Diabetes Mellitus Flashcards
Diabetes
Chronic metabolic disease characterised by elevated levels of blood glucose which leads over time to serious heart, blood vessel, eye, kidney, and nerve damage
Which type of diabetes is autoimmune
Type 1
What cell disruption causes type 1 diabetes
Disruption of pancreatic beta cells in islets of langerhans
What causes type 1 diabetes
Autoantibodies attack islets of langerhans
Insulitis
Inflammation of islets of langerhans
What causes type 2 diabetes
Abnormal insulin action and beta cell dysfunction
Type 2 diabetes risk factors
Family history
Ethnicity
Overweight
Diet
Inactivity
Older age
Hypertension
Impaired glucose tolerance
History of gestational diabetes
Poor nutrition in pregnancy
How does obesity cause insulin resistance
Accumulation of lipids and their metabolites
Incr circulating conc of FFAs
Chronic inflammation
Altered adipokine levels
Mitochondrial dysfunction
Oxidative stress
ER stress
How does hyperinsulinaemia lead to type 2 diabetes
Increases lipid synthesis and exacerbates insulin resistance
Do most genetic susceptibility genes for type 2 diabetes impair insulin secretion or impact insulin action
Impair insulin secretion
What environmental components can damage beta cells
Lipotoxicity
Glucotoxicity
Glucolipotoxicity
Hyperinsulinaemia
What is the most common type of monogenic diabetes
Maturity onset diabetes of the young MODY
What causes maturity onset diabetes of the young MODY
Impairment of insulin secretion/beta cell dysfunction due to mutation of single MODY gene
What pregnancy complications are associated with gestational diabetes
Hypertension
Large birth weight babies
Obstructed labour
Why are children of mothers with gestational diabetes predisposed to becoming overweight
Exposure to hyperglycaemia in the womb
What are possible mechanisms of gestational diabetes
Excessive proinsulin may induce beta cell stress
High hormone concentrations may affect beta cell function and peripheral insulin sensitivity
What type of diabetes has features of type 1 and type 2 diabetes
Latent autoimmune diabetes of adults LADA
How is diabetes diagnosed
Symptoms
Plasma glucose
Oral glucose tolerance test
HbA1c
What plasma glucose results indicate diabetes
Random - >11.1mmol/L
Fasting - >7mmol/L
What test is recommended for gestational diabetes diagnosis
Oral glucose tolerance test
What plasma glucose levels indicate gestational diabetes
Fasting - >5.6mmol/L
2 hrs - >7.8mmol/L
What is HbA1c
Hb with glucose attached
What does HbA1c test show
Average plasma glucose over previous 8-12 wks
What HbA1c indicated diabetes
48mmol/L - 6.5%
What is indicated by a HbA1c level of 42-47 mmol/L
Prediabetes
How is type 1 diabetes treated
Insulin and analogues
What drugs are used in type 2 diabetes
Biguanides
Sulfonylureas
Thiazolidinediones
GLP1R agonists and DPP-4 inhibitors
SGLT2 inhibitors
Meglitinides
Alpha glucosidase inhibitors
Bile acid sequestrants
What drug type is metformin
Biguanide
How do biguanides help diabetes
Inhibit Gluconeogenesis
Enhance insulin sensitivity
How do thiazolidinediones help diabetes
Increase insulin sensitivity by promoting adipogenesis
What is the main issue with thiazolidinediones in type 2 diabetes treatment
Cause weight gain
How do solfonylureas and prandial glucose regulators help type 2 diabetes
Stimulate insulin secretion
Why are DPP-4 inhibitors given with GLP-1 receptor agonists
DDP4 cleaves GLP-1
How do SGLT2 inhibitors help diabetes
Reduce glucose reabsorption and increase urinary glucose secretion
How is DKA treated
Fluids
Electrolytes esp K+
Insulin
What causes Kussmaul’s respiration in DKA
incr breathing to counteract metabolic acidosis
What can reduced insulin and excess glucagon cause in diabetics
DKA
Chronic complications of diabetes
Hyperglycaemia
Atherosclerosis
CV events
Nephropathy
Neuropathy
Retinopathy
Amputation
Dislipidaemia
Diabetic retinopathy mechanisms
Dilation of retina veins
Microaneurisms of retina veins
Internal haemorrhaging and oedema in retina
Formation of fragile new blood vessels which bleed, reduce vision, and cause separation and detachment of areas of the retina
Decr retinal blood flow
Diabetic macular oedema
Apoptosis of retinal pericytes
What is diabetic nephropathy
Disease of the kidney involving damage to the blood vessels in the glomerulus
Characteristics of diabetic nephropathy
Proteinuria
Glomerular hypertrophy
Decr GFR
Renal fibrosis
Types of diabetic neuropathy
Peripheral
Autonomic
Proximal
Focal
What type of diabetic neuropathy causes pain or feeling loss in the hands arm feet and legs
Peripheral
What type of diabetic neuropathy causes changes in digestion, bowel and bladder problems, erectile dysfunction, and heart problems
Autonomic
What type of diabetic neuropathy causes pain in the thighs and hips and weakness in legs
Proximal
What type of diabetes can affect any nerve in the body causing pain or weakness
Focal
What are complications of diabetic neuropathy in the feet
Foot ulcers
Infection
Limb amputation
Why does diabetes increase risk of athersclerosis
Hyperglycaemia
Dislipidaemia
AGE modification of oxidised LDL and their receptor
Glycation of apolipoprotein, LDL, or LDL receptor
How do hyperglycaemia and Dislipidaemia cause atherosclerosis
Causes Endothelial cell dysfunction which increases adhesion of monocytes and platelets
How doe sAGE modification of oxidised LDLs and their receptor cause atherosclerosis
Incr LDL uptake into atherosclerotic plaques
Pro inflammatory cytokines production
How does glycation of apolipoprotein, LDL, and LDL receptors cause atherosclerosis
Impairs cholesterol effluent from atherosclerotic plaques and cholesterol clearance
What are vascular complications of diabetes
Compromised nutrient and oxygen supply to tissues
Stroke
Heart disease
Peripheral artery disease
Why is COVID morbidity higher in diabetics
Impaired immune response
Expression and activity of ACE
Inflammation
Atherothrombotic state
