Diabetes Flashcards
What does diabetes show in urine?
sugar and high blood sugar
When does diabetes develop
when insulin production or use is inadequate
Besides type I and II what are two other types of diabetes?
gestational
secondary
What percentage of people in US have diabetes?
9.3% or 28.9 million
Symptoms of diabetes
- increased urine
- increased thirst
- unexplained weight loss
- fatigue
- blurred vision
- sores that don’t heal
- increased hunger
What are the three ways you can diagnosis diabetes?
- A1C test (Hemoglobin A1c, HbA1c, glycohemoglobin test)
- fasting plasma glucose test (FPG)
- oral glucose tolerance test
What percent would your A1C level be if you had diabetes?
6.5 and above
What percent would your A1C level be if you had pre diabetes?
5.7 - 6.4
What is a normal A1C?
about 5
What would your FPG be in diabetes?
126 or above
What would your FPG be in pre diabetes?
100 - 125
What would a normal FPG be?
99 or below
What would a diabetic oral glucose tolerance test be?
200 or above
What would a pre diabetes oral glucose tolerance test be?
140 - 199
What would a normal oral glucose tolerance test be?
139 or below
Which is more sensitive FPG or oral glucose tolerance test?
Oral glucose tolerance test
When is an oral glucose tolerance test given?
Fasting 8 - 12h
When is a baseline level drawn for an oral glucose tolerance test?
0 hour
Oral glucose tolerance test
- given measured dose of glucose
- blood drawn at various time points
What is the glucose dose based on in US?
based on body weight
What type of diabetes is the most common?
type II
What percent of people with diabetes have type II?
90-95%
When does type II diabetes occur?
any age, but mostly older age and obesity
Characteristics of T2D
- hyperglycemia
- hypertriglyceridemia
- ketoacidosis NOT common
Insulin levels in T2D
normal or elevated
What is T2D often preceded by?
obesity
Insulin levels in T2D vs obese with no diabetes
not as high as obese with no diabetes
What can cause T2D?
IR
impaired B-cell function
Risk factors of T2D
- family history
- 45 and older
- race
- overweight, not active
- history of gestational
- impaired glucose tolerance (pre diabetes)
When does someone with pre diabetes develop T2D?
10 years
Gestational diabetes
- during pregnancy
- can cause complications for mother and baby
Link between obesity and T2D
- obese are hyperinsulinemic
- response to insulin diminished
- elevated FFAs –> cause IR
- Increase in TNFa, resisting
- decrease in adiponectin
What is the percentage of those with T2D that are obese?
80%
Factors predisposing obese individuals to T2D
- lipid toxicity
- adipose inflammation
- altered adipokine secretion
- genetic factors
Insulin and glucose
improves glucose uptake in muscles and adipose tissue
Insulin and gluconeogenesis
Suppresses
Insulin and glycogen
promotes storage in liver and adipose tissue
Insulin and FAs
promotes synthesis in liver and adipose tissue
Insulin and fat storage
Improves in adipose
Insulin and protein
suppresses breakdown in muscles
What drug targets the liver and gluconeogenesis?
biguanides
What drug targets the pancreas and stimulate insulin release?
Sulfonylureas
What drug targets the gut and improves insulin secretion?
GLP-1R
What drug inhibits glucose reabsorption by kidneys?
SGLT2 inhibitors
What does adipose tissue release on demand?
FFA
What is adipose tissue responsive to?
insulin
What does adipose tissue secrete?
- adipokins
- cytokines
- growth factors
Adipose tissue inflammation and T2D target
- inflammatory mediators released from obese AT
- chronic low grade inflammation risk factor
- TNFa impairs insulin signaling
What are some anti-inflammatory drugs used to treat T2D?
- salsalates
- PPAR gamma agonists
- Interleukin 1 receptor antagonist
Strengths of bariatric surgery
- effective in achieving weight loss
- reduction in co-morbidities
- enhanced survival
Weaknesses of bariatric surgery
- preoperative mortality
- surgical complications
- frequent need for reoperation
When does T1D usually appear?
Childhood or in teens
Insulin and T1D
secretion is very low
T1D and cells
- defective B-cell function due to autoantibodies
Characteristics of T1D
- hyperglycemia
- hypertriglyceridemia
- severe ketoacidosis
Hyperglycemia
- inability of tissues to take up glucose
- accelerated hepatic gluconeogenesis
Hypertriglyceridemia
- Increased VLDL production
- chylomicron accumulation
- low LPL activity
Ketoacidosis
- Increased AT lipolysis
- accelerated hepatic FA oxidation
Management of T1D
- insulin therapy
- islet cell transplantation
- dietary and lifestyle modification
Complications of insulin therapy
- hypoglycemia
- insulin allergy
- immune insulin resistance
- lipodystrophy at injection site
Which type of diabetes is insulin deficiency?
T1D
Which type of diabetes is insulin resistance?
T2D
Long term complications of diabetes
- stroke
- heart disease
- HTN
- vascular disease
- foot problems
- eye disease
- renal disease
- neuropathy
Biochemical mechanisms of diabetes complications
- advanced glycation end products
- sorbitol pathway
- oxidized LDL
- oxidative stress
Polyol pathway
- conversion of glucose to sorbitol
What enzyme is used in the Polyol pathway?
aldose reductase
When is the polyol pathway activated?
if large amounts of glucose are present
What does an increased sorbitol accumulation lead to?
increased oxidative stress
What can polyol pathway cause?
glycation of cellular proteins impairing their function
What is the clinical significance of the polyol pathway?
Diabetic complications
