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°¡ ¾ÇȵǾúÀ» ¶§ °¡´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 ¼Òȱâ°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 ¾ÇȰ¡´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±¸ÀûÀ̾î¼
Ç÷´çÀÌ Á¤»óȵǾ 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