diabetes Flashcards
What is a metabolic disorder?
Abnormal chemical reactions disrupting the body’s metabolism. Metabolism is the chemical processes that occur within a living organism to maintain life. E.g catabolism, anabolism.
What are some statistics about diabetes?
- 1/10 people live with diabetes in the world
- number of people living with diabetes will increase by 250 million by 2045
- diabetes impacts over 319,000 people in Scotland
(World Health Organization, 2023)
What are the different types of diabetes?
(Herrington, 2019)
Type 1 diabetes:
- Average age of onset is before 30
- Rapid rate of onset
- 10% of all diabetics
- Caused by an insulin deficiency resulting from destruction of beta cells in pancreas
- May be caused by autoimmune disease but contributing factors are uncertain
- Treated by daily insulin injections
Type 2 diabetes:
* Average age of onset usually after 40
* Gradual rate of onset
* 90% of all diabetics
* Caused by a loss of insulin receptors on target cells, leading to insulin resistance
* Contributing factors include excess body weight and inactive lifestyle, more prevalent in certain ethnicities
* Treated through lifestyle changes hopefully controlling disease, if not oral diabetic medication or insulin injections may be used.
Gestational diabetes:
- About 1 in 50 women develop diabetes during pregnancy.
- Usually disappears after the woman gives birth
What are the functions of the pancreas?
Exocrine- cells secrete digestive enzymes into ducts in small intestine
Endocrine- pancreatic islets contain alpha, beta, and delta cells.
Alpha cells- secrete glucagon which stimulates liver cells to convert glycogen into glucose and fatty acids and amino acids into glucose when blood glucose levels fall. This glucose is then released into the bloodstream, causing blood glucose to rise.
Beta cells- secrete hormone insulin which stimulates cells to absorb glucose and amino acids from the blood causing blood glucose to fall.
Delta cells- secrete somatostatin, a hormone that works with the pancreas to regulate other endocrine cells, e.g. inhibiting the release of glucagon and insulin.
(Marshall, 2017)
Describe the regulation of blood glucose
the bloodstream
* high BG levels stimulate beta cells to secrete insulin
* insulin triggers the liver to take up more glucose and store it as glycogen. This results in BG levels returning to normal
* when BG drops below a certain point, alpha cells in the pancreas release glucagon into the blood
* Glucagon stimulates the liver to break down stored glycogen into glucose, which is then released into the bloodstream, raising BG.
(Marshall, 2017)
List some symptoms of hyperglycaemia:
- extreme fatigue
- frequent urination
- sudden, unexplained weight loss
- slow healing wounds
- always hungry
- blurry vision
- always thirsty
- numb or tingling feet
- diabetic ketoacidosis
- lowered B-cell function
(Diabetes UK, 2022)
How is diabetes diagnosed?
- Haemoglobin A 1c value >6.5%
- Fasting venous plasma >7 moll/L
- Symptoms of hyperglycaemia and a casual (random), plasma glucose >200 mg/dl or 11.1 mmol/L
Prediabetes- a haemoglobin A 1c value of 5.7-6.4%
Non diabeteic patients have a blood sugar level less than 7.8mmol/L .
(Diabetes UK, 2022)
How is diabetes treated?
Oral hypoglycaemic agents for T2:
- some stimulate B cell production of insulin
- decrease hepatic glucose production, decreases intestinal absorption of glucose, increases insulin sensitivity
- reduce insulin resistance and increases sensitivity
Insulin Therapy
there are long, medium, short, and rapid acting insulins, or mixes.
(NHS, 2024)
Describe the different insulin types.
Rapid- take at start of a meal, takes 3-5 hours
short- take 25 mins before a mean, lasts 5-8 hours, taken alongside basal insluin
intermediate- basal, take one or twice per day
long-acting- basal, taken once per day at the same time
(NHS, 2024)
What factors affect insulin dosage?
- carbohydrate intake
- physical activity
- illness
- body mass
- insulin resistance
(NHS, 2024)
What should be done in the case of hyperglycaemia?
The recommended BG target for diabetes patients is 6-10 mmol/L (4-12 is also acceptable). some patients will have lower BG target e.g. pregnant women
Check BG levels, ideally review BG pattern over last 48 hours. If BG is elevated over 8mmol/L it’s hyperglycaemia.
Adjust insulin dose prior to elevated BG. Increase by 10% of insulin dose is recommended.
Check ketone levels in T1 diabetics and all patients during illness.
Observe pattern of pre-meal BG levels therafter and adjust dose again is necessary.
(NHS, 2024)
How is diabetes managed long term?
- Closed loop insulin delivery system: links a secondary device called a continuous glucose monitor (CGM sensor) which automatically adjusts some of the insulin delivered based on continually monitored blood sugar levels.
-iLET bionic pancreas: made of an insulin pump and software that decides how much insulin to deliver based on person’s individual requirements - lab grown B cells to produce insulin (still under research)
(NHS, 2024)
List some non-pharmacological management techniques for T2
- education for healthy living advice
- daily physical activity
- smoking cessation
- weight reduction
- dietary changes- low carb diet has been shown to have positive outcomes after a year, reduction in HbA1c and weight loss, resulting in less medication
- reduced alcohol consuption
(World Health Organization, 2023)
What is diabetic ketoacidosis (DKA)?
Occurs when a lack of insulin cayses ketones, a chemical produced in the liver during fat breakdown, to build up in the blood.
This can be very harmful and life threatening and needs urgent treatment.
(Centers for Disease Control and Prevention, 2022)
List some symptoms of DKA.
- feeling thirsty
- needing to pee more often
- stomach pain, feeling sick or being sick
- diarrhoea
- breathing more deeply than usual
- breath that smells fruity (like pear drop sweets or nail polish remover)
- feeling tired, sleepy or confused
- blurred vision
(Centers for Disease Control and Prevention, 2022)
