diabetes and obesity (W2) Flashcards
pancreas cell types
beta cells and alpha cells
what switches acetyl CoA carboxylase off and on
on - phosphatase, insulin
off - kinase
why does excess glucose convert to fat
excess insulin activates acetyl CoA carboxylase, which helps produce fat
changes to reverse obesity trends - societal change?
content of processed foods (reduce sugar, salt, fat)
healthy & nutritious options available
restrict certain food marketing
support and encourage regular physical activity
taxation policy
social policy
individual change to reduce obesity?
reduce energy intake from sugar and possibly fats (reduce processed food)
increase consumption of fruit, veg, whole grains, nuts
regular physical activity
type 2 diabetes risk factors (10)
overweight/obesity
abdominal or central obesity
age
low socio-economic status
sedentary lifestyle
unhealthy diet choices
smoking
genetic ancestry
family history
psychosocial stress and depression
diabetes mellitus presentation
asymptomatic hyperglycaemia (majority) or symptoms of hyperglycaemia
hyperglycaemia meaning
elevated blood glucose
hyperglycaemia symptoms
polyuria
polydipsia
fatigue
recurrent infections
weight loss (type 1)
polyuria?
passage of large volumes of urine with an increase in urinary frequency
polydipsia?
excessive thirst
diabetes diagnosis - different tests?
random plasma glucose
fasting plasma glucose
haemoglobin A1c
random plasma glucose level in diabetes
greater or equal to 11.1mmol/L
fasting plasma glucose level in diabetes
greater or equal to 7.0mmol/L
haemoglobin A1c level in diabetes
greater or equal to 48mmol/mol
pre-diabetes features
impaired glucose tolerance
impaired fasting glucose
name for glycated haemoglobin that is tested for in diabetes?
haemoglobin A1c
why are haemoglobin A1c tests effective for diabetes
higher glucose is in the blood, the more glucose will bind to haemoglobin therefore the higher your haemoglobin A1c is.
how long will a patient have to have diabetes symptoms for to have an increase in haemoglobin A1c levels
at least 4-6 weeks
type 1 diabetes presentation
typically young
weight loss
ketones in blood
fast onset of symptoms
often has family history
type 2 diabetes presentation
slow onset
variable symptoms
family history (but not to same extent as type 1)
normally after age 40
type 1 diabetes treatment
insulin therapy
type 2 diabetes pathogenesis
decreased incretin effect
increased lipolysis
increased glucose reabsorption
decreased glucose uptake
inflammation
neurotransmitter dysfunction
vascular insulin resistance
increased hepatic glucose production
decreased insulin secretion
increased glucagon secretion
what component produced by the intestine stimulates insulin production
incretin
most important treatment for type 2 diabetes
lifestyle advice!
-nutritional advice
-weight loss advice
-exercise
-stop smoking
-reduce alcohol
weight loss advice specifics for type 2 diabetes
aim to lose 5-10% of original weight over 6-12 months
drug treatment for type 2 diabetes
metformin
metformin effects?
sensitizes insulin action
opposes action of glucagon
reduced hepatic gluconeogenesis
increase glucose uptake by muscle
causes weight loss
metformin side effects?
GI upset
target for Haemoglobin A1c for metformin treatment in type 2 diabetes?
48-53 mmol/mol
most likely second line drug for type 2 diabetes treatment
SGLT2 inhibitor (flozins)
flozins example?
canagliflozin
complications of diabetes mellitus
hypertension
kidney disease
retinopathy
cardiovascular disease
neuropathy (peripheral or autonomic)
infections
