Endocrine Disorders W4 Flashcards
What is considered the fastest growing chronic disease?
Type II Diabetes
What is Diabetes Mellitus defined as?
Diabetes mellitus refers to “presence of glucose in the urine”
It is associated with a lack of secretion or a lack of activity of the hormone insulin, which, in uncontrolled diabetes, results in raised blood glucose levels
Explain this diagram. What is the bidirectional relationship between diabetes and periodontitis?
The relationship between diabetes and periodontal disease is a two way process. Hyperglycaemia increases risk of periodontitis and poor periodontitis health negatively impacts diabetes.
More specifically:
Higher blood sugar levels in diabetes = increased formation of glycated AGE’s (advanced glycation end products) which are proinflammatory mediators
= more inflammation, increased osteoclasts, destruction of oral tissues
What is the difference between Diabetes Mellitus and Diabetes Insipidus?
- Diabetes mellitus: blood level glucose (blood sugar) = excessively high. The kidneys try to remove the extra glucose by passing it in urine. Associated with deficiency of the hormone, insulin.
- In diabetes insipidus, your blood glucose levels are normal, but your kidneys can’t properly concentrate urine. Caused by a deficiency of ADH.
What is the main distinction between Type 1 diabetes and Type 2 diabetes?
Type 1: genetic condition that shows in early life. Characterised by the destruction of insulin-producing beta cells in the pancreas. An absolute lack of insulin.
Type 2: heterogeneous condition, lifestyle related (unhealthy diet, physical inactivity) shows later in life. Disorder of both insulin levels (insufficient) AND insulin disfunction/resistance = hyperglycaemia results.
Explain the difference between Type 1A and 1B diabetes
Type 1A: immune-mediated ie. autoimmune destruction of pancreatic beta cells = NO insulin = evelaveted blood glucose levels & breakdown of body fat and proteins
Type 1B: idiopathic ie. arises spontaneiously (cause unknown) - possible inheritence
If diabetes is not controlled, what is the basic impact of the condition on the metabolism?
In uncontrolled Diabetes, a person is unable to transport glucose into fat and muscle cells.
= cells being “starved”
= fat and protein breakdown is increased in order to compensate and provide an energy source for these cells.
What leads to the loss on insulin production with Type I Diabetes?
An autoimmune reaction directed at insulin-producing beta cells in the pancreas. Or idiopathic (1b) spontaneous.
If Type 1 diabetes is not carefully managed, sufferers can develop the serious problem of ____.
What causes this problem?
Ketoacidosis
Insulin inhibits lipolysis (breakdown of fat) and release of free Fatty Acids (pro inflammation) from adipocytes. Free FA’s convert to ketones in the liver.
Therefore if insulin isn’t present, lipolysis is not inhibited and its effect yields uncontrolled Free FA release- ketoacidosis.
How is Type I and Type II diabetes diagnosed?
blood tests…
- fasting plasma glucose levels
- casual (random) plasma glucose tests
- glucose challenge test
- glycosylated haemoglobin test (long term picture of blood glucose levels)
Hyperglycaemia = above 7mmol/L
What is Type II Diabetes defined as?
Heterogeneous, lifestyle disease, progressive condition.
Disorder of both insulin levels (beta cell dysfunction) and insulin function (insulin resistance). Results in hyperglycaemia.
What are some factors that lead to beta-cell dysfunction in the pancreas with Type 2 Diabetes?
What role does a high-fat diet play in this process?
Obesity,
Increased Free FA concentration and adipokines, stimulates beta-cells to secrete insulin
Chronic and excess stimulation causes beta-cell failure
What does insulin normally do
Induces glucose storage in liver, muscle and aipose tissue = lowering blood glucose levels
What causes insulin resistance in type 2 diabetes
Due to inflammatory processes in the dysfunctional visceral adipose tissue
ie. Obestity = inflammation (particularly in adipose tissue)
= dysfunctional adipose tissue ie. adipocytes can’t take more lipids and die an early cell death
= membrane ruptures release of intracellular contents (adipokines: pro-inflammatory ex. free F.A’s)
= attracts more pro-inflam cytokines
= low-grade systemic inflammation
= impaired insulin signalling
= insulin resistance
What is the disease process/propogation of type 2 diabetes
- Obestity = chronic systemic inflammation = insulin resistance
- Initially insulin production in beta cells is upregulated to combat diminised insulin action
- Beta cells dysfunction and exhaustion = insulin deficiency
- Blood glucose levels continue to rise
What is the condition associated with insulin resistance and the associated symptoms
Metabolic syndrome
hyperglycaemia
central obestiy
abnormal blood lipids
hypertension
insulin resistance
Inflammation
Requires 3 of the above symptoms for diagnosis
Insulin resistance not only contributes to hyperglycaemia, but plays a role in other metabolic abnormalities. What are these called, and what are the signs of this?
Metabolic Syndrome- Insulin Resistance Syndrome
High LDLS,
Low HDLS,
Hypertension
Systemic inflammation
Vascular Disease