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Diabetes mellitus ´ëÀå°æ Á¤¸®

1. IGT: 25-30%¿¡¼­ type 2 DMÀ¸·Î ÁøÇà

cardiovascular diseaseÀÇ risk¿Í °ü·ÃÀÖÀ¸³ª microvascular Cx°ú´Â ¹«°üÇÑ´Ù.

2. ´ç´¢ ÇÕº´ÁõÀ» ¿¹¹æÇÒ¼ö ÀÖ´Ù°í »ý°¢µÇ´Â Ç÷´çÁ¶Àý ¸ñÇ¥

½ÄÀü: 80-120 ÀÚ±âÀü: 100-140, HbA1c: 7%

3. type 1 DM¿¡¼­ NO¸¦ Áõ°¡½ÃÄÑ insulinºÐºñ¸¦ ¾ïÁ¦½ÃŲ´Ù°í ¾Ë·ÁÁø cytokine? IL-1¥â

4. type 1 DM¿¡¼­ °¨¼ö¼º ¹× ƯÀ̵µ°¡ °¡Àå ³ôÀº ÀÚ°¡Ç×ü 2°¡Áö? GAD Ab, ICA512/IA-2

5. type 1 DM¹ß»ý°úÁ¤¿¡ °ü¿©ÇÑ´Ù°í ¾Ë·ÁÁø cytokines: IL-1, TNF-¥á, INF-¥ã, lymphotoxin

6. Á¤»óÀÎÀÇ ±âÀú Àν¶¸° ºÐºñ´Â ¹Úµ¿¼ºÀ̸ç Á¦ 2Çü ´ç´¢º´ ȯÀÚ¿Í ´ç´¢º´ ¹ß»ýÀ§ÇèÀÌ

³ôÀº »ç¶÷¿¡¼­´Â ÀÌ·¯ÇÑ ¹Úµ¿¼ºÀÌ ¼Ò½ÇµÈ´Ù.

7. Àν¶¸° ÀúÇ×¼ºÀÇ °¡Àå Å« »ý¸®ÇÐÀû °á°ú´Â glycogen formationÀÇ Àå¾ÖÀÌ´Ù.

8. MODYÁß °¡Àå ÈçÇÑ type°ú ¿øÀÎ À¯ÀüÀÚ À§Ä¡?

MODY2, glucokinase gene on chr 7

9. gestational DM

24-28ÁÖ 50g OGTT 1hr > 140 -> 100g OGTT

fasting>105, 1hr>190, 2hr>165, 3hr>145(ÀÌÁß 2°³)

10. ´ç´¢º´ Àӽźο¡¼­ ÅÂ¾Æ ¹× ½Å»ý¾Æ ÇÕº´Áõ

hyperinsulinemia & macrosomia, ÅÂ¾Æ ¹× ½Å»ý¾Æ »ç¸Á, ÀúÇ÷´ç, È£Èí°ï¶õÁõ,

hyperbilirubinemia, hypocalcemia

11. ÀÓ½ÅÇÑ ¿©¼ºÀº ÀÓ½ÅÀü¿¡ ºñÇØ ¸»ÃÊÁ¶Á÷ÀÇ Àν¶¸° ÀúÇ×¼ºÀÌ Áõ°¡ÇÑ´Ù.

12. ´ç´¢º´À» À¯¹ßÇÒ¼ö ÀÖ´Â ³»ºÐºñ Áúȯ

acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma,

glucagonoma, somatostatinoma, aldosteronoma

13. ´ç´¢º´ ȯÀÚÀÇ protein¼·Ãë·®

renal cx(-) : ÃÖ¼Ò 0.9 g/kg/d

microalbuminuria: 0.8 g/kg/d

overt nephropathy: 0.6 g/kg/d

14. DMÄ¡·áÁß ¹ß»ýÇÏ´Â secondary failureÀÇ ¿øÀÎ: ¸Å³â 5-10%

: diet & exercise¸¦ Áö¼ÓÀûÀ¸·Î ÇÏÁö ¾ÊÀ½

progressive ¥â cell failure

other medical problem or drug superimpose

drug tolerance

15. acarbose CIx: IBD, gastroparesis, s-Cr>2.0 mg/dL, liver cirrhosis

16. sulfonylureaÁß ÀÛ¿ë½Ã°£ÀÌ °¡Àå ±ä ¾àÁ¦? chlorpropamide

cf. chlorpropamide´Â SIADH À¯¹ß

17. BiguanideÀÛ¿ë±âÀü

°£¿¡¼­ ´ç½Å»ý ¾ïÁ¦, ¸»ÃÊÁ¶Á÷¿¡¼­ insulin receptor¼ö¿Í ÀÛ¿ë Áõ°¡, ¼ÒÀå¿¡¼­ ´çÈí¼ö

¾ïÁ¦

18. troglitazoneÀÌ °áÇÕÇÏ´Â ¼¼Æ÷ÇÙ³» ¼ö¿ëü? PPAR¥ã(peroxisome proliferator-activated

receptor)

19. troglitazone¿¡´Â ¥á-tocopherolÀÌ ÀÖ¾î Ç×»êÈ­È¿°úµµ ±â´ëÇÒ¼ö ÀÖ´Ù.

ÀÓ»êºÎ ¹× ¼öÀ¯ºÎ¿¡ ´ëÇØ ¾ÈÀü¼ºÀÌ È®¸³µÇÁö ¾Ê¾Ò´Ù.

20. insulin sensitizer 2°¡Áö ¾àÁ¦: troglitazone, metformin

21. ½ÄÈÄ °íÇ÷´çÁ¶Àý¿¡ ÀûÇÕÇÑ °æ±¸ ´ç´¢¾à? ¥á-glucosidase inhibitor, repaglinide

22. DKA¶§ °¨¼ÒÇÏ´Â °Í

malonyl-CoA, fructose-2, 6-bisphosphate, acetyl-CoA carboxylase

23. DKA¶§ Áõ°¡ÇÏ´Â °Í: hepatic carnitine concentration

24. DKA¿¡¼­ glucagonÀÌ ´ç´ë»ç¿¡¼­ ¾ïÁ¦ÇÏ´Â 2°¡Áö È¿¼Ò?

phosphofructokinase, acetyl-CoA carboxylase

25. DKAÄ¡·áÁß acidosisÀÇ È£Àü¿¡µµ ºÒ±¸Çϰí bicarbonate levelÀÌ °è¼Ó ³·Àº ÀÌÀ¯?

i) NaClÀÇ Áö¼ÓÀû Åõ¿©·Î ÀÎÇÑ hyperchloremia

ii) potential bicarbonateÀÎ ketoneÀÇ urineÀ¸·ÎÀÇ ¼Ò½Ç

iii) intracellular buffer¿ÍÀÇ exchange

26. DKAÀÔ¿ø½Ã poor prognostic signs

hypotension, azotemia, deep coma, associated illness

27. DKAÄ¡·á½Ã bicarbonate·Î rapid alkalinizationÇÒ °æ¿ì¿¡ »ý±æ¼ö ÀÖ´Â ºÎÀÛ¿ë?

i) O2 dissociation curve¸¦ Lt shift½ÃÅ´À¸·Î½á tissue hypoxia¾ÇÈ­

ii) hypokalemia ¹× overshoot alkalosis

iii) cardiac functionÀå¾Ö

28. DKA ÁÖ»ç¸Á¿øÀÎ: MI, infection(ƯÈ÷ pneumonia)

29. hyperosmolar coma¶§ DKA¶§º¸´Ù K+À» »¡¸® ÁÖ´Â ÀÌÀ¯?

acidosis°¡ ¾øÀ¸¹Ç·Î Ä¡·áÁß¿¡ K+ÀÌ ºü¸¥ ¼Óµµ·Î intracellular shiftÇϱ⠶§¹®

30. DMȯÀÚ¿¡¼­ Ç÷¾×ÀÀ°í´ÉÀÌ Áõ°¡ÇÏ´Â ÀÌÀ¯

PAI-1¡è, platelet adhesiveness(TXA2¡è, prostacycline¡é), endothelin-1¡è, NO¡é

Factor VIII, vWF¡è, tissue factor pathway inhibitor type I deficiency

31. retinopathy severity´Â durationÀÌ Áõ°¡ÇÒ¼ö·Ï Áõ°¡ÇÑ´Ù.

¿¹¿Ü> early childhood diabetes(before puberty)

32. PDRÀÇ °æ¿ì ¹Ý¼ö¿¡¼­ 5³â³» ½Ç¸íÇÑ´Ù.

33. diabetic retinopathy¿Í °ü·ÃÇÑ factors: IGF-I, FGF, VEF, HGF

34. PDR¼Ò°ß: new vessel, scar(retinitis proliferans), vitrous hemorrhage, retinal

detachment

35. diabetic retinopathy¿¡ ÀÇÇÑ ½Ã·Â¼Õ»óÀÇ ¿øÀÎ 2°¡Áö: PDR, CSME

36. DM nephropathy¿¡¼­ overt proteinuria°¡ »ý±ä ´ÙÀ½ºÎÅÍ GFRÀÌ ¸Å´Þ 1ml/min¾¿ °¨¼Ò

ÇÑ´Ù.

37. DM nephropathy¿¡¼­ retinopathy°¡ ¾øÀ»¶§ ½ÅÁ¶Á÷°Ë»ç°¡ ÇÊ¿äÇÏ´Ù.

38. DM nephropathy¿¡¼­ º¼¼ö Àִ ƯÀÌÀûÀÎ Á¶Á÷ÇÐÀû ¼Ò°ß 2°¡Áö

: hyalinization of afferent arterioles, Kimmelstiel-Wilson nodule

39. DM nephropathy¶§ ACE inhibitorÀÇ À̷οî È¿°ú

i) angiotensin IIÀÇ ÀÛ¿ëÀ» ÀúÇØÇÏ¿© efferent arterioleÀÇ ÀúÇ×À» °¨¼Ò½ÃÅ´À¸·Î½á

intraglomerular pressure¸¦ °¨¼Ò½ÃŲ´Ù.

ii) ¼¼Æ÷¿Í »ç±¸Ã¼¸¦ ºñÈĽÃŰ´Â angiotensin IIÀÇ trophic actionÀ» Â÷´ÜÇϰí mesangium

¿¡¼­ ±âÁúÀÇ ÃàÀûÀ» ¾ïÁ¦ÇÑ´Ù.

40. ACE inhibitor»ç¿ëÁß renal failure°¡ ¾ÇÈ­µÇ¾úÀ» ¶§ °¡´ÉÇÑ ¿øÀÎ

: elderly, NSAIDsº¹¿ëÁß, bilateral renal artery stenosis

41. DM neuropathy´Â ºÎ±³°¨½Å°æÀå¾Ö°¡ ¸ÕÀú ³ªÅ¸³ª°í ±³°¨½Å°æÀå¾Ö°¡ ³ªÅ¸³­´Ù.

42. DM autonomic neuropathy´Â ¼ÒÈ­±â°è¸¦ °¡Àå ÈçÇÏ°Ô Ä§¹üÇÑ´Ù.

mc: constipation

43. DM autonomic neuropathy·Î ÀÎÇÑ orthostatic hypotensionÀÌ ÀÖÀ» ¶§ Á¶½ÉÇØ¾ß

ÇÏ´Â ¾à?

(orthostatic hypotensionÀ¯¹ß or ¾ÇÈ­°¡´ÉÇÑ ¾à)

¥á-blocker, thiazide diuretics, TCA, vasodilators(nitrates), insulin

44. ´ç´¢º´À¸·Î ÀÎÇÑ ¹ß±âºÎÀüÀÇ Ä¡·áÁ¦: sildenafil

±âÀü> phosphodiesterase type 5 inhibition -> endogenous NO degradation¾ïÁ¦

±Ý±â> nitrateº¹¿ëȯÀÚ

45. DM neuropathyÁß ÀúÀý·Î ȸº¹µÇ´Â °Í

acute sensory neuropathy, proximal motor neuropathy(amyotrophy),

mononeuropathy

46. DM complication¹ß»ý±âÀüÁß °íÇ÷´çÀ» ±³Á¤Çϸé Á¤»óÀ¸·Î µ¹¾Æ¿Ã¼ö ÀÖ´Â °Í

polyol pathway, oxidative-reductive stress, PKC activation

* irreversible: nonenzymatic glycation process

47. chronic complicationÀ» ÀÏÀ¸Å°´Â µÎ°¡Áö ±âÀü

i) nonenzymatic glycation(AGE) ii) polyol pathway·Î ÀÎÇÑ sorbitolÃàÀû

48. hyperglycemic memory

Ç÷´çÀÌ Á¤»óÀ¸·Î µÈ ÈÄ¿¡µµ diabetic complicationÀÌ °è¼Ó ÁøÇàÇÏ´Â °ÍÀ» ¸»ÇÑ´Ù.

±âÀüÀº hyperglycemiaµ¿¾È Çü¼ºµÈ ACE products°¡ ºñ°¡¿ªÀûÀÌ°í ¿µ±¸ÀûÀ̾

Ç÷´çÀÌ Á¤»óÈ­µÇ¾îµµ Á¶Á÷¼Õ»óÀ» Áö¼ÓÇÑ´Ù.

49. DCCT¿¡¼­ öÀúÇÑ Ç÷´çÁ¶Àý·Î ´ëÇ÷°ü ÇÕº´ÁõÀÇ À§ÇèÀ» °¨¼Ò½Ãų¼ö ÀÖ´ÂÁö´Â ºÒºÐ¸í

ÇÏ´Ù.

50. insulin-resistant states

1) prereceptor resistance: anti-insulin Ab

2) receptor and postreceptor resistance:

type A insulin resistance(receptor°¡ ¾ø°Å³ª ±â´É¡¿)

type B insulin resistance(insulin receptor¿¡ ´ëÇÑ Ab)

ataxia-telangiectasia

51. hyperinsulinemia¿¡¼­ Ç÷¾ÐÀÌ Áõ°¡ÇÏ´Â ±âÀü

i) renal Na retention & sympathetic activity¡è

ii) insulin mitogenic action¿¡ ÀÇÇØ vascular smooth muscle hypertrophy

iii) insulin-sensitive vascular or renal tissueÀÇ cytosolic Ca¡è

52. insulin resistanceÄ¡·á: °í¿ë·®ÀÇ Pd, sulfated insulin

<Hypoglycemia>

53. hypoglycemia anawareness°¡ ¿Ã¼ö ÀÖ´Â °æ¿ì

i) Ç÷´çÁ¶ÀýÀ» ¾ö°ÝÈ÷ ÇÏ´Â °æ¿ì

ii) insulinoma

iii) autonomic neuropathy

iv) ¥â-blockerÀÇ »ç¿ë

54. postprandial(reactive) hypoglycemiaÀÇ ¿øÀÎ

alimentary hypoglycemia, galactosemia, hereditary fructose intolerance

55. hyperinsulinismÀ» µ¿¹ÝÇÑ È¯ÀÚ¿¡¼­ insulin°ú·®Åõ¿©¿Í insulinoma¸¦ °¨º°ÇÒ¼ö ÀÖ´Â

µÎ°¡Áö °Ë»ç?

: proinsulin, C-peptide

56. 72hr fasting test¶§ ÃøÁ¤ÇØ¾ß ÇÒ Ç׸ñ

: glucose, insulin, C-peptide, cortisol

57. ´ç´¢È¯ÀÚ°¡ Ưº°ÇÑ ÀÌÀ¯¾øÀÌ ÀúÇ÷´çÀÌ ÀÚÁÖ¿À¸é¼­ Àν¶¸° ¿ä±¸·®ÀÌ ÁÙ¾îµé ¶§ °¡´ÉÇÑ

ÀÌÀ¯?

i) diabetic nephropathy

ii) autonomic adrenal insufficiency¹ß»ý(PGAÀÇ ÇÑ ºÎºÐÀ¸·Î¼­)

iii) high level of circulating insulin Ab

iv) permanent remission of DM

v) insulinoma