#13 Diabetes and Autoimmune disease Flashcards
1
Q
which diabetes is an autoimmune disease
A
type 1
2
Q
What is type 2 diabetes correlated with?
A
lifestyle choices
3
Q
which diabetes is insulin-dependent diabetes mellitus (IDDM),
A
type 1
4
Q
which diabetes is called non-insulin-dependent diabetes mellitus (NIDDM) or
A
type 2
5
Q
Type 1 diabetes
A
Beta cells in the pancreas are mostly or entirely destroyed by the body’s own immune system. This person needs insulin injections.
6
Q
type 2 diabetes
A
Beta cells make insulin, but the person’s tissues are not sensitive enough to the hormone and use it inefficiently.
7
Q
how much do health problems caused by diabetes cost society yearly?
A
cost society nearly $174 billion each year in direct and indirect costs
8
Q
hyperglycemia
A
When a person cannot utilize the body’s energy currency (glucose), the glucose concentrations increase in the blood, causing a condition called
9
Q
chronic hyperglycemia can lead to
A
long-term damage and even failure of body organs, especially the eyes, kidneys, nerves, heart, and blood vessels
10
Q
Symptoms of hyperglycemia
A
Excessive urination (polyuria) Excessive thirst (polydipsia) Weight loss, sometimes with excessive eating (polyphagia) Fatigue, weakness Blurred vision Slowed healing Increased risk of infection complications in pregnancy
11
Q
Long term complications of hyperglycemia
A
Heart disease
Stroke
High blood pressure
Overall mortality
blindness in adults 20–74 years (diabetic retinopathy).
end-stage renal disease
mild to severe forms of nervous system damage
12
Q
What is the leading cause of diabetes-related deaths?
A
heart disease 2–4 times higher rate than those without diabetes
13
Q
Stroke risk is ____times higher in persons with diabetes.
A
2-4
14
Q
_____of people with diabetes have a blood pressure ≥130/80 mmHg (high)
A
73%
15
Q
overall mortality of diabetes
A
diabetes has ranked in the 10 leading causes of death since 1932, and it currently causes ∼73,000 deaths annually and contributes to an additional 234,000 deaths
16
Q
diabetes is higher in which age group and by how much?
A
Death rates are 2x higher in middle-aged people with diabetes
17
Q
diabetes is the leading cause of
A
- Diabetes is the leading cause of new cases of blindness in adults 20–74 years (diabetic retinopathy).
- Diabetes is leading cause of end-stage renal disease
18
Q
About _____ of people with diabetes have mild to severe forms of nervous system damage
____ + of lower limb amputations are performed each year among people with diabetes
A
60-70%
60%
19
Q
Complications of pregnancy caused by poorly controlled diabetes before conception and during 1st trimester
Major birth defects in ____ %
Spontaneous abortions in ______
A
5-10% major birth defects
15-20% spontaneous abortions
20
Q
how to diagnose diabetes?
A
fasting plasma glucose concentration The reason the assessment is done while a patient is fasting is so that any effect of dietary intake on glucose is controlled for
21
Q
Fasting plasma glucose
A
Fasting plasma glucose:
≥126 mg/dl = diabetes
100-125 mg/dl = pre-diabetes (impaired)
<100 mg/dl = normal fasting glucose
Diagnosis comes after confirmation on a different day
22
Q
Prevalence / incidence for diabetes
A
23.6 million Americans diagnosed
5.7 million have not been diagnosed
57 million aged twenty years and older are pre-diabetic
1.6 million new cases each year
1 in 4 people aged sixty years and older has diabetes
23
Q
Diabetes is more common among:
A
elderly, minorities and women
24
Q
what is the preventability or population attributable risk for type 2 diabetes?
A
90-plus percent
25
```
Evidence indicates that _____ of type 2 diabetes can be attributed to poor lifestyles.
Obesity
Physical inactivity
Unhealthy diet
Smoking
```
90%
26
In the US ____of adults are obese at time of diagnosis (70% attributable risk)
about 85%
27
most significant risk factor for type 2 diabetes
maintaining a healthy weight
| diet and exercise
28
The population attributable risk for type 2 diabetes based on the characteristics of obesity is estimated to be ___%
70
29
healthy body weight vs. exercise for diabetes
50–75% reduced risk of type 2 diabetes when maintaining healthy body weight compared to obese
30–50% reduced risk of type 2 diabetes associated with regular, moderate to vigorous exercise compared to sedentary
30
Exercise also has a metabolic effect on
blood glucose regulation
31
the most important prevention measure for type 2 diabetes
avoidance of weight gain with increasing age
32
Long-term epidemiological studies have indicated that diabetes risk is as much as ______ times higher in those using refined and processed grain products. These discoveries have been made in studies of both men and women.
two and a half
33
In a study of nearly eighty-five thousand female nurses, results suggested that the risk of developing diabetes was ____percent lower in those women who ate the healthiest diet
51%
34
16-year study of 85,000 nurses and the risk of developing diabetes was 51% lower in those eating the healthiest diet
including:
```
Low intake of trans fat
Low glycemic load
High cereal fiber
High ratio of polyunsaturated to saturated fat
When diet score was combined with:
Low BMI
30+ minutes of daily exercise
Avoidance of tobacco
1/2 drink of alcohol per day
91% of the cases of diabetes could have been prevented
```
35
the risk for diabetes decreased with increasing quintiles for:
positive aspects of diet (fiber and polyunsaturated fat to saturated fat intake ratio)
36
the risk for diabetes increased for:
he negative dietary components (trans fat and glycemic load)
37
In a fourteen-year study of men, exercise amount defined by ______ showed reductions in the risk of type 2 diabetes.
caloric expenditure
38
Exercise and Type 2 diabetes with men study
14-year study on ∼6,000 men
Each 500 kcal increase in PA expenditure reduced risk by 6%
For men who were both obese and inactive, risk was 4x higher for diabetes
Other studies in women also confirm the role of exercise in reducing the risk of type 2 diabetes.
39
Nurses health study
Nurses' Health Study demonstrated that risk of developing type 2 diabetes is 40–50% lower among the most active
Overall, the evidence points to a high body mass index as the most significant risk factor for type 2 diabetes.
40
You can see from these data that risk of type 2 diabetes rises exponentially with increasing levels of ____
BMI
41
At the highest BMI category (35.0 or greater), the risk of becoming diabetic was _____ times higher (RR=93.2) compared to the less–than-22.2-BMI category.
9,220
42
exercise vs. metformin drug for diabetes
Mean of 2.8 years of follow-up
Diabetes incidence per 100 person-years was:
11.0 for placebo
7.8 for metformin (31% decreased incidence)
4.8 for lifestyle (58% decreased incidence)
Results also showed that the lifestyle group lost more weight and increased physical activity more than the other two groups.
43
Type 1 diabetes onset usually occurs in
childhood
44
Type 1 diabetes link to drinking cow's milk as baby / child
The immune system attacks the pancreas cells that make insulin.
There seems to be some link to molecular mimicry for milk and other dietary proteins.
Cow’s milk protein fragments and the pancreatic cell similarity causes the immune system to destroy both.
A study done in Chile showed that genetically susceptible children weaned too early onto cow’s milk had a 13.1x greater risk for type 1 diabetes.
A study done in the United States showed that genetically susceptible children fed cow’s milk as infants had a 11.3x greater risk for type 1 diabetes.
45
Role of exercise for type 1 diabetes
Researchers have known for 50 years that regular exercise will reduce the insulin requirements for the type 1 diabetic by 30–50%.
improvement in insulin insensitivity lasts for one to two days.
A given amount of insulin following exercise is more effective in causing glucose uptake.
Studies have failed to show long-term glucose control is improved.
Type 1 diabetics still have much to gain.
cardiovascular fitness
weight control
psychological well-being
social interaction and recreation
46
autoimmune disease
arising from and directed against the person’s own tissues, as in autoimmune disease; may be systemic, as lupus erythematosus, or organ specific, as thyroiditis
47
The National Institutes of Health (NIH) estimates that up to ____million Americans suffer from autoimmune diseases.
23.5 million
48
Other organizations, like the American Autoimmune Related Diseases Association, estimate the total prevalence could be as high as ____
53 million
49
T/F The NIH recognizes twenty-four diseases, but researchers have identified eighty to one hundred different autoimmune-related conditions
True
50
auto immune disease cases most common in?
Other sources indicate that 250,000 cases in the United States are diagnosed each year (US Congress 2007). Women are afflicted more than men, and some autoimmune diseases occur significantly more in women (7 times more patients with thyroiditis are women).
51
common autoimmune diseases
```
Graves’ disease
Rheumatoid arthritis
Thyroiditis
Vitiligo
Pernicious anemia
Glomerulonephritis
Multiple sclerosis
Type 1 diabetes
Systemic lupus erythematosus
Sjogren’s disease
Myasthenia gravis
Polymyositis/dermatomyositis
Addison’s disease
Scleroderma
Primary biliary cirrhosis
Uveitis
Chronic active hepatitis
```
(first nine account for 97% of all diseases)
52
Graves disease symptoms
there is an overproduction of thyroid hormones (hyperthyroidism) and often an enlarged thyroid gland. Another symptom is bulging eyes or Graves’ ophthalmopathy
53
Rheumatoid arthritis
chronic inflammatory disorder that typically affects the small joints in the hands and feet. The condition can be very painful and results in bone erosion and joint deformity
54
vitiligo
he pigment-producing cells in the skin stop functioning or die. Other areas of the body can also be affected, like the inside of the mouth or the hair. The condition is progressive, but it is not life-threatening.
55
Multiple sclerosis and type 1 diabetes have nearly identical ethnic and geographic distribution; the further from the ____ the ____ the incidence of the diseases.
equator, greater
56
multiple sclerosis is one hundred times more prevalent in _____ than at the______.
northern lattitudes, equator
57
white blood cells
cells are a primary feature of the immune system and are one of the three major cellular components of circulating blood
58
Lymphocytes
re a subset of white blood cells. There are two subsets of lymphocytes: T-cells and B-cells. Stem cells are produced in the bone marrow and can be differentiated into specialized cells that have immune system functions. In fact, B-cells are called B-cells because they are produced in the bone. Other cells travel to the thymus in the chest cavity from the marrow and become T-cells (“T” for “thymus”).
59
B and T cells
Both B- and T-cells manufacture weapons (antibodies) to destroy pathogens. The foreign invaders are protein molecules called antigens and have distinct protein amino acid arrangements. The amino acid sequences are like fingerprints that are recognized as foreign invaders and are destroyed by the immunity cells. Immunity cells can also remember these invaders and preemptively strike when seen again. This is why an initial exposure to chicken pox can lead to significant illness, but subsequent viral encounters with chicken pox may not even make someone feel sick.
60
arthritis facts
Arthritis means joint inflammation and includes more than 100 kinds of rheumatic disease (52.5 million).
Osteoarthritis (most common, 27 million)
Fibromyalgia syndrome (5 million)
Rheumatoid arthritis (1.5 million)
It’s an autoimmune disease that affects 2.1 million people in the United States.
It affect three times more women than men.
The disease usually appears between the ages of 20 and 50.
The afflicted die 5–15 years sooner than those who are not afflicted.
61
Rheumatoid arthritis
is the most common type of autoimmune-based arthritis. It is different from osteoarthritis, which is mechanical wear and tear on the joints. Rheumatoid arthritis occurs when the immune system attacks the lining of the joints in the hands and feet. There are a number of lifestyle-related behaviors that can be effective treatments for this condition
62
Rheumatoid arthritis treatments
anti-inflammatory medications
proper, regular exercise
maintaining joint mobility
strengthening muscles around the joint
exercise that causes minimal stress on joints
weight loss and management
proper diet
Until more data are available, follow a prudent diet.
Higher intakes of red met and total protein combined with lower intakes of fruit and vegetables and vitamin C are associated with increased risk of arthritis.
A Mediterranean-type diet may have protective effects.
Diets high in omega 3 fatty acids tend to lessen inflammation.
More research is needed before a consensus can be reached.
63
Multiple Sclerosis
Chronic disease of unknown etiology is characterized by focal areas of degeneration of the myelin sheaths of the nerve fibers in the brain and spinal cord.
Onset of symptoms before age 15 and after age 40 is rare.
Women are afflicted two to three times more than men.
About 2.5 million people worldwide are affected by it.
About 400,000 people in the United States have it, and about 200 people per week are diagnosed with it.
64
Patterns for MS
It is not directly inherited, but those who are genetically predisposed to it are more susceptible.
It more commonly affects those of northern European ancestry.
There are lower levels of incidence in African, Asian, and Hispanic populations.
Migration patterns indicate that persons who move from a high-risk area to low-risk area before age 15 adopt the risk of the new area.
65
links with MS
There have been links between genetics, viruses, environmental exposures, diet, and even cow’s milk.
66
geographic patterns have also been observed in the cases of
MS, type 1 diabetes Rheumatoid arthritis
67
diet and MS study
Patients fell into one of two categories: those who at less than 20 g of saturated fat a day and those who ate more than 20 g of saturated fat a day.
For those who began the diet in the early stages of MS, 95% remained only mildly disabled for 30 years and only 5% died from MS.
80% of patients with early MS who ate a poor diet died from MS.
68
T/F there is a link in LDS and lower rates MS
T Comparison with MS rates from Utah and other states of comparable latitude suggest that strict LDS have an MS prevalence that is lower than expected and may reflect their healthy life style.
69
Treatment of MS
```
Exercise benefits MS patients.
low to moderate intensity endurance training
moderate intensity resistance training
some evidence of beneficial effects of combining endurance and resistance training
FDA approved medications
Rehabilitation
PT, OT, ASLP, etc.
Stress Management
Acupuncture
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