Clinical diabetes Flashcards
symptoms of diabetes
polyuria
polydipsia
fatigue
what is polyuria
excessive passing of urine
what is polydipsia
thirst
what is diabetes insipidus
polyuria even with restricted fluid intake, patients have excessive thirst ADH deficiency
what is polyuria in diabetes insipidus caused by
osmotic diuresis
more prevalent type of diabetes
type 2
in which type is insulin required to sustain life
type 1
which is an autoimmune condition
type 1
which has more genetic linkage
type 2
MODY=
maturity onset diabetes of the young
LADA=
late autoimmune diabetes in adults
what happens in type 1 diabetes
autoimmune condition where immune system seeks out and destroys insulin producing beta cells
what is the main attacking cell in type 1
CD8+ T cells
what is required to activate the autoimmune response
combo of environmental triggers and genetic predisposition
phase one of type 1 diabetes
Beta cell death (happens naturally)
Phase 2 of type 1 diabetes
priming of autoreactive B and T cells
what is the movement of primed/ differentiated B and T cells to islets in pancreas called
insulitis
phase 3 of type 1
destruction of Beta cells
what increases in CD8+ T cells
the potential to kill beta cells by apoptosis
what does an increased number of antibodies to islets antigens correlate to
an increased risk of disease
in genetically susceptible individuals with 3 antibodies against islets antigens what is the prognosis
they will get type 1 diabetes
what is the strongest genetic association for type 1 diabetes
Major histocompatibility complex (MHC)
outside of MHC what are the most common genetic association (2)
Immunoregulatory genes (PTPN22) CD25
2 environmental factors causing type 1
Bystander activation
molecular mimicry
what is bystander activation
immune response to infection causes damage to healthy tissue leading to release of islet antigens
what is molecular mimicry
viral proteins resembles beta cell proteins, immune system attacks both as consequence
consequence of severe insulin deficiency
ketoacidosis develops rapidly (especially in children)
what is type 2 diabetes often detected via
routine screenings
what is type 2 often associated with at diagnosis
high bloop pressure and/or cholesterol levels
who do you inherit type 2 diabetes from
from mother
what 2 things happen in type 2
beta cells don’t produce enough insulin to regulate blood glucose levels
Also develops insulin resistance
how do Free fatty acids result in insulin resistance
they result in fat oxidation in the mitochondria and cellular stress, when mitochondria are stressed–> increased IL-6 and TNF production
how do Free fatty acids ceraminde intakes affect insulin
FFA take in ceramide which can act on PKB/AKt impeding effective responses to insulin and movement of GLUT4 to plasma membrane
in type 1 diabetes after 40 years what is found in the blood
measurable C peptide
what is the measurable C peptide in type 1 diabetes called
beta cell insulin microsecretors
diagnosis of LADA
elevated pancreatic autoantibodies
risk factor for LADA
Metabolic syndromes
what can diabetic complications be split into
macrovascular and microvascular
Macrovascular=
large blood vessels
4 macrovascular
stroke
heart disease and hypertension
peripheral vascular disease
foot problems
microvascular=
small blood vessels
4 microvascular
diabetic eye disease
renal disease
neuropathy
foot problems
diabetes most common problem=
heart attack
diabetic nephropathy=
diabetic kidney disease
what happens in diabetic nephropathy
raised glucose alters chemical composition of kidney causing glomerulus to malfunction resulting in leakage of protein into urine
after prolonged raised blood glucose levels what can happen to the kidneys
scar formation—> kidney failure
what is diabetic neuropathy
family of nerve disorders caused by diabetes
diabetic foot syndrome results from
peripheral nerve damage and associated peripheral artery disease (PAD)
3 consequences of diabetic foot
infections
ulceration
increased risk of amputation
diabetic retinopathy=
damage to blood vessels in retina can leak blood into eye
HbA1c=
glycated haemoglobin
C-peptide vs HbA1c
HbA1c is a more realistic measure as RBC only glycated if serum glucose remain consistently high
HbA1c levels normal range
4-6
HbA1c levels good=
6.5-7
HbA1c levels acceptable=
7.1-8.0
> 8 HbA1c=
poor
when is the most important time to regulate blood glucose levels
at diagnosis
