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Pancreas

Diabetes mellitus - general


Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 29 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Chronic disorder of carbohydrate, fat and protein metabolism due to defective or deficient insulin secretory response (Wikipedia)

Epidemiology
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● 3% of world population, 26 million in U.S. but only 75% are clinically diagnosed
● #7 leading cause of death in 2007 (underlying cause on 71,382 death certificates, Diabetes.org)
● Lifetime risk of diabetes: type 1 - 0.5%, type 2 - 5%
● Numerous variations, all with hyperglycemia

Etiology
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● Destruction of islets due to drugs (steroids, thiazides, pentamidine), hemochromatosis (“bronze diabetes” due to hemosiderin deposition in pancreas), hereditary ceruloplasmin deficiency (Hum Pathol 1997;28:499), infections (congenital rubella, CMV, coxsackievirus [Arch Pathol Lab Med 1980;104:438], enteroviruses [Diabetologia 2004;47:225]), pancreatitis, surgery, tumors, endocrinopathies (pituitary, adrenal, pregnancy) or idiopathic

Diagnosis
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● High fasting glucose or impaired glucose tolerance (without diabetes, oral glucose loads cause only slight rise in blood glucose due to brisk insulin response; with diabetes, blood glucose rises markedly for a sustained period)

Micro description
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● Type 1: inconsistent reduction in number and size of islets, uneven insulinitis (T lymphocytes)
● Type 2: subtle reduction in islet cell mass, amyloid replacement of islets due to amylin fibrils (also seen in aging nondiabetics); associated with marked fatty replacement
● Gestational diabetes: lower total insulin+ area due to smaller islets (Islets 2011;3:231)
● Infants of diabetic mothers: islet cell hypertrophy/hyperplasia

End of Pancreas > Diabetes mellitus - general


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