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Clinical Gems

Our clinical gems come from the top selling medical books, and text books because knowledge is everything when it comes to diabetes.

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #24: Pancreatic Morphology in Normal and Diabetic States Part 4 of 4

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Chronically elevated glucose and/or free fatty acids: type 2 diabetes is characterized by increased circulating nutrients including glucose and free fatty acids (FFA).The literature clearly shows that chronic exposure of beta cells to elevated glucose results in impaired beta-cell function, but the data regarding cellular toxicity in response to this nutrient are more mixed.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #23: Pancreatic Morphology in Normal and Diabetic States Part 3 of 4

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Disturbances in pancreas/islet morphology in diabetes: Type 1 diabetes (T1DM) is classically associated with autoimmune destruction of beta cells. However, the pancreas is more broadly affected, with overall pancreas size being decreased in individuals with this form of diabetes, and loss of exocrine tissue occurring close to areas of immune infiltration.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #22: Pancreatic Morphology in Normal and Diabetic States Part 2 of 4

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Islet vasculature: The islet is richly vascularized; while islets comprise only ∼2% of pancreas volume, they receive approximately 15% of the blood flow. Arterioles enter the islet and branch into tortuous capillaries, which have been suggested to contact almost every endocrine cell in the islet. These then converge on collecting venules outside the islet.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #20: Development and Maintenance of the Islet Beta Cell Part 4 of 4

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For many years it was speculated that beta cells, much like neurons, were postmitotic and that their turnover in the mammal was minimal or zero. Over the last two decades, studies in mice have suggested a more dynamic picture, wherein beta-cell mass can change in response to physiologic states such as growth, pregnancy, and obesity.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #18: Development and Maintenance of the Islet Beta Cell Part 2 of 4

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Pancreatic growth and epithelial branching morphogenesis: the extensively branched structure of the mature pancreas is attained by continued growth and remodeling of the primitive tubular epithelium in both dorsal and ventral buds. Once the buds have been induced, they are critically dependent on interaction with the mesenchyme for continued morphogenesis and cytodifferentiation.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #17: Development and Maintenance of the Islet Beta Cell Part 1 of 4

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The discovery of insulin by Banting and Best in the early 1920s marked the beginning of a new era of diabetes research that focused on the study of insulin and the biology of the hormone-producing cells of the pancreas. In the ensuing decades, although much was learned regarding the synthesis, structure, and action of insulin, the developmental origins of insulin-producing β cells remained ambiguous.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #16: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 5 of 5

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Obesity and weight gain have consistently been shown to be the one of the strongest modifiable risk factors for diabetes. The ratio of a person’s weight in kilograms divided by the square of their height in meters called the body mass index (BMI) has been used in numerous studies as a surrogate for obesity. In a representative sample of the US population, each unit increase in BMI was associated with a 12% increased risk of T2DM. Compared to people with BMI less than 22 kg/m2 those with BMI of 25–27 kg/m2 had 2.75 times the risk of diabetes, and each kilogram increase in body weight over 10 years was associated with a 4.5% increase in diabetes risk.

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