CSI case 5 - T2 diabetes Flashcards
What is prediabites?
when blood sugar > but not high enough to diagnose T2
peoplet at high risk of developing T2 diabities
Other names of prediabetes?
borderline diabetes
impaired glucose regulation
non - diabetic hyperglycaemia
impaired fasting glucose AND impaired glucose tolerance
What are symptoms of pre-diabetes?
No symptoms
If have symptoms most likely already have it
What are the 2 main types of factors that increase risk of diabetes
modifiable and non-modifiable
What are examples of modifable?
smoking, high blood pressure, overweight - esp centripetal obesity, sedentary lifestyle (inactivity), alchol
What are examples of non-modifiable risk factors?
age,
ethnicity - african/south asian at more risk, person in families with diabetes,
Gestational diabetes ( levels increase during pregenancy)
Polycystic ovary syndrome (associated with insulin resistance)
mental health conditions
antipyschotic medication
What is the NHS prevention programme?
joint commitment for NHS england, PHE, and diabities uk to
deliver large scale evidence based behavioural intervetions
for individuals at high risk of T2
Why did they do NHS prevention programme?
- As T2 diabetes can be prevental
- behavourial interventions is evidently effective at reducing risk of T2 through reducing weight, increase activity and improving diet
- Diabetes huge implications for NHS and society
What are long term goals of NHS Diabetes Prevention Programme?
reducde incidence of T2 diabetes
reduced complications such as micro/macro vascularture problems related to diabets
reduce health unequalities associated with incidence of diabetes
What the interventions of diabetes programme? (3)
- Achieving healthy weight
- achieving dietary requirements
- achieve CMO physical activity recommendations
Eligibility of NHS Diabetes Prevention Programme?
over 18
have to be non - diabetic hyperglycaemia: - HbA1c 42-47 mmol/mol OR fasting glucose of 5.5 - 6.9
has to be within last 12 months and most recent blood reading
What are referral routes for NHS Diabetes Prevention Programme?
- Identified of having elevated risk level (by HbA1c or FPG) in past or on register of patients with high levels of them
- through NHS health check programmme for ppl 40-74, has a filter to be at high risk and offered blood test to confirm
- diagnosed as non-diabetic hyperglaecmia through opportunistic assessment in routine care
What are 2 core defects of T2 diabetes?
1. impaired insulin secretion by b cells caused by:
-lipotoxity insulin resistance adipose tissue increase lipolysis and fatty acid in blood
-glucotoxity: increase glucagon and increase glucagon sensitivity in liver leads to increase HGO
-incretin resistance: resistance to GLP-1, dont secrete insulin
- insulin resistance in muscle, liver, kidney
By which mechanism does insulin resistance cause hyperglycaemia?
- increase glucose reabsorption
- decrease glucose uptake into cells
- increase lipolysis
- inflammation
- NTs dysfunction
- increase glucagon secretions
- increase HGO
- decreased insulin secretion
- vascular insulin resistance
- decrase incretin effect
explain each of mechanism that insulin resistance causes hyperglycaemia
less insulin produced later stages due to B cell failure
- increase renal glucose reabsorption by Na+/gluco co-transporter a
- decrease glucose update due to insulin resistance and less of it
- inflammation causes expression protiens that supress insulin pathways
- resistance of appetite suppressive effects for hormones and low dopamine and high serotonin increases weight
- increase glucagon as insulin inhibits its secretion and alpha resistance to insulin when high
- adipose resistance increase lipolysis and free acid level in blood. cause resistance muslce and liver and B cell failure
- decrease insulin secretion due to GLP-1 resistance and tissue resistance
- high insulin increase vasculature resistance
- resistance to GLP-1
How is insulin involved in glucose metabolism?
Binds to insulin protien in muscle and adipose cell
allos for glucose uptake through glu4 receptor
Glycolysis to pyruvates
pyruvate oxidation to Acetyl coA
Acetyl CoA to ATP via TCA + oxidative phos
30 ATP
What is difference between GLUT receptors and SGLT receptors?
GLUT - facilicated diffusions, found everywhere apart from small intestine, kidney.
SGLT- active transport luminal epithelial cells in kidney and small intestine
Where is distribution and function of each Glut transporter?
all insulin independent apart from GLUT4
What happens then when glucose high but insulin resistance?
GLUT4 muscles and adipose not glucose in, so lipolysis and glucagonlysis
GLU1,2,3 - neurones, endothelium, kidney, SI, liver, B cells neurones, placenta, erthyotcyes take in lots of glucose
What insulin effects on liver, muscle and adipose?
Stages of insulin levels in type 2 diabetes?
insulin resistance in liver, muscle, fat don’t respond to insulin
causes stages increased insulin due to high glucose. (GLUT2 B cells)
over time B cells worn down so don’t produce as much insulin and not enough to overcome resistance
Difference between type 1 and type 2?
1 - no insulin produced
2 - insulin resistance and eventually little insulin produced
What are glucose thershold (fasting, post prandial, random) for impaired fasting glucose?
impaired glucose tolerance?
diabetes?
What is post pradnial glucose?
patient fast for 8 hours
give 75g oral glucose load
measure blood 2 hours after
What is difference between fasting glucose and impaired glucose tolerance?
area affected?
fasting is predominantly hepatic resitance so large glucose output
while tolerance is muscle resistance and bad insulin release elads to poor cellular glucose
can occur together
What are 3PS for diabetes T2 symptoms?
explain each one
polydipsia, increase thirst - blood glucose high so kidneys more urine to remove extra glucose
polyuria, increase urination - filter out more water as more glucose in urine
polyphagia - can’t use glucose for energy in muscles and liver so no energy from glucose so feel very hungry
How is T2 diagnosed?
Symptoms + 1 red glucose test range
no symptoms and multiple red ranges
Why is HbA1c measured?
as it is haemoglobin glycosylated, jointed to sugar
proportional to plasma glucose levels
blood cells last 120 days, so indicative for 2-3 months of blood glucose
Adantages of HbA1c?
takes into account 2-3 months, not dependent on day
easy to measure - no fasting and acure pertubations like exercise affect it
cheap
disadvantages of HbA1c?
only an approximate measure
not reliable for certain groups: sickle cells, pregnancy (as Hb levels changes), renal failure
What is drug action of metoformin?
decrease glucogenesis and HGO
increase sensitivity of cells to insulin by increase glucose uptake by GLUT4
What is behaviour insight?
knowledge of how and why people behave to encourage +ve behaviour
Why is behavioural insights effective?
considers all aspects of behaviour and acknowledeg importance of fast automatic system in driving behaviour
How do you implemenent behavioural change?
Make it easy,attractive, social, timely to uptake the activity
Retention it
and cause behaviour change
What is the least most important diagnoses it T2 diabetes?
Urine dip
How does obesity lead to type 2 diabetes?
Too much visceral fat; release adipokines, lead to inflammation, toxic on beta cells and which lead to vicious cycle of increasing glucose concentration
What are causes of insulin resistance?
genetic abnormalities
ectopic lipid accumulation
mitochondrial dysfunction
inflammation
endoplasmic reticulum stress
What are the 2 umbrella complications associated with T2 diabetes?
microvascular and macrovascular
Give examples of microvascular
(retinopathy, nephropathy and neuropathy)|
Gives examples of macrovascular?
(myocardial infarction, peripheral vascular disease and stroke) result from dyslipidaemia, hypertension, hyperglycaemia and inflammation
