Complications of diabetes mellitus Flashcards
What are the types of diabetes?
Type 1: autoimmune destruction of insulin-producing beta-cells (8%)
• Type 2: combination of insulin resistance and relative insulin
deficiency (90%)
• Gestational diabetes
• Other:
✓ Type 3c – damage to the pancreas (pancreatitis, pancreatic cancer,
hemochromatosis, cystic fibrosis)
✓ Steroid induced diabetes
✓ Maturity onset diabetes of the young (MODY)
✓ Neonatal diabetes
What are type 1 diabetes?
autoimmune destruction of insulin-producing beta-cells
What cells produce insulin
islet cells
How do you get type diabetes from being fat
- Fatty liver (resistant to insulin)
- Impaired insulin-mediated suppression of gluconeogenesis
- Liver paradoxically produces excess of glucose
- Fatty pancreas
- Destruction and/or Impaired function of beta-cells
What does insulin do?
Icreases glucose uptake
increases glycogen synthesis
Deccreases lipolysis
What does glucagon do?
Increase Glycogenolysis
Increase Gluconeogenesis
Increase Lipolysis
What is used as an emergency treatment for type 1 diabetes?
Glucagon
What happens if insulin is inhibited in hyperglycemia?
High glucose in blood
Protein breakdowwn - muscle wasting
Lipolysis
Formation of ketone bodies
What is an acute complication of Type 1 diabetes ?
Diabetes ketoacidosis
What is an acute complication of Type 2 diabetes ?
Hyperglycaemic hyperosmolar state HHS
What does an increase in ketone bodies do?
Metabolic acidosis
Increase in osmotic diuresis hypovolaemia and less glomerular filtration which leads to hyperosmolality leasds to dehydration
What does increase in hyperglycemia do?
Increase in osmotic diuresis hypovolaemia and less glomerular filtration which leads to hyperosmolality leads to dehydration
What are the differences in DKA and HHS?
Glucose- Mainly more hyperglycemia in HHS
Osmolality- Serum hyper osmolality in HHS, variable in DKA
Ketonemia- Absence in HHS, + in DKA
Acidosis - Absence in HH, pH< 7.3 / bicarbonate <15mmol/l
Hypovolaemia- Severe in HHS, Less Severe in DKA
What are chronic complications of diabetes?
Microvascular
Retinopathy-disease of the small retinal blood vessels(endothelial cells in the retina)
Nephropathy- deterioration of kidney function (attack on cells in renal glomerulus)
Neuropathy- type of nerve damage (neurons and schwaan cells)
What are chronic complications of diabetes?
Macrovascular
Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease
What is the polyol pathway?
Glucose shunted through aldose reductase into sorbitol -> fructose
all these things are going through reactive oxygen species,cause damage to blood vessels and to endothelium
What do AGE do?
Advanced glycation end products cause connective tissue to become stiff therefore:
contractures in collagenous tissue in their hands
lose heparin sulphate proteoglycans important for normal basement membrane drummer of functioning
What is the protein kinase C pathway?
Increase in vascular endothelial growth factor causes new vessel formation in the back of the eye not useful causes proliferative retinopathy
What can treat diabetic retinal disease?
anti-VEGF treatment
What is the Hexosamine pathway
Increase in oxygen reactive series = toxic
What treatment is given for someone with protein in urine?
ACE inhibitors
What do ACE inhibitors do?
preferential efferent arteriole vasodilatation
What does metformin do?
Suppression of hepatic gluconeogenesis
What does Sulfonylurea do?
Increase in insulin secretion from beta-cells
What does Meglitinides do?
Increase in insulin secretion from beta-cells
What does DPP-4 inhibitors do?
Inhibit GLP-1 degradation – promotes glucose
dependent insulin secretion
What does GLP-1 agonists do?
Promotes glucose dependent insulin secretion
What does SGLT-2 inhibitors
do?
Increased glucosuria through inhibition of SGLT-2 in the kidney
What does Alpha-glucosidase inhibitors do?
Reduce intestinal glucose absorption
What does Thiazolidinediones do?
Reduce insulin resistance
What does Amylin analogs do?
Reduce glucagon release, reduce gastric emptying
Which drugs suppress hepatic gluconeogenesis
metformin
Which drugs increase insulin secretion from beta-cells
Sulfonylurea
Meglitinides
Which drugs promotes glucose
dependent insulin secretion by inhibiting GLP-1 degradation
DPP-4 inhibitors
Which drugs promotes glucose
dependent insulin secretion
DPP-4 inhibitors
GLP-1 agonists
Which drugs increase glucosuria through inhibition of SGLT-2 in the kidney
SGLT-2 inhibitors
Which drugs reduce intestinal glucose absorption
Alpha-glucosidase inhibitors
Which drugs reduce insulin resistance
Thiazolidinediones
Which drugs reduce glucagon release and reduce gastric emptying
Amylin analogs
What is the Incretin effect?
oral glucose elicits higher insulin secretory responses than does intravenous glucose for healthy patients
What happens to the incretin effect for people with Type 2 diabetes?
Reduced effect
