Diabetes 1 +2 Flashcards
What is type 2 diabetes mellitus
The resistance of tissues to insulin even with increased insulin release from the pancreas, leading to ↓ pancreatic activity.
Treated initially by change of lifestyle
Drug interventions include, metaformin, sulphonylureas, GLP-1 (glucagon like peptide 1) and DPP IV inhibitors)
NON insulin dependent diabetes
CVD problems also need to be treated.
Type 1 diabetes
Autoimmune destruction of β pancreatic cells in the islets of langerhans leading to ↓ insulin secretion and hyperglycaemia.
Treated with same strict lifestyle and insulin replacement.
Untreated can lead to ketosis and acidosis due to the breakdown of fats and proteins in gluconeogenesis
Hypoglycaemia in diabetics
Low blood glucose levels
Caused by:
↑ insulin levels
↑ utilisation of glucose
↓ intake of glucose (missing meal)
Leads to sympathetic stimulation (palpitations, sweating etc) , neuropathy (confusion, aggression coma)
Could be a problem with too high insulin levels in treatment
What insulin does in the body and where its produced.
Hormone produced by the pancreatic β cells of the islets of langerhans
Main function is to ↓ blood glucose levels
- uptake of glucose and use in fats and muscle
- prevention of gluconeogenesis (fat and protein turning to glucose)
- prevents glucose uptake
- opens sodium potassium atp channels
- promotes protein synthesis
Metaformin
Treatment of type 2 diabetes
- ↑ peripheral uptake of glucose and use
- prevents glucose uptake in GI tract
- decreases gluconeogenesis
Adverse effects
- GI disturbance nausea vomiting
- b12 deficiency
- lactic acidosis
Treatment of diabetes mellitus
Metaformin- ↓ glucose uptake and gluconeogenesis
Sulphonylureas- stimulates active β cells to secrete insulin, ↑ density of insulin receptors and sensitivity
GLP-1 - binds to G protein receptors and ↑ insulin production in β cells
DPP IV inhibitors- prevent the breakdown of GLP-1, ↑ length of effect of GLP-1
Sulphonylureas’
↑ secretion of insulin from β cells
↓ breakdown of insulin
↑ density of insulin receptors on cells
Adverse effects
- hypoglycaemia
- GI Upset
- weight gain
- hypersensitivity rash
REQUIRES FUNCTIONAL β CELLS
GLP-1 in type 2 diabetes
↑ production of insulin in β cells of pancreas
Adverse effects
- cancer of pancreas
- pancreatitis
DPP IV inhibitor
Prevents breakdown of incretin hormones (GLP-1) allowing for the further stimulation of Β cells
But also ↓ circulating glucagon
Adverse effects
- nasopharangitis, upper respiratory infections, headache, nausea
Note: DPP IV inhibitors and GLP-1 promote the effects of insulin by ↑ its production in the pancreas.
This leads to the effects of insulin
.
Insulin effects in liver
↑ glycogen production for storage
↓ gluconeogenesis
↓ glycogenolysis
↑ glycolysis
Effect of insulin on skeletal muscle
↑ glycolysis ↑ GLUT 4 receptor concentration in skeletal muscle for uptake of glucose ↑ uptake of amino acids ↑ protein synthesis ↑ glycogen production
Effect of insulin on adipose tissue
↑ GLUT 4 membrane translocation = ↑ glucose uptake
↑ glycerol production
What is diabetes mellitus a deficiency of
Endogenous insulin
What is the result of ↓ endogenous insulin
Hyperglycaemia
