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When you steal from one author, it's plagiarism; if you steal from many, it's research . Wilson Mizner. Normal Pancreatic Function. Exocrine pancreas aids digestion Bicarbonate Lipase Amylase Proteases Endocrine pancreas (islets of Langerhans) Beta cells secrete insulin
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CPT= Carnitine Palmitoyl
-Cell mass 100%
Circulating autoantibodies (ICA, GAD65)
Loss of first-phase
insulin response (IVGTT)
only 10% of-cells remain
Eisenbarth GS. N Engl J Med. 1986;314:1360-1368
The patient was diagnosed with type 1 diabetes 2 years ago when he presented to a different hospital with symptoms of polyuria, polydipsia, and weight loss.
The laboratory data showed an anion gap, metabolic acidosis, and hyperglycemia (pH of 7.14, anion gap of 24, bicarbonate 6 mmol/l, urinary ketones 150 mg/dl, glucose 314 mg/dl) consistent with the diagnosis of DKA. The patient's hemoglobin A1c (A1C) was 13.5%.
February 15, 1923
Patient J.L., December 15, 1922
■ Resistance to the actions of insulin is strongly associated with the microvascular complications of diabetes, independently of metabolic control and hypertension
■ Insulin resistance is an important marker of risk and a key target for intervention, as those patients who achieve a greater improvement of insulin sensitivity achieve better microvascular outcomes
■ Diabetes and obesity are associated with pathway-selective insulin resistance in the phosphatidylinositol-3-kinase signaling pathway, while signaling via extracellular signal-regulated kinase dependent pathways is comparatively unaffected, tipping the balance of insulin’s actions in favor of abnormal vasoreactivity, angiogenesis, and other pathways implicated in microangiopathy
■ Insulin resistance is able to enhance key pathways involved in hyperglycemia-induced microvascular damage and to exacerbate hypertension
■ The strong association between insulin resistance and microvascular disease might also reflect a common genotype or phenotype