Diabetes and its treatment Flashcards
how is insulin made
beta cells of pancreas –> proinsulin –> breaks down in to C peptide and insulin
effects of insulin
decreases blood glucose
increases glucose in liver, kidneys, muscle
normal range of blood glucose levels
4-7M/m
define diabetes
metabolic disorder characterised by chronic hyperglycaemia resulting from defects in insulin secretion/ action/ both
difference between type 1 and type 2 insulin
type 1: insulin deficiency. autoimmune destruction of pancreas
type 2: insulin resistance (due to other hormones/ obesity)
why is obesity linked to insulin type 2 diabetes 2
hormones linked to obesity prevent insulin binding to receptor IRS1
mutations of 2nd messengers
what is cut off point for having diabetes
4-7m/M normal
8-10 impaired glucose tolerance
11 M/m DIABETES
IGT stand for and relevance to diabetes
impaired glucose tolerance
50% go on to develop diabetes
how doe HbA1c test for diabetes work
looks at glucose over ast 2-3 months (lifetime of current haemoglobin
HbA1c cannot pick up rapid changes, so do not use…
cannot pick up rapid changes, so do not use:
- children/ young people
- symptoms suggesting type 1 diabetes
- short duration diabetes symptoms
- pts at high risk of diabetes who are acutely ill
- pts taking medication that may cause rapid glucose rise eg corticosteroids
when HbA1c can be innacurate
TABLE ON DIAGNOSIS VALUES
- HIGH HbA1c 2: persistant HbF (thalassaemia), uraemia (carbamylates Hb) *high HbF Fucking High)
- LOW HbA1c 2: haemolysis, inc red cell turnover, blood loss (HbS, HbC, Low and SexC)
3 types of diabetes
1,2, gestational
2 types of pre diabetes
impaired fasting glycaemia
impaired glucose tolerance
impaired fasting glycaemia:
a. cause
b. risk of diabetes
c. risk of disease
d. treatment
e. preventing progress to diabetes
a. cause: unknown, ?glucose sensitising
b. risk of diabetes: 50%, 50% recovery to normal
c. risk of disease: not known
d. treatment: healthy diet, yearly glucose checks
e. preventing progress to diabetes: not known
impaired glucose tolerance:
a. cause
b. risk of diabetes
c. risk of disease
d. treatment
e. preventing progress to diabetes
a. cause: insulin resistance
b. risk of diabetes: 50%, 50% return to normal
c. risk of disease: heart disease, cerebrovascular disease
d. treatment: diabetic diet, yrly glucose checks, tx of cardiac risk factors
e. preventing progress to diabetes: exercise, weight loss
causes other than diabetes for
a. insulin deficiency
b. insulin resistance
a. insulin deficiency: cancer/ alcohol –> destroy pancreas
b. insulin resistance: receptor abnormalities (leprechaunism, insulin resistance symptoms A and B)
excessive hormones (cushing’s, acromegaly)
type 1 diabetes:
a. incidence
b. cause
c. pathology
a. incidence: 1/10 000, M>F, normally
6 symptoms of type 1 diabetes
- polyuria (bedwetting)
- thirst esp for sugary drinks
- weight loss
- dehydration
- ketoacidosis
- coma
possible genes for type 1 diabetes
DR3, DR4
new options for type 1 diabetes tx
- insulin pumps (continuous insulin –> less hypos but v expensive)
- inhaled insulin (only 1/10 dose absorbed. long term safety not known)
- islet cell transplant (beta cells)
- pancreas transplant
type 2 diabetes
a. incidence
b. cause
c. pathology
a. incidence: 1/1000 (more undiagnosed), m=f, normally >40
b. cause: genetic > environment
c. pathology: insulin resistance, insulin deficiency
relationship between birthweight and type 2 diabetes
low birthweight, go on to be heavy adults –> higher risk of diabetes
4 things which contribute to type 2 diabetes development
birthweight
genetics
exercise
fat distribution (upper body obesity ie in abdomen mroe risk of diabetes)
2 step model of type 2 diabetes
genetic predispositon –>
insulin resistance –>
relative lack of insulin –>
hyperglycaemia
diet/ activity levels/ level of obesity all contribute to this process
