Diabeetus Flashcards
What is the difference between type 1 and 2 diabetes?
Type 1 is due to insufficient insulin (generally autoimmune and develops early in life)
Type 2 is due to insulin resistance (Develops in late adulthood and associated with obesity)
What are the clinical signs of diabetes?
Both forms of diabetes cause elevated blood sugar, excess urination and thirst.
In type 1 fat breakdown is accelerated thus resulting in high production of ketone bodies.
What are the potential complications of the production of ketone bodies caused by type 1 diabetes?
Ketoacidosis results from high concentration of ketoacids.
Bicarbonate system is activated leading to altered breathing.
Breakdown of ketone body acetoacetate produces acetone which is expelled via the breath.
Untreated diabetes leads to dramatic weight loss.
What are the symptoms of diabetes?
Being more thirsty than usual
Passing more urine
Feeling tired and lethargic
Always feeling hungry
Having cuts that heal slowly
Itching/skin infections
Blurred vision
Unexplained weight loss (type 1) or weight gain (type 2)
Mood swngs
Headaches
Feeling dizzy
Leg cramps
What are the long-term effects of elevated blood sugar?
Proteins can be glycosylated especially at free amino groups.
Haemoglobin can be glycosylated compromising O2 delivery. (especially in extremities)
Higher risk of CVD, renal failure, and damage to small blood vessels and nerves.
How is blood glucose maintained in patients with type 1 diabetes?
Insulin therapy:
Long acting insulin to maintain basal rate of glucose uptake.
Short acting insulin to compensate for food intake.
What are the symptoms of hypoglycaemia?
Loss of concentration, tiredness, confusion
Sweating, tremors, heart palpitations
If untreated coma/death
What happens to glucagon production in type 1 diabetics?
They fail to produce glucagon in response to elevated insulin injected into the bloodstream. (only catecholamines and stress hormone response used to compensate for insulin)
What happens during moderate to intense exercise in type 1 diabetics?
Blood sugar drops in addition to insulin which can trigger a state of mild hypoglycaemia.
What does HbA1c test?
Measures glycosylation of RBCs which indicates average glycaemic control.
How often is HbA1c measured in type 1 diabetics?
every 3 months
What are the complications of diabetes?
Diabetes affects all cells in the body so complications are possible in all organs.
Microvascular complications include neuropathy, nephropathy, and vision disorders.
Macrovascular complications include: Heart disease, stroke, and peripheral vascular disease
Other complications include: Infections, metabolic difficulties, impotence, autonomic neuropathy and pregnancy problems
Oral infections (type 2 diabetes is most commonly diagnosed by dentists)
Peripheral neuropathy, charcotes foot, and diabetic foot ulcers (diagnosed by podiatrists)
What are the risk factors for insulin resistance?
Genetics
Obesity
Sedentary lifestyle
Aging
What causes decline of beta-cell function?
Genetics
Glucose toxicity
FFA toxicity
What is pre-diabetes/metabolic syndrome?
A serious, treatable medical condition in
which blood glucose levels are higher than
normal but not yet high enough to be
diagnosed as diabetes. Without intervention,
nearly one-half of these individuals progress
to clinical diabetes in five years.
What are the cardiovascular risk factors associated with increased risk for type 2 diabetes and cancer?
Visceral adiposity
Insulin resistance
Low HDL
Systemic pro-inflammatory state
What are the risk factors for type 2 diabetes?
Age >40
Family history
Ethnicity
Obesity (abdominal fat distribution)
Sedentary lifestyle
Hypertension
Hyperlipidemia
Previous impaired glucose tolerance
What happens normally when blood glucose is low and how does elevated plasma FFA affect glucose production?
Insulin is low
Fat cells undergo lipolysis to produce FFA as an energy source
Liver responds to increased FFA by increasing its production of glucose
Elevated FFA when blood glucose is not low also stimulates hepatic glucose production.
What does too much fat do?
Increases hepatic glucose production
Adipose tissue acts as an endocrine organ and secretes adipocytokines
When fat cells are filled with fat their secretion of adipocytokines changes. (Less adiponectin, more resistin, TNFalpha, IL-6, and leptin)
Insulin resistance results from these changes
How is type 2 diabetes prevented?
Setting weight loss goals
Setting goals for increased exercise.
How effective was lifestyle intervention for preventing diabetes?
1 case of diabete4s is prevented for every 7 - 8 people who participate in an intensive lifestyle intervention program for 3 years.
Achieving all diet and exercise goals virtually stalls the progression to diabetes
