2 Diabetes Flashcards
what are the exocrine functions of the pancreas?
secretes digestive enzymes such as amylase and lipases
what are the endocrine functions of the pancreas?
alpha, beta and delta cells
what do delta cells produce?
somatostatin to suppress release of growth hormone
what type of diabetes is insulin dependent?
type I
what are the functions of insulin?
increase glucose uptake in cells and carry out glycogenesis, increase amino acid uptake and protein synthesis, inhibit gluconeogenesis and glycogenolysis
what are the functions of glucagon?
acts on hepatocytes to carry out glycogenolysis, form glucose from amino acids and lactic acid
what is the role of amylin?
co-secreted with insulin and decreases gastric emptying to suppress glucagon secretion and glucose production
in which type of diabetes is amylin levels lowest? what does this cause?
type I as this gives person no response of satiety after a meal and so can cause obesity
what is type I diabetes?
pancreas fails to produce insulin due to loss of beta cells
what is type II diabetes?
failure to respond to insulin
how might reduced insulin lead to brain dysfunction?
glucose released so higher plasma glucose, higher filtration via the kidneys leading to osmotic diuresis, so higher sodium and water loss, causing a lower plasma volume and BP causing a reduced blood flow to the brain
how might increased plasma ketones cause brain dysfunction?
lack of insulin means body burns fat stores generating ketones, leading to plasma acidosis and brain dysfunction
what are the possible treatments of type I?
islet cell transplants, partial pancreas transplants, full pancreas transplant
what are the positives of basal and prandial insulin?
mimics the physiology of insulin release
what effect does pramlintide have when given with insulin?
decreases the rise of glucose following a meal
what makes type II a progressive disease?
deterioration of beta cells over time that leads to increased insulin resistance
what are the problems associated with monitoring glucose levels?
changes due to exercise, food intake varies, illness/stress uses glucose
what is HbA1c?
a non-covalent form of haemoglobin caused by glucose
what can HbA1c be used to measure?
long term glucose levels
what is the issues with using HbA1c to monitor glucose?
does not show day to day changes, episodes of hyper/hypoglycaemia not shown
what causes acute toxicity in hyperglycaemia?
a sudden spike in blood glucose
what causes chronic toxicity of blood glucose?
a continuous rise in hyperglycaemia
what do acute and chronic toxicity lead to?
tissue sessions and diabetic complications
what are the two different types of diabetic complications that may arise with hyperglycaemia?
microvascular and macrovascular
what are the microvascular diabetic complications?
retinopathy, nephropathy and neuropathy
what are the microvascular diabetic complications?
PVD, myocardial infarction, strokes
how can retinopathy occur?
micro aneurysms occurring in retinal veins
how does nephropathy occur?
lesions on the glomeruli impairing kidney function, causing proteins to be lost in urine
how can neuropathy occur?
branching fibres of neurones are lost
what blood pressures are considered as hypertension?
systolic above 130 mmHg and diastolic above 80 mmHg
what medications can be used to treat hypertension?
ACE inhibitors or angiotensin receptor blockers
how might lipid levels be affected in diabetics?
metabolism of lipids may be altered due to insulin regulating lipid metabolism
what should levels of LDL be?
below 100 mg/dl
what should levels of HDL be?
above 50 mg/dl
what should triglyceride levels be?
below 150 mg/dl
when should statins be considered?
when someone has overt CV disease, or above 40 and no CV yet other risk factors, or those below 40 but with altered LDL levels
what are the CVD risk factors?
dyslipidaemia, hypertension, smoking, family history
how does lipid build up link to increased albuminuria?
lipid build up in vessels increased blood pressure and so caused proteins to be forced out of glomerulus
when should nephropathy screening occur in diabetics?
annually in type I 5 years after diagnosis, annually in type II
how can glomerular filtration rate be assessed?
measure serum creatinine
