10. Diabetes

• types of diabetes:

  1. types 1 diabetes
  2. type 2 diabetes
  3. monogenic diabetes - gene related diabetes, like mitochondrial diabetes
  4. other - gestational diabetes, drug induced diabetes etc
• type 1 diabetes:

  • insulin dependent diabetes, juvenile onset diabetes
  • onset is typically before 40 years
  • presence of ketones due to different fuel source use - pear drop smell in breath.
  • cause: insulitis, autoimmune destruction of beta cells
• type 2 diabetes:

  • insulin resistance - cannot respond to insulin
  • genetic predisposition and associated with obesity
  • no ketones
  • cause: insulin resistance followed by beta cell dysfunction and death
• metabolic syndrome:

  • occurrence of type 2 diabetes associated with CVS pathologies like high blood pressure and hyperglycaemia.
  • associated with obesity, inactivity and genetics.
• diabetes symptoms include weight loss, extreme fatigue, infections, osmotic symptoms and slow healing wounds.

  • diagnosis via:
  • measuring urine glucose.
  • measuring blood glucose.
  • measuring glycalated Hb in blood
• insulin is produced by the beta cells in the pancreas - released in response to high glucose levels in the blood

  • acts on liver to inhibit glucose production
  • acts on muscle to increase glucose uptake
  • leads to decrease in blood glucose levels
• how to treat type 1 diabetes

  • lifestyle change
  • insulin injections using glucose monitoring devices
• how to treat type 2 diabetes

  • lifestyle changes
  • incretins - hormones that are secreted by the gut and increase insulin section - also manage weight
  • bariatric surgery
  • metformin, sulphonylureas, thiazolidinediones, SGLT2 inhibitors
• metformin

  • biguanide
  • insulin sensitiser
  • has side effects
  • no hypoglycaemia or weight loss
• sulphonylureas

  • stimulates insulin release from beta cells
  • side effects: hypoglycaemia and weight loss
  • not effective in late T2DM where beta cell function is ceased
• thiazolidinediones

  • ligands of PPARg, a nuclear receptor that is involved in lipid uptake
• SGLT2 inhibitors

  • inhibits glucose reabsorption in proximal renal tubule
• incretins

  • GLP1 and GIP
  • hormones released during food ingestion from L cells in colon and K cells in duodenum
  • stimulate glucose dependent insulin secretion, so no hypoglycaemia
• diabetes complications

  • stroke, heart disease
  • kidney failure, diabetic retinopathy

  T2D patients usually present with complications