Diabetes Flashcards
GLUT - 4
Skeletal muscles, adipose
Insulin dependent glucose transport)
GLUT - 3
Neurones, placenta
High affinity transport (insulin independent)
GLUT - 2
Kidney, small intestine, liver, pancreatic B - cells
Low - affinity transport (insulin independent)
GLUT - 1
Endothelium, erythrocytes Basal transport (insulin independent)
Insulin effects on liver
Glucose uptake thus decrease gluconeogenesis
Increase Glycogenesis thus decrease glycogenolysis
Lipogenesis
Insulin effects on adipose tissue
Glucose uptake
Increase Lipogenesis
Thus decrease lipolysis
Insulin effects on muscle tissue
Increase Glucose uptake
Increase Glycogenesis
Increase protein synthesis thus decrease protein catabolism
Normal metabolism blood glucose
F - < 5.5
PP - < 7.8
R - < 11.1
Impaired fasting glucose blood glucose
F - 5.5-6.9
PP - < 7.8
R - < 11.1
Impaired glucose tolerance blood glucose
F - < 7
PP - 7.8-11.1
R - < 11.1
Diabetes blood glucose
F - > 7
PP - > 11.1
R - > 11.1
Impaired fasting glucose VS Impaired glucose tolerance
IFG - predominantly hepatic insulin resistance - continuous output of glucose
IGT - muscle resistance and impaired post prandial insulin release
What is HBA1C
Glycated haemoglobin, haemoglobin that has become glycosylated. Formation of HBA1C occurs proportionately to plasma glucose levels.
Advantages of HBA1C test
easier for patient, don’t have to fast
AVERAGE - less influenced by small fluctuation
Disadvantages of HBA1C test
cannot be done on patients with blood disease ie SCA
This is an AVERAGE over 3 months, thus if there have been recent changes suggesting issues with blood glucose they will be out average by the healthy past few months.
Less SPECIFIC - cant distinguish IFG or IGT.
Why is metformin used as a first line agent to treat diabetes?
Oral Doesn't cause weight gain Low risk of hypoglycaemia Cheap Reduces heart disease Usually well tolerated
Metformin method of action
Decreasing glucose production of liver, generally increases insulin sensitivity of body tissues, increases translocation of GLUT - 4 into membrane.
2 main problems in diabetes and their consequences
Insulin resistance and impaired B cell function - high blood glucose and high free fatty acids
Diabetes risk factors
Overweight Poor diet Sedentary lifestyle Family history Race Age High blood pressure
Microvacular complications of Diabetes
Damage to small blood vessels:
Retinopathy
Kidneys - Nephropathy
Nerves - Neuropathy
Macrovascular complications of Diabetes
Cardiovascular disease - heart attacks, strokes and insufficiency in blood flow to legs.
Diabetic retinopathy ESDT
E - Blindness and visual disability S - Blurred vision D - Eye examinations T - Good metabolic control can delay onset and progression. And early detection.
Nephropathy ESDT
E - Kidney failure
S - Tired, anemic, electrolyte imbalance, can’t think clearly.
D - Urine test / kidney function blood test
T - control of high BG, BP, restriction of protein
Neuropathy ESDT
E - Nerve damage, sensory loss, damage to limbs, impotence
S - numbness and pain in extremities, impotence, decreased sensation can lead to damage and foot infections.
D - regular examinations for symptoms
T - blood glucose controlled to prevent / delay
Diabetic Foot Disease
due to changes in blood vessels and nerves leads to ulceration and subsequent limb amputation.
T - regular inspection and good care ie footwear etc
Diabetic cardiovascular disease
Hyperglycaemia causes atherosclerosis. Decreased flow to heart, brain, extremities - pain and decreased healing from infections.
S - ranging, chest - leg pain, confusion, paralysis.
D - detection of smoking, high BP, high cholesterol and obesity are more important.
T - controlling risk factors with BG
