Diabetes

    Cards (46)

      • What does the liver do?

      • regulates the release of glucose into the bloodstream
      • two hormones are important in this regulation
      • What is diabetes mellitus
      • A chronic progressive disease caused by either a deficiency of, or resistance to a hormone called insulin
      • Can lead to serious complications and premature death if not managed well
      • This differs from the less common diabetes insipidus which is caused by a deficiency of another hormone called vasopressin
      • Diabetes Definition
      • condition in which there is a chronically raised blood glucose concentration. It is caused by a relative or absolute lack of hormone insulin”
      • chronic hyperglycaemia
      • Describe Type 2 diabetes
      • non autoimmune
      • Reduces secretion of insulin
      • Dysfunctional islet of Langerhans
      • Reduced sensitivity to insulin (insulin resistance)
    • What type of cells produce insulin?
      BETA CELLS
    • What is the primary function of insulin in the bloodstream?

      It removes glucose from the blood after digestion.
    • How does insulin affect the body's metabolism?

      It switches on metabolism to use glucose instead of fat for energy.
    • What does insulin signal the body to do with glucose?

      It signals the body to make glycogen and triglycerides.
    • What are the effects of insulin on liver, muscle, and fat cells?

      • Liver cells: Convert glucose to glycogen and make triglycerides.
      • Muscle cells: Transport glucose into cells.
      • Fat cells: Stop breakdown of triglycerides and release of fatty acids into the bloodstream.
      • Describe Type 1 Diabetes
      • destroyed / dysfunctional islets of Langerhans
      • Insulin deficient
      • What are the early signs / symptoms of diabetes
      • Polyuria (passing urine more often, esp. at night
      • Polydispsia (increased thirst)
      • Polyphagia (increased apetite)
      • Tiredness
      • Unexplained weight loss
      • Regular episodes of thrush / infection
      • What is the criteria for persistent hyperglycaemia
      • HbA1c of 48 mmol/mol (6.5%) or more
      • Fasting plasma glucose level of 7.0 mmol/L or more
      • Random plasma glucose of 11 mmol/L or more in the presence of symptoms or signs of diabetes
      • Describe some common signs of type 1 diabetes
      • Ketosis - metabolic state where your body burns fat for energy instead of glucose
      • rapid weight loss
      • age of onset under 50 years
      • BMI below 25
      • personal and / or family history of autoimmune disease
      • do not use BMI alone to exclude or diagnose type 1 diabetes in adults
      • What are some risk factors of Type 2 diabetes
      • Overweight
      • Inactive
      • Family history
      • Ethnicity
      • Diet
      • History of gestational diabetes
      • Describe how blood glucose is controlled
      • Carbohydrate in food is broken down by the body into glucose
      • However in order for the cells to open up and let glucose in, they need insulin which acts as a key to open the doors of the cell
      • What does glucagon do
      • Acts in an opposite manner to insulin; switches body’s metabolism so that it uses fatty acids instead of glucose as its energy source and it signals body to increase glucose production
      • Liver cells break down glycogen and release glucose into the bloodstream
      • Glucagon signals the fat tissues to break down triglycerides and release glycerol and fatty acids into the blood
      • What is the function of the pancreas?
      • Gland - has exocrine and endocrine functions
      • Acinar cells (exocrine): enzyme rich juice used for digestion
      • Islets of Langerhans (endocrine)
      • What is the function of alpha cells
      • produce glucagon
      • INCREASE GLUCOSE
      • What is the function of beta cells
      • secrete insulin
      • LOWERS GLUCOSE
      • How is insulin secreted?

      • See diagram
      • How does insulin reduce blood glucose?

      Insulin binds at receptor -> binding promotes autophosphorylation of beta subunits. This autophosphorylation enables protein IRS-1 -> IRS protein interact with signaling molecules such -> activate MAP kinase
      -> causes GLUT4 glucose transporters to be placed in cell membrane to promote glucose transport into cell
      • What is insulin resistance
      • Insulin levels are high over a prolonged period of time causing body’s own sensitivity to hormone to be reduced
      • One of earliest and most noticeable symptoms of insulin resistance is weight gain
      • Other symptoms
      • lethargy
      • hunger
      • difficulty concentrating
      • high blood pressure
      • What are some acute emergencies in diabetes
      • Ketoacidosis
      • Hyperosmosis
      • Hypoglycaemia
      • What are some chronic effects of diabetes?
      • Eye problems (retinopathy)
      • Foot problems
      • Foot problems
      • Heart attack and stroke
      • Kidney problems (nephropathy)
      • Nerve damage
      • What are some long term complications of diabetes
      • Diabetes to a two fold excess risk for cardiovascular disease
      • Diabetic retinopathy is the leading cause of preventable sight loss
      • Up to 100 people have a limb amputated in UK as a result of diabetes
      • Depression nearly 2x as high among people w diabetes v those without
      • Numbness on skin
      • weakened muscles
      • incontinence of bladder
      • erectile dysfunction
    • What is Retinopathy?

      Blood vessels block retina
    • What is nephropathy?

      Kidney disease
      • What are the early abnormalities of diabetes
      • Hyperglycaemia
      • leads to increased capillary flow = increased pressure
      • this causes damage to the vessel wall + stimulates basement membrane thickening
      • vessel closure = decrease O2 a
      • vessel permeability = leak water, fat and blood
      • Describe obesity as a risk factor of diabetes
      • 90% of adults with type 2 diabetes aged 19-54 are overweight or obese
      • Describe genetic background as a risk factor
      • 150 polymorphisms associated with altered T2DM susceptibility
      • exact site unclear - most likely in islets
    • Type 1 diabetes treatment overview
      • Insulin replacement - since type 1 diabetics’ bodies no longer produce insulin
      • diet and lifestyle
      • What are the aims of the treatment
      • Labratory parameter targets
      • Blood glucose controlled
      • 4-7mmol/l before meals
      • 5-9mmol/l, 90 minutes post meals
      • HbA1c <48mmol/l (6.5% or lower)
      • Prevent/reduce acute and long term complications
      • Encourage self management as it is a lifelong condition
      • How do we monitor diabetes treatment?
      • Self testing finger prick (capillary); blood glucose by patient
      • Continuous glucose monitoring devices to be made available to all adults (type 1)
      • HbA1C in clinic, every 3-6 months in adults
      • What is HbA1c?
      • Some of the glucose in your blood binds to haemoglobin - this combination of glucose to haemoglobin is called haemoglobin A1c
      • Amount of HbA1c formed is directly related to avg concentration of glucose in your bloodstream. Red blood cells live for 2-3 months - therefore HbA1c in blood reflects average level of glucose in your blood during last 2-3 months
      • If your diabetes is not well controlled, your blood glucose levels will be high causing higher HbA1c levels.
      • What are the targets from NICE guidelines?
      • Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower to minimise the risk of long-term vascular complications
      • Agree an individualised HbA1c target with each adult with type 1 diabetes. Take into account factors such as their daily activities, aspirations, likelihood of complications, comorbidities, occupation and history of hypoglycaemia
      • Ensure that aiming for an HbA1c target is not accompanied by problematic hypoglycaemia in adults with type 1 diabetes
      • What are the blood glucose targets
      • The optimal targets for glucose self-monitoring in adult type 1s is
      • FASTING PLASMA GLUCOSE LEVEL OF 5-7 mmol / L on waking
      • PLASMA GLUCOSE LEVEL OF 4-7 mmol / L
      • (for adults who choose to test after meals) PLASMA GLUCOSE LEVEL of 5-9 mmol / L at least 90 minutes after eating
      • Remind patient to be particularly careful to avoid hypoglycaemia when driving
      • Pharmacological management for Type 1 diabetes

      • Insulin
      • Different types
      • How/why
      • Pumps
      • Islet Transplantation
      • Insulin Regime
      • Goal is to have an insulin release profile most similar to a physiological state
      • Choosing a regime depends on
      • level of daily activities
      • diet
      • stability of blood glucose
      • monitoring of blood glucose
      • CONSIDER LIFESTYLE AFE AND ABILITY TO SELF BLOOD-TEST GLUCOSE
      • Species of insulin
      • Human
      • genetically engineered; either yeast or e.coli
      • Animal
      • Beef - increased incidence of allergic problems
      • Pork - less antigenic than beef
      • available as purified insulin
      • Type 1 treatment overview
      • Insulin replacement - since type 1 diabetics’ bodies no longer produce insulin
      • diet and lifestyle
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