Cardiovascular Complications Of Diabetes Flashcards
Describe diabetes
• 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
What are the 5 phenotypic clusters of diabetes
- Severe autoimmune
- Severe insulin - deficient
- Severe insulin-resistant
- Mild obesity-related
- Mild age-related
Type 1 diabetes, risk factors, symptoms, management, cure and prevention
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
Type 2 diabetes, risk factors symptoms, management, cure and prevention
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
Common symptoms between type 1 and 2 diabetes
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)
What is diabetic ketoacidosis
When ketones increase in the blood at dangerous levels
If diabetic ketoacidosis is left untreated what are the symptoms that appear
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
What is hypoglycaemia
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
What is the biggest challenge for diabetes in the future?
Complications, low health expenditures in poor countries, poor health systems and low care, increased health expenditures
Glucose ….. go through cell membrane
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
Insulin dependent tissues and receptor
Heart, adipose, muscle
Glut 4
insulin independent tissues and receptor
Endothelial cells, RBCs, -> Glut 1
Liver, pancreas, small intestine -> glut 2 low affinity
Brain, neurons -> Glut 3, high affinity
Insulin is an ….. hormone
Anabolic
Common diabetic complications cane be ……… or ……. (Examples)
Micro vascular - eye, kidney, neuropathy
Macro vascular - brain, heart, extremities
Cardiovascular complications in diabetes
Coronary heart disease - atherosclerosis , heart attack
Cerebrovascular disese - stroke, neurodegeneration
Peripheral artery disease - PVD
High blood sugar arises from the ….
Inability of insulin sensitive tissues to uptake glucose
what is particularly sensitive to hyperglycaemia
Endothelium
Risk factors for diabetes
• 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
Hyperglycemia leads to ……
Endothelial cell dysfunction
Lipotoxicity
endoplasmic reticulum stress
Redox imbalance
Mitochondrial dysfunction
-> endothelial activation and death
Treatments that target hyperglycemia : type 2 diabetes
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
Ozempic
GLP-1 agonist
Incretin mimetics
Increases insulin sensitivity
Gliflozins
Treatment to target hyperglycemia
Inhibits glucose reabsorption in kidney
Metformin
Treatments in type 1 diabetes hyperglycemia
Blood glucose monitoring
Insulin administration with pumps or injection
Prevention of hypoglycaemic events
Prevention of ketoacidosis
4 staged of type 2 treatment
Treatments target:
• 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
