Diabetes Flashcards
What is diabetes?
Metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion,
defective insulin action or both
What is a type 1 diabetes?
autoimmune disease leading
to destruction of beta-cells of
pancreas, impairs insulin secretion
(no, or very little, insulin is produce)
What is a type 2 diabetes?
insulin resistance/insensitivity – cells do not respond to insulin. May lead to impaired insulin secretion
What are the general characterisitics of type 1?
Age at onset (most commonly): <30 yr
Associated obesity: No
Propensity to ketoacidosis requiring insulin to control: Yes
Endogenous insulin secretion: Extremely low
Cell response to insulin: Normal
What are the general characterisitics of type 2?
Age at onset (most commonly): >30 yr
Associated obesity: Yes
Propensity to ketoacidosis requiring insulin to control: No
Endogenous insulin secretion: Significant but variable
Cell response to insulin: Resistant
What are the metabolic consequences of diabetes?
Hyperglycemia
* Glucosuria
* Water moves into blood compartment (osmotic pressure)
→ Polyuria → dehydration → polydypsia
What are the diagnosis tests for diabetes?
- Fasting plasma glucose
- 12 hr no food - 2 hr 75-g OGTT (oral glucose tolerance test)
- A1C (glycated hemoglobin)
- Hb chemically linked to sugar
To diagnose obesity in children, the following measure(s) is (are) used:
A) BMI formula like for adults
B) So called BMI-for-age
C) None as it is very variable
B) So called BMI-for-age
What is the burden of diabetes?
- Rates continure to grow
- 30% Canadians live with diabetes or pre-diabetes today (diagnosed and undiagnosed)
What is the possible diabetes complications?
- (50%) Chronic kidney disease
- Eye disease (retinopathy) leading to blindness
- Foot problems
- (70%) of Lower limb (leg, foot, toe, etc.) amputation
- (40%) of Heart attack, (30%) of strokes
- Nerve damage
What are the risk factors for type 2 disbetes?
Pre-diabetes
* Age
* Obesity
* Physical inactivity
* Certain ethnicities
* Family history of diabetes (or gestational diabetes)
Clicker Question 2
Which of the following statements is correct?
A) Diabetes but not pre-diabetes can be diagnosed using fasting plasma glucose levels, glucose
tolerance test and glycated hemoglobin test
B) Blood glucose levels within last several months are reflected in glycated hemoglobin test
C) Fasting plasma glucose is the only test that can be used to diagnose both diabetes and pre-diabetes
D) All of the above are correct
B) Blood glucose levels within last several months are reflected in glycated hemoglobin test
What are reducing risk of type 2 diabetes?
- Weight management
– Lose weight if overweight/obese - Regular physical activity
- Diet (healthy eating)
- Being smoke-free
How does diet prevent diabetes?
Quality not quantity of fats and
carbohydrates
– Plant-based fats better than animal fats (unsaturated > saturated fats)
– Lower glycemic index and glycemic load foods
What is glycemic index (GI)?
Increase in blood glucose during 2-hour period after consumption of a certain amount of CHO
(carbohydrates) compared with equal CHO from reference food
What is glycemic load (GL)?
- Considers quantity and quality of CHO in a food
- GI x g of CHO in 1 serving of food
According to the meta-analyses results in the previous slide, intakes of which of the following
are associated with reduced risk for type 2 diabetes?
A) Heme iron, Mg, Vit D
B) DHA/EPA, cereal fibre, Mg, Vit D
C) Fibre, Mg, Vit D
D) Heme iron, glycemic index, cereal fibre, Mg, Vit D
E) Cereal fibre, Mg, Vit D
E) Cereal fibre, Mg, Vit D
Referring to the figure showing meta-analyses of food and food groups associated with risk of type 2 diabetes, which of the following components of a DASH/Mediterranean diet is not likely to reduce risk of type 2 diabetes?
A) Whole grains
B) Vegetables
C) Dairy
D) Fish/Seafood
E) Limiting processed meat
D) Fish/Seafood
How is dietary protein intake and risk of type 2 diabetes?
Positive assoication in increasing risk of type 2 disbetes
Animal meats/processed meats
- animal fats (saturated fats)
- N-nitroso compounds
- AGE: advanced glycation endproducts
How is vitamin D and diabetes associated?
Blood vitamin D levels measured
- From food and skin synthesis
- Potential confounders: time spent outdoors, ie. active lifesyles
Potential mechanisms:
- direct effects on insulin signaling via vit D receptor
- effects of vit D on calcium homeostasis
- anti-inflammatory effects of vit D
How is Mg and diabetes associated?
- Direct effects of Mg on insulin action
– Tyrosine kinase activity of insulin receptor - Interaction with other nutrients (ie. Calcium)
What is the ideal dietary patterns for diabetes prevention?
“healthy dietary patterns for diabetes prevention and management were typically rich in whole grains, fruits and vegetables, nuts, and legumes;
moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-
sweetened beverages.” – Ley, Lancet 2014
What are the dietary treatment of type 2 diabetes?
- Timing and distribution of meals
– Consistent carbohydrates spaced throughout the day - Weight control
– Weight loss helps to reverse insulin resistance - Alcohol
– Zero is the safest level; may also interact with some oral
hypoglycemic drugs - Physical activity
– Improves blood glucose (increase insulin sensitivity)
– Contributes to weight loss
– Improves blood pressure
Why are dietary management matter but is difficult to implement?
- Areas of consensus in formulating evidence based
dietary guidelines:
– Weight management
– Energy balance
– Dietary patterns
– Foods to avoid - Areas of uncertainty in formulating evidence based
dietary guidelines:
– Optimal macronutrient composition
– Fish, dairy, oils
– Weight loss helps to reverse insulin resistance - Further research is needed to resolve areas of uncertainty and controversy
What is diet and exercise in the prevention and treatment of type 2 diabetes mellitus?
- Studies show that weight loss can produce remission of type 2
diabetes mellitus (T2DM) in a dose-dependent manner - In patients with T2DM and obesity, weight loss of ~15 kg, achieved by an intensive management programme involving calorie restriction, can lead to remission of T2DM in ~80% of individuals
- Carbohydrate restriction might help maintain weight loss and
maximize metabolic benefits - When combined with calorie restriction and weight loss, increases in physical activity and fitness are an important contributor to T2DM remission
- Preliminary work suggests that pretreatment glycaemic status
could be used to stratify patients in order to optimize dietary
recommendations
