Cardiovascular Complications Of Diabetes Flashcards

1
Q

Describe diabetes

A

• Diabetes is a chronic health condition that affects how the body utilizes glucose, the energy the cells need to function.
• Glucose uptake by the cells is regulated by insulin
• In diabetes, the body cannot produce insulin (absence of insulin) or cannot use the insulin it makes (insulin resistance)
• In the absence of insulin production (Type 1 diabetes) or insulin action (Type 2 diabetes) glucose cannot be uptaken inside the cells and glucose levels are increased in the blood ->hyperglycemia -> diabetic complications
• Currently there is no cure for diabetes. Patients can only manage the disease

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2
Q

What are the 5 phenotypic clusters of diabetes

A
  1. Severe autoimmune
  2. Severe insulin - deficient
  3. Severe insulin-resistant
  4. Mild obesity-related
  5. Mild age-related
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3
Q

Type 1 diabetes, risk factors, symptoms, management, cure and prevention

A

Autoimmune disease that attacks beta cells in the pancreas reducing thei ability to produce insulin (insulin deficieny)
Genetic, environment and viral infection are risk factors
Symptoms appear quickly and at a young age
Management is insulin injections
No cure at the moment

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4
Q

Type 2 diabetes, risk factors symptoms, management, cure and prevention

A

Insulin resistance that can lead to beta cell destruction
Risk factors are genetic and obesity
Symptoms appear slowly and at older age
Managed by insulin, medication, exercise, diet
Can be prevented and put into remission

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5
Q

Common symptoms between type 1 and 2 diabetes

A

Polyuria (osmotic diuresis)
Polydipsia (loss of water due to polyuria leads to osmoreceptor activation in brain)
Loss of weight (inability to utilise glucose)
Polyphagia (increased hunger)
Appearance of complications (ketoacidosis, hypoglycaemia, diabetic retinopathy, slow wound healing)

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6
Q

What is diabetic ketoacidosis

A

When ketones increase in the blood at dangerous levels

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7
Q

If diabetic ketoacidosis is left untreated what are the symptoms that appear

A

Fast, deep breathing
Dry skin and mouth
Flushed face
Fruity-smelling breath
Headache
Muscle stiffness or aches
Being very tired
Nausea and vomiting
Stomach pain

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8
Q

What is hypoglycaemia

A

When blood glucose levels fall below 70mg/dL
Very common in insulin-dependent diabetes
4/5 T1D and 1/month in T2D
Shaky, jittery, hungry, tired. Headache
Severe - lose consciousness, seizure

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9
Q

What is the biggest challenge for diabetes in the future?

A

Complications, low health expenditures in poor countries, poor health systems and low care, increased health expenditures

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10
Q

Glucose ….. go through cell membrane

A

Glucose is hydrophilic and cannot diffuse into the hydroPHOBIC cell membrane -> it needs to bind to cell membrane transporters to be translocated into the cell
14 different glucose transporters

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11
Q

Insulin dependent tissues and receptor

A

Heart, adipose, muscle
Glut 4

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12
Q

insulin independent tissues and receptor

A

Endothelial cells, RBCs, -> Glut 1
Liver, pancreas, small intestine -> glut 2 low affinity
Brain, neurons -> Glut 3, high affinity

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13
Q

Insulin is an ….. hormone

A

Anabolic

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14
Q

Common diabetic complications cane be ……… or ……. (Examples)

A

Micro vascular - eye, kidney, neuropathy
Macro vascular - brain, heart, extremities

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15
Q

Cardiovascular complications in diabetes

A

Coronary heart disease - atherosclerosis , heart attack
Cerebrovascular disese - stroke, neurodegeneration
Peripheral artery disease - PVD

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16
Q

High blood sugar arises from the ….

A

Inability of insulin sensitive tissues to uptake glucose

17
Q

what is particularly sensitive to hyperglycaemia

A

Endothelium

18
Q

Risk factors for diabetes

A

• Hyperglycemia
• Hypertension
• Chronic kidney disease
• Obesity
• Abnormal lipids
• Smoking
• Physical inactivity
• Unhealthy eating habits
• Alcohol
• Low birth weight, preterm births
• Environmental risks
• Low socioeconomic status, stress
• Lack of awareness
• Age
• Sex (<60 years old, men more susceptible
• Family history
• Ethnicity

19
Q

Hyperglycemia leads to ……

A

Endothelial cell dysfunction

20
Q

Lipotoxicity

A

endoplasmic reticulum stress
Redox imbalance
Mitochondrial dysfunction
-> endothelial activation and death

21
Q

Treatments that target hyperglycemia : type 2 diabetes

A

Meglitinides, sulfonylureas -> act on ATP dependent K+ chennales to increase insulin release
Thiazolidinediones (glitazones) -> activate PPAR-game receptor -> promote adipogenesis, incr insulin sensitivity, increase glucose transporter

22
Q

Ozempic

A

GLP-1 agonist
Incretin mimetics
Increases insulin sensitivity

23
Q

Gliflozins

A

Treatment to target hyperglycemia
Inhibits glucose reabsorption in kidney

24
Q

Metformin

A
25
Q

Treatments in type 1 diabetes hyperglycemia

A

Blood glucose monitoring
Insulin administration with pumps or injection
Prevention of hypoglycaemic events
Prevention of ketoacidosis

26
Q

4 staged of type 2 treatment

A
27
Q

Treatments target:

A

• Increase insulin from beta cells (Meglitinides, Sulfonylureas, Thiazolidinediones, DDP-4 inhibitors, GLP1 agonists, Metformin, Bariatric surgery)
• Increase insulin sensitivity (metformin, exercise, diet, weight loss, bariatric surgery)
• Increased glucose clearance by excretion (gliflozins)
• Preservation of beta cells (T2D: islet transplants, insulin, metformin, exercise, diet, weight loss)
• More options for T2D than T1D