Diabetes and Metabolic Syndrome Flashcards
Alpha Cells
secrete glucagon –> which elevates glucose and causes liver/kidney to secrete and retain glucose
Beta Cells
secrete insulin, C-peptide, and amylin
Type 1 Diabetes
autoimmune destruction of beta-cells in islet of Langerhans leading to absolute insulin deficiency
- rapid onset, 50% concordance in monozygotic twins
- “honeymoon” phase can be present
- antibodies to glutamic acid decarboxylase-65
Type 2 Diabetes
progressive insulin secretory defect on background of insulin resistance (80% of beta-cell function is lost at time of diagnosis)
- insidious onset, environmental factors contribute
- abnormal insulin action and secretion
- impaired suppression of glucagon
Things that lead to hyperglycemia
- Decreased incretin
- Decrease insulin secretion
- Increased glucagon secretion
- Increased HGP
- Neurotransmitter dysfunction
- Decreased glucose uptake
- Increased glucose reabsorption
- Increased lipolysis
Gestational Diabetes
diagnosed during pregnancy with glucose tolerance test
- first hour challenge if >140, do more
Screening for diabetes
Overweight individuals with >1 risk factor
- physical inactivity
- 1st degree relative
- high risk ethnicity
- woman with baby > 9lbs
- HTN
- high cholesterol/triglycerides
- women with POCS
- history of CVD
Diagnosis of Diabetes
- fasting glucose of >126 on 2 occasions
- random glucose of >200 with symptoms
- plasma glucose >200 after glucose load
- glycosylated hemoglobin >6.4% (GOLD STANDARD)
Complications of diabetes
Microvascular
- retinopathy, neuropathy, nephropathy
Macrovascular
- CVD, claudication, CAD
Labs for diabetes
glucose, A1c, lipids, renal panel, microalbumin (urine), TSH, hepatic
- every diabetic should be on a statin
Treatment of Type 1 diabetes
INSULIN!
- intensive therapy with tight control decreases risk of chronic microvascular complications
Treatment of Type 2 diabetes
First line therapy --> diet, exercise, education MANY DRUGS - always metformin - sulfonylureas - alpha-glucosidase inhibitors - thiazolinediones - amylinomimetics - incretin modulators
Metformin (glucophage)
decreases hepatic glucose production
- no hypoglycemia, weight neutral, lipid lowering
- decreases macrovascular complications!
- S.E. = GI
- contraindicated in someone with renal impairment (high creatinine) –> lactic acidosis
Sulfonylreas
bind sulfonylurea receptors on beat-cells and stimulate insulin release –> requires pancreas function!
S.E. = hypoglycemia, weight gain, potential impairment of cardiac ischemic preconditioning
- decreased effectiveness with prolonged use
Thiazolidinediones
increases amount of glucose taken up by muscle cells –> keeps liver from over-producing glucose
- no hypoglycemia, lipid lowering, and reduces macrovascular complications
S.E. = edema, CHF, fractures in women, MI?
EXPENSIVE
