products

Answer 17

metabolic products of glucose non-enzymatically linked to amino groups of intra-and extracellular proteins

Question 18

AGE leads to:

Answer 18

• release of pro-inflammatory cytokines and growth factors from intimal macrophages
• Generation of ROS in endothelial cells
• Increased procoagulant activity on endothelial cells
• Enhanced proliferation of vascular smooth muscle cells and synthesis of extracellular matrix