Diabetes Flashcards
Uk prevelance
2019- 3.8 milion people
% of type I
10%
% of Type II
90%
blood glucose levels fasted and OGTT for normal
fasting - <5.6mmol.l
2 hour plasma OGTT - <7.8
blood glucose levels fasted and OGTT for pre-diabetes
fasted - 5.6-6.9
2hr post OGTT - 7.8-11
blood glucose levels fasted and OGTT for diabetes
fasted- >7
2hr post >11.1
how is type I managed
diet
exercise
self adminsted insulin
effect of type I on stroke and heart attack
3.5 times more liekly to have a stroke
4 times more liekly to have a heart attack
how is type II managed
lifestyle
effect of type II on stroke and heart attack
2 time more likley to have storke
2.5 times more likely to have a heart attack
describe type I
juvenile onset abrupt onset genetic predipostion reduced or absent insulin 10% of cases
describe type II
usually mature onset, now younger gradual onset genetic predisposition hyperinsulinaemia 90% of cases
how many people die from complications and comorbidites associated with diabetes and what are they
more then 500 people die prematurely due to complications from diabetes every week
stroke
heart attack
heart failure
glycogenesis
glucose -> glycogen
insulin promotes this
glycogenlysis
glycogen -> glucose
insulin inhibits this
gluconeogensis
lactacte/AA -> glucose
insulin inhibts this
lipolysis
TAG -> FA + Glycerol
insulin inhibits this
ketogenesis
FA -> ketones
insulin inhibits this
Lipogenesis
Glucose/AA -> TAG
insulin promotes this
periperhal neuropathy
limited sensation in peripheries
may promote damage, abrasion or ulcers
hyperglycaemia reduces immune function and blood flow
how many patients who develop foot ulcers willl require amputation
20%
exercise impliactions of diabetes
– Vision may be impaired
– Joints may hurt (so consider low impact activities)
– Consider peripheral sensation (tripping + avoidance of cuts)
– Appropriate footwear (avoid blisters)
risk factors of diabetes
overweigth/obesity physical inactivty diet metabolic syndrome ethnicity family history age sex history of gestational diabetes
benefical effects of exercsie for type I
fitness insulin requirements lipids endotheial function mortaility insulin resistance CVD well being
benefical effects of exercsie for Type II
fitness insulin requirements lipids endotheial function mortaility insulin resistance CVD blood pressure beta cell function glycaemic control
effect of exercise on mechanisms
increased GLUT 4 protein load and translocation
increased GLUT4 Gene actiavtion
recommendations aerobic
mod to vig
at least 150 mins MVPA
3-7 days a week
HIIT and continous
resistance training
8-10 exercises
1-3 sets
10-15 reps
overall benefits of exercise
social improved QoL decreased fear of disease improved self esteem improved metabolic health increased muscel mass improved body composition improved insulin sensivity increased GLUT4 protein load + translocation lower CVD risk
non/pre-proliferative retinopathy
widespread death of periocytes
leaky blood flow due to endothelial growth
- micro-aneurism
- LDL bulid up on back of eye - hard exudates
deteced during eye exam
diabetes without retinopathy
pericytes exposed to excessive amounts of glucose
unable to process
results in increased blood flow and endothelial cell growth
- no symptons, unable to detect
what is role of pericytes
pericytes found on capillaries in the eye
help control blood flow and vasotone
prevents endothlial cell proliferation
proliferative retionpathy
angiogensis - formation of new blood vessels retina is hypoxic due to leaks vasodilation VEGF released - encourages angiogensis increased blood vessels can causes detached retina
neuropathy = kidney
1/5 with diabetes will need kidney treatment
hyperglycemia causes vasoconctriction of efferent
increases pressure in bowmans
damages mesangial
inflammation and oxidatiive stress
capilaries become more leaky = loss of proteins
