Diabetes Flashcards
Type 1 diabetes is
a progressive metabolic disorder of catastrophic beta cell failure with normal tissue insulin sensitivity
Immune mediated
Type 2 diabetes is
a progressive metabolic disorder of beta cell dysfunction and/or insulin resistance where fasting gluscose is > 7mmol/L
What defines metabolic syndrome?
Waist >102cm BP> 130/85 TG>1.7mmol/l Glucose>6mmol/L HDL
Actions of insulin
Anabolic hormone Increased glycogenesis and glucose uptake Decreased hepatic gluconeogenesis TG synthesis and protein synthesis Decreased ketones
What is hormone sensitive lipase activated by?
Starvation
Low glucose
Low insulin
Therefore lipolysis can occur
Signs and symptoms of DKA
High blood glucose (>15mmol/L) Ketones in blood/urine Diuresis Thirst Tired/lethargy Blurry vision Nausea and vomiting Deep sighing breaths Smell of ketones on breath Collapse/unconciousness
Why does ketone synthesis occur in DKA?
Low glucose in cells, low insulin -> lipolysis
NEFA from lipolysis enter carnitine shuffle
Not enough insulin for acetyl coA for fatty acid synthesis (acetyl-coA carboxylase doesn’t work) to occur so instead ketones are made
Name the 3 ketones
Acetone, acetoacetate and 3-hydroxybutyrate
Why does glucose build up in the blood in DKA?
Glucose can’t enter cells because of lack of insulin
Oxaloacetate can’t be used in FA synthesis so is used in hepatic gluconeogenesis
Treatment of DKA?
Resuscitation (0.9% IV saline)
Insulin (0.1units/kg/hr IV)
Potassium IV
What % of diabetic patients develop foot ulcers?
15%
Why does retinopathy occur in diabetes?
Microvascular disease -> increased vascular permeability and haemorrhage
Inflammatory changes and angiogenesis
Osmotic effects and cell damage
Plaques, exudate, haemorrhage
Ischaemic changes, proliferative retinopathy
Erectile dysfunction affects up to:
50% of men with chronic diabetes
3 pathophysiology pathways?
Glycosylation of proteins
Polyol pathway
Protein kinase C activation
Explain the glycosilation of proteins pathophys?
Glycation-> abnormal function
Glycated collagen-> LDL trapped in arterial walls
Glycated cell surface receptors-> activation of inflammatory cells and cytokine release
