Diabetes mellitus Flashcards
what is diabetes?
the inability of the body to regulate blood glucose through insulin
type I diabetes
insulin dependent
auto immune; loss of insulin producing beta cells
genetically linked
triggered environmentally
type II diabetes
non-insulin-dependent
insensitivity to insulin
lifestyle and genetics
adult onset, though becoming more prevalent in juveniles
gestational
develops during pregnancy
40% increased likelihood of developing type II later
-fetus-induces changes in metabolism
what percent of the population has diabetes?
10%
do more people have type I or type II?
type II
how many are type I diabetics?
2 million
when you have a spike in glucose levels what else spikes?
insulin
if you eat sucrose rich foot compared to starch rich foods what is different?
the level of glucose and insulin released is higher
what are signs of diabetes?
polyuria and thirst weakness or fatigue polyphagia(excessive hunger) and weight loss blurred vision peripheral neuropathy nocturnal enuresis
what are some other signs of diabetes?
sweet smelling breath
sweet smelling urine
impaired wound-healing
type I key characteristics
insulin absent
elevated glucagon
glucose, fats, and AAs released into and
improper fatty acid metabolism
increases in ketone production and release
lack of insulin leads to what?
dysregulated metabolic state of extreme fasting and starvation
autoimmune targeting of beta cells drives type I how?
it is currently unknown 95% of cases are immune medated 5% idopathic strong genetic predisposition environmental trigger
pathogenesis of type I diabetes
loss of insulin signaling
system mimicry of prolonged fasting
loss of glucose transporters on membrane
thus no glycolysis in cells leading to FA metabolism
adipose tissue is starved of triglycerides due to glucose not being able to enter cells. this leads to what in leptin?
a decrease, so you are hungry all the time leading the hyperglycemia
decrease in insulin leads to decrease in leptin
with insulin deficiency fatty acid oxidation is increased which leads to an increase in ketone bodies. what are the ketone bodies?
acetone - toxic
beta hydroxybutyrate - metabolized
acetoacetate
l
elevated blood ketones leads to what?
osmotic diuresis->dehydration->reduced blood flow->coma and tachycardia
type I diabetes requires what 3 things?
insulin administration
glucose monitoring
diet control
what is the goal of insulin administration
maintain blood glucose between 80-140 mg/dl
what are the two ways to give insulin?
injection
pump-more control over injection
basal insulin does what?
maintains low-level systemic insulin
long half life
what does bolus insulin do
given when food is consumed
hypoglycemia neuroglycopenic symptoms
exhaustion loss of lucidity irritibility blurred vision dizziness headache loss of speech coma and death
hypoglycemia autonomic symptoms
increased heart rate sweating trembling nausea hunger
causes of hypoglycemia
excess insulin
too much activity
insufficient food
illness
treatment for hypoglycemia
immediate sugar glucagon test blood sugar repeatedly test call 911 if necessary
hyperglycemia signs
headache nausea thirst dry mouth excessive urnination ketones blurred vision
causes of hyperglycemia
high blood sugar lack of insulin inactivity excess food illness
treatment of hyperglycemia
insulin
oral hypoglycemic
activity
diet
long term diabetic complications
cardiovascular disease blindness kidney disease neuropathy impaired wound healing and amputation
type II diabetes
progressive increase in fasting glucose due to reduced insulin sensitivity followed by a degeneration of insulin production (destroyed beta cells)
possible mechanisms for insensitivity
adipokine signaling
extopic lipid storage
inflammatory signaling
what is macrophage chemotaxis protein (MCP-1)
released by adipose tissue and recruit macs once they reach a certain capacity of fat
what do macs release once they get to the adipose tissue
TNF alpha which releases fatty acids from adipose tissue, which makes muscles use fatty acids for energy and not glucose, thus insensitivity to glucose
treatment for type II diabetes
lifestyle changes
oral hypoglycemics
insulin once beta cell masses degenerate, reversible
what do oral hypoglycemics do? 3 things
increase insulin
increase insulin sensitivity
decrease carb absorption
type II drugs to treat hyperglycemia
metformin
sulfonylureas
peroxisome proliferator-activated receptor agonists
alpha-glucosidase inhibitors
what are the five ways to detect diabetes
urinalysis glucose monitoring (fasting) HGA1c glucose tolerance test C-peptide test
what is the glucose tolerance test
known amount of glucose is given (100grams)
levels are tested at 30 min and 90-120 min
if glucose levels stay high then they may have diabetes, BUT DOES NOT TELL YOU WHICH TYPE THEY HAVE
**what is a C-peptide test **
done to determine type I or type II
- *if you have no C-peptide then you have no insulin being produced and thus you are type I
- *if you have C-peptide then you have type II
