Diabetes Mellitus Flashcards
What’s DM?
DM is a group of metabolic diseases characterized by hyperglycemia resulting from impaired secretion of insulin, impaired action of insulin or both
The chronic hyperglycemics of diabetes is associated with long-term damage,dysfunction failure of various organs, eye, kidney, heart, blood vessels, nerves
Physiology of DM and action of insulin
Betacells from pancreas secrete insulin,
Insulin acts on target tissues (e.g., muscle, liver, and adipose tissue
Insulin connect/ bind with specific receptors( insulin receptors) on cell surface to transport glucose to or in the cell.
Insulin Regulates/ maintains the normal glucose levels (3.3-5-5
M/mol/L)
Insulin also takes part in protein synthesis and lipid synthesis
Levels that regulate glucose
For insulin
Glycogen synthesis+
Gluconogenesis-
Glycolysis+
For Glucagon/ glucocorticoids
Glycogen synthesis-
Gluconogenesis+
Glycolysis-
More info on the levels that regulate glucose
Glycogen Synthesis (Glycogenesis)
Glycogen synthesis, also known as glycogenesis, is the process by which glucose molecules are converted into glycogen, a storage form of glucose in the body. Glycogenesis primarily takes place in the liver and muscle cells. It is stimulated by insulin and facilitated by the enzymes glycogen synthase and branching enzyme. Glycogen is an important energy reserve that can be broken down into glucose during periods of fasting or increased energy demand, such as during exercise.
Gluconeogenesis
Gluconeogenesis is the process of generating glucose from non-carbohydrate sources, such as lactic acid, glycerol, and certain amino acids. This process occurs primarily in the liver and, to a lesser extent, in the kidneys. Gluconeogenesis is essential during periods of fasting, intense exercise, or low carbohydrate diets, as it helps to maintain a stable blood glucose level and provide energy to glucose-dependent tissues like the brain and red blood cells. Key enzymes involved in gluconeogenesis include pyruvate carboxylase, phosphoenolpyruvate carboxykinase, fructose 1,6-bisphosphatase, and glucose 6-phosphatase.
Glycolysis
Glycolysis is a metabolic pathway that breaks down glucose (a six-carbon molecule) into two molecules of pyruvate (a three-carbon molecule). This process occurs in the cytoplasm of cells and generates ATP (adenosine triphosphate), NADH (nicotinamide adenine dinucleotide), and other intermediate metabolites. Glycolysis is an anaerobic process (does not require oxygen) and serves as a primary energy source for cells, especially under anaerobic conditions or during periods of high energy demand. Key enzymes involved in glycolysis include hexokinase, phosphofructokinase-1, and pyruvate kinase.
In summary, glycogenesis and gluconeogenesis are two opposing metabolic pathways responsible for the synthesis and degradation of glycogen, respectively. Glycogen acts as an energy storage molecule. Glycolysis, on the other hand, is the breakdown of glucose to produce energy in the form of ATP, which fuels various cellular processes.
More info on the levels that regulate glucose
Glycogen Synthesis (Glycogenesis)
Glycogen synthesis, also known as glycogenesis, is the process by which glucose molecules are converted into glycogen, a storage form of glucose in the body. Glycogenesis primarily takes place in the liver and muscle cells. It is stimulated by insulin and facilitated by the enzymes glycogen synthase and branching enzyme. Glycogen is an important energy reserve that can be broken down into glucose during periods of fasting or increased energy demand, such as during exercise.
Gluconeogenesis
Gluconeogenesis is the process of generating glucose from non-carbohydrate sources, such as lactic acid, glycerol, and certain amino acids. This process occurs primarily in the liver and, to a lesser extent, in the kidneys. Gluconeogenesis is essential during periods of fasting, intense exercise, or low carbohydrate diets, as it helps to maintain a stable blood glucose level and provide energy to glucose-dependent tissues like the brain and red blood cells. Key enzymes involved in gluconeogenesis include pyruvate carboxylase, phosphoenolpyruvate carboxykinase, fructose 1,6-bisphosphatase, and glucose 6-phosphatase.
Glycolysis
Glycolysis is a metabolic pathway that breaks down glucose (a six-carbon molecule) into two molecules of pyruvate (a three-carbon molecule). This process occurs in the cytoplasm of cells and generates ATP (adenosine triphosphate), NADH (nicotinamide adenine dinucleotide), and other intermediate metabolites. Glycolysis is an anaerobic process (does not require oxygen) and serves as a primary energy source for cells, especially under anaerobic conditions or during periods of high energy demand. Key enzymes involved in glycolysis include hexokinase, phosphofructokinase-1, and pyruvate kinase.
In summary, glycogenesis and gluconeogenesis are two opposing metabolic pathways responsible for the synthesis and degradation of glycogen, respectively. Glycogen acts as an energy storage molecule. Glycolysis, on the other hand, is the breakdown of glucose to produce energy in the form of ATP, which fuels various cellular processes.
Classifications of DM
Type I - idiopathic and autoimmune( immune mediated)
Type 2 - insulin resistance and insulin secretory deficiency
Others specify-
a)Monogenic DM(MODY)- typical for young people basically like type one with mild symptoms of type 2 caused by mutation of genes responsible for insulin secretion. usually develops before the age of 25
b)Secondary DM- i) by endocrine disorders normally with hyper production of hormones example Pheochromocytoma(that produces an excessive amount of adrenaline and noradrenaline). Cushing’s Syndrome ( caused by the overproduction of cortisol, a stress hormone produced by the adrenal gland)
ii) by pancreas disease- Pancreatic Trauma (Traumatic injuries to the pancreas), chronic pancreatitis,cystic fibrosis,
c)Drug induced DM- glucocorticoids drugs
Gestation Diabetes-leaves after pregnancy
Diabetes in pregnancy
Type one DM
Type 1 Diabetes
Type 1 diabetes, also known as insulin-dependent, is an autoimmune disorder where the body’s immune system attacks and destroys insulin-producing beta cells in the pancreas.
It usually develops in childhood or adolescence but can occur at any age.
Fast process, severe leads to absolute insulin
Insufficiency
Type one symptoms
Thirst, weight loss, hunger, polyuria,
Excessive thirst and increased fluid intake (polydipsia).
Frequent urination (polyuria), particularly at night (nocturia).
Unexplained weight loss, despite increased appetite and food intake (polyphagia).
Fatigue and weakness due to the body’s inability to properly use glucose for energy.
Blurred vision as a result of high blood glucose levels causing fluid shifts in the eye.
Slow-healing wounds and frequent infections, as high blood glucose can impair the immune system and hinder wound healing.
Nausea, vomiting, or stomach pain, which can occur as a result of diabetic ketoacidosis (DKA), a life-threatening complication of Type 1 diabetes.
Type two DM
Type 2 diabetes, also known as non-insulin-dependent or adult-onset diabetes, is the most common form of diabetes.
It occurs when the body becomes resistant to the effects of insulin or does not produce enough insulin to meet its needs.
Type 2 diabetes typically develops in adulthood, but is increasingly seen in children and adolescents due to rising obesity rates.
Gradual, mild clinical symptoms, problem with receptors
Symptoms of type two
Obesity,
Increased thirst and frequent urination: Just like in Type 1 diabetes, the body tries to rid itself of excess glucose through urine, leading to increased thirst and urination.
Fatigue: High blood glucose levels can cause fatigue, as the body is unable to use glucose for energy effectively.
Blurred vision: High blood glucose levels can cause fluid shifts in the eye, leading to blurred vision.
Slow healing wounds: High blood glucose levels can impair the immune system and delay wound healing.
Numbness or tingling in the hands or feet: Over time, high blood glucose levels can cause nerve damage, resulting in numbness or tingling sensations in the extremities.
Dark patches of skin: Diabetes can cause dark patches of skin, especially in the armpits and neck.
DM diagnostics
Blood glucose test( capillary/ venous)
Oral glucose tolerance
Glycated hemoglobin BT( HBAIc)
DM Insulin therapy- absolute indication for insulin
DM type 1
DM + diabetes ketoacidosis , diabetic coma
DM+ pregnancy
DM type2 + therapeutic failure of oral antidiabetic agents
Normal secretion of Insulin in thebody
A) basal secretion- insulin is secreted in Bits (long and intermediate)
B) prandial secretion -meal secretion here insulin increases after eating ( short acting and rapid)
Mixed
Prandial secretion rapid acting drugs and short acting drugs
Prandial secretion refers to the release of certain hormones or enzymes in response to food intake.
Rapid-acting insulin: These drugs are designed to be absorbed quickly and start working within 15 minutes, with a peak action time of about 1 hour
Rapid-acting insulin:
NovoLog (insulin aspart)
Humalog (insulin lispro)
Apidra (insulin glulisine)
Short-acting insulin: These drugs take longer to start working compared in to rapid-acting insulin, usually beginning to act within 30 minutes and peaking after 2-3 hours
Short-acting insulin:
Regular insulin (Humulin R)
Actrapid
basal secretion interme acting drugs and long acting drugs Examples
Basal secretion refers to the continuous release of insulin by the pancreas to meet the body’s needs between meals and during periods of fasting
Intermediate-acting insulin:
Humulin N (NPH insulin)
Novolin N (NPH insulin)
Long-acting insulin:
Lantus (insulin glargine)
Levemir (insulin detemir)
Tresiba (insulin degludec)
