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General medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes can occur when..

A
  • Pancreas does not produce enough insulin
  • When the body cannot effectively use the insulin in produces
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2
Q

Where does hyperglycaemia especially cause damage?

A

especially the nerves, kidneys, and blood vessels

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3
Q

How many people have diabetes?

A

 About 10% of the global population has diabetes (422 million in 2014)

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4
Q

Prevalence of diabetes is rising more rapidly in countries with which socio-economic state?

A

 Prevalence has been rising more rapidly in low- and middle-income countries than high-income

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5
Q

How many deaths are directly caused by diabetes? (2019)

A

 1.5 million deaths worldwide were directly caused by diabetes (2019)

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6
Q

What types of diabetes are there?

A
  • Type 1 (young, thin people)
  • Type 2 (obese, middle-aged, family members hereditary)
  • Gestational diabetes (after delivery),
  • Rare types (purely genetic, associated with other diseases)
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7
Q

What types of diabetes are there?

A
  • Type 1 (young, thin people)
  • Type 2 (obese, middle-aged, family members hereditary)
  • Gestational diabetes (after delivery),
  • Rare types (purely genetic, associated with other diseases)
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8
Q

T2 diabetes accounts for …% of all diabetes cases

A

90%

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9
Q

How is blood glucose regulated in the body?

A

After ingesting meal -> glucose enters blood -> triggers beta-cells of pancreas, insulin stimulates uptake in skeletal muscle, liver, adipose tissue. At same time: insulin suppresses glucose output liver.
After a while, insulin levels go down, liver makes glucose again. Glucose uptake reduced

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10
Q

Which organs are involved in blood glucose regulation?

A

Liver, skeletal muscle, adipose tissue, intestine, pancreas

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11
Q

What is the meaning of hyperglycemia, insulin resistance, ß-cell dysfunction

A

= high blood glucose. Insulin resistance = cells don’t respond well to insulin -> cannot easily take up glucose
Beta-cell dysfunction = beta cells secrete insulin, but when this fails = dysfunction

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12
Q

Explain the development of type II diabetes over time

A

Insulin resistance slowly develops over time, in response the beta-cells secrete more insulin for glucose to enter the cells. Then, in the long run, beta-cell function fails. Secretion finally goes down. Control blood glucose is disturbed, hyperglycemia starts to develop. Initially after meal, ultimately also in the fasting state. Diabetes is diagnosed.

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13
Q
  • the difference between type I and II diabetes?
A

= type 1 diabetes is a genetic condition that often shows up early in life, and type 2 is mainly lifestyle-related and develops over time.

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14
Q

What is the incidence of diabetes?

A

1.5 mil new patients/year (US), Lifetime incidence: 40% of patients develop t2 diabetes during their lifetime

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15
Q

What is the prevalence of diabetes worldwide and its trend

A

463 mil people (90-95% t2), rising (700 mil 2045) bc populations are ageing and growing, high increase in Africa, but everywhere worldwide

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16
Q

What are the three main reasons why the prevalence of type II diabetes is rising

A
  • ageing
  • growing population
  • increase in obesity
17
Q

What are the two explanations for differences in the % of people with diabetes across different ethnicities?

A

Differences in socio-economic status
Genetics

18
Q
  • how is blood glucose regulated in a healthy state and how this is dysregulated in type II diabetes
A

Healthy state: glucose in the blood stimulates the pancreas, which secretes insulin that binds to insulin-receptors. This triggers a cascade of events within cells, leading to increased uptake of glucose in these organs (muscle, adipose tissue, liver).
Insulin also promotes glucose storage (glycolysis and glycogenesis in liver, or storage as fat)

In T2 diabetes: insulin resistance. Receptors don’t work properly, insulin does not work properly on liver, adipose tissue, skeletal muscle. -> results in high blood glucose levels for longer times. Pancreas is therefore told to secrete more insulin.

19
Q
  • why people with untreated type II diabetes have polyuria and increased thirst?
A

Glucose travels to kidneys and is secreted out (= glucosuria), which results in osmotic diuresis. -> glucose drags water with it, person pees more (polyuria) = loss water + electrolytes = dehydration + hyperosmolar state. This leads to increased thirst.

20
Q

how can untreated type II diabetes lead to kidney failure?

A

high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they don’t work as well as they should

21
Q
  • how insulin resistance may lead to ß-cell atrophy, and its consequences for treatment
A

Body does not respond to insulin properly, therefore beta cell atrophy happens. Need to be on insulin injections.

22
Q

What are the four symptoms of uncrontrolled diabetes?

A
  • Polyphagia = eating more because of hunger / weight loss.
    Mechanism: cells cannot use glucose from the blood, and therefore the fat tissue starts to break down fat and muscle tissue breaks down proteins. This leads to weight loss. This catabolic state makes people feeling hungry and eating more.
  • Glucosuria = glucose spill-over into the urine
  • Polyuria = when glucose gets excreted into urine, it attracts water due to osmosis → more urine → more frequent urination
  • Polydipsia = thirst → drinking more because of the increased frequency of urination
23
Q

What does glucagon do?

A

increase blood glucose levels

24
Q
  • describe how type 1 diabetes results from a genetic abnormality in the function of T-cells
A

There is a type 4 hypersensitivity immune response where a persons own T-cells attack the pancreas. There is a loss of self-tolerance that target the beta-cell antigens.
People with diabetes T1 often have specific HLA genes in common with each other (human leukocyte antigen

25
Q
  • explain how the four clinical symptoms of uncontrolled diabetes are related to each other
A

Polyphagia: absence of glucose for the cells, adipose tissue and muscle tissue start breaking down fat and protein, resulting in weight loss + hunger
Glycosuria: blood gets filtered to the kidneys, some glucose is spilled into the urine.
Polyuria: glucose is osmotically active, therefore there is an increase in urination
Polydipsia: bc there is so much urination, people become dehydrated and thirsty

26
Q
  • explain why type 1 diabetes needs to be treated with lifelong insulin
A

Even though people cannot make their own insulin, they still respond to insulin. Therefore this is the treatment.

27
Q
  • describe what diabetic ketoacidosis is (normal blood pH ranges from 7.35 to 7.45), how it is related to lipolysis, and how it affects respiration
A

= adipose tissue breaks down fat into FFA, liver turns this fat into ketone bodies. This increases energy, but also turns the blood more acidic -> individuals can develop kussmaul respiration: deep and laboured breathing as the body tries to move CO2 out of the blood, in an effort to reduce acidity.

28
Q
  • describe how ketoacidosis can result in low potassium stores in the body
A

Cells have a transporter that exchanges H+ ions or protons for potassium. Acidic blood is loaded with protons, that get sent into the cells while potassium gets transported outside of the cells (hyperkalemia in the blood: excreted).

29
Q
  • explain how ketoacidosis can be treated
A
  • Giving fluid for dehydration
  • insulin helps lower blood glucose levels
  • Replacement of electrolytes like potassium
30
Q
  • explain why diabetic ketoacidosis is much more common in type 1 diabetes than in type 2
A
  • Because genetic factors probably play a major role as well
31
Q
  • explain how excess fat in adipose tissue can result in insulin resistance (type 2 diabetes)
A

Extra fat tissue is though to release FFA and adipokines, which can start inflammation, which seems related to insulin resistance

32
Q
  • know what hyperplasia and hypertrophy mean (concerning the beta-cells of the pancreas)
A

Hyperplasia = increased number of beta-cells, hypertrophy = beta-cells grow in size

33
Q
  • describe the hyperosmolar hyperglycemic state and how this can lead to dehydration
A

More common in T2 diabetes: causes an increase in plasma osmolarity from dehydration. When the osmolarity is very high, water starts to leave the body cells and enter the blood vessels, leaving them dry. Increased water in blood = increased urination, ..

34
Q
  • explain how insulin, when taken without food, can result in hypoglycemia
A

Because then it will induce the uptake of glucose from the blood, but there is no ‘refill’ of the glucose from a meal. Blood sugar levels will become low = hypoglycemia

35
Q
  • recall the symptoms and treatment of hypoglycemia
A

Dizziness, fainting, weakness, hunger, shaking, seizures

36
Q
  • recall the most probable cause of gestational diabetes (mostly 3rd trimester in pregnancy)
A

Pregnancy hormones that interfere with insulins action on insulin receptors cause an increased blood glucose in the 3rd trimester

37
Q
  • recall the cut-off for a healthy fasting glucose in mg/dL or mmol/L and the cut-off for diabetes
A

100 mg/dL – 125 mg/dL = pre-diabetes
126 mg/dL or higher = diabetes
Non-fasting:
200 mg/dL or higher = diabetes

38
Q
  • explain how the HbA1C test is a more long-term measure of diabetes, and recall the cut-off (a percentage) for diabetes
A

= proportion of hemoglobin (Hb) with glucose stuck to it (= glycated hemoglobin). This proportion does not change day to day, thus gives an indication for the past 2-3 months

5.7% - 6.4% = pre-diabetes
6.5% or higher = diabetes

39
Q

What is ulceration, as concequence of diabetes?

A

(diabetic foot)

General medicine (27 decks)

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