Diabetes Flashcards
Part 2 of 3
What is diabetes
It is the abnormal metabolic response to glucose resulting in hyperglycaemia due to:-
Insufficient insulin secretion
And/or a failure to respond to insulin
Type 1
Usually develops before the age of 40
Genetic
Environmental
Lack of insulin production due to cell mediated autoimmune destruction of pancreatic beta cells
Inability to secrete insulin
Cells are starving
Treat with insulin & dietary management
Used to be known as insulin dependent DM
Severe and sudden onset
Type 2
Usually occurs in the +40 years
But seeing increasingly at a younger age
Cases up by 50% over last 5 years in U25s
But in South Asians & African-Caribbeans often appears after the age of 25
Usually due to insulin resistance
Strongly associated with increase in body weight especially with central obesity
86% T2 are overweight/obese
3 out of 5 cases could be prevented
Type 2 treatment
Diet & physical activity
Medication
Insulin
Used to be known as non insulin dependent DM
Less severe and more gradual onset
Insulin Resistance
Failure to respond to insulin
Loss of sensitivity of insulin receptors
Therefore pancreas tries to produce more insulin
Known as insulin resistance
Some glucose may enter the cell therefore not completely starving
Number of possible causes which lead to reduced insulin sensitivity & insulin resistance
Adipose tissue especially when deposited centrally is metabolically active & produces a number of hormones, proteins & free fatty acids
What Happens with insulin resistance?
Hyperglycaemia
Glucosuria
Polyuria
Results in extreme thirst
Polyphagia
Can lead to weight gain (usually seen in type 2)
Risk of hypoglycaemia (T1)
Increase in lipolysis
Risk of ketoacidosis (T1)
Breakdown of protein
Muscle wastage
Weight loss (mainly seen in type 1)
Role of Diet
To control blood glucose & insulin
To prevent extremes of glycaemia
Hypoglycaemia
Ketoacidosis
Reduce the risk of CVD & microvascular complications
Control body weight
Special Diet?
Guidelines devised by the Nutritional Subcommittee of the Diabetes Care Advisory Committee of Diabetes UK (2011)
No special diet
Based on healthy eating guidelines
But weight loss is a priority in those overweight
Key is to promote a healthy lifestyle which can be self-managed
Diabetic Foods
Not allowed to be called for ‘diabetics’
Usually contain fructose or polyols as:-
Has a lower glucose and insulin response
Fructose is sweeter than sucrose
But potential effect on lipid profile & laxative effect
Expensive
Products usually high in calories & fat
Vitamins & Minerals
Due to increased oxidative stress & increased risk of CVD
Important to consume rich sources of antioxidants such as:-
Fruit & vegetables
Wholegrain cereals
Important to reduce sodium
As increased risk of hypertension
Salt keep to less than 6g/d
Supplements not recommended for diabetics:-
Insufficient evidence for benefit
Long term effects unknown
Insulin Treatment
Need to balance the hypoglycaemic effect of the type of insulin used and dietary carbohydrates
May have fixed dose at fixed times
Diet remains relatively constant and based around peaks in insulin
Or may need to make daily adjustments to dose of insulin to suit lifestyle & diet
Need guidance on:-
Carbohydrate content & glycaemic effect
Level of physical activity
How to adjust diet &/or insulin on basis of blood glucose levels
Caution as insulin therapy can result in weight gain
Hypoglycaemia
Blood glucose drops <4mmol/l
Secrete adrenaline to attempt to release stored glucose
Signs include:-
Sweating, shakiness, nausea, increased heart rate, irritability
Brain function can become impaired if continues
Confusion
Disorientation
Slurred speech
Often become aggressive
Confused with drunkenness
Hypoglycaemia - causes
Missed or delayed meal
Not enough carbohydrates in last meal
Being more physical active than normal
Taking too much insulin
Misuse of medications aimed at increasing insulin production e.g. sulphonylureas
Alcohol
How to treat hypoglycaemia
Treat preferably with 15-20g glucose
15g = 170ml lucozade or 150ml coke or 5 glucose tablets or 5 jelly babies
If unconscious inject with glucagon to release hepatic glucose
After recovery a source of slow acting carbohydrate should be given
Physical Activity
Should be recommended
Improves glycaemic control
Reduces insulin resistance
Helps weight loss
Reduces CVD risk
At least 150 mins moderate activity/week
But need to avoid hypoglycaemia
By consuming carbohydrates before, during or after exercise
And/or by reducing the amount of insulin or sulphonylurea before exercise
