KCP: Diabetes Mellitus & Obesity Flashcards
Risk factors for diabetes mellitus
- Obesity
- Age
- Sendenty lifestyle
- High sugar diet
- Smoking
- Genetics
What might be the reasons for genotypes and phenotypes susceptable to diabetes mellitus?
Genotype:
In times of famine you are going to want to not store energy and instead use it
Phenotype:
Foetal malnutrition can lead to reduced beta cells and insulin resistance so that the baby doesn’t starve. Generation born during Dutch famine had higher prevelence of diabetes
Common gut microbiome that is responsible for obesity and why?
Fermicutes
These produce more harvisable energy from foods and more common in obese people
Symptoms of Hyperglycaemia?
- Polyuria (passing lots if urine)
- Polydipsia (thirst)
- Fatigue
- Inffections
Diagnoses of diabetes
- Random plasma glucose or plasma glucose 2h after 75g of glucose >11.1mmol/L
- Fasting plasma glucose >7mmol/L
- Haemaglobin A1c >48mmol/mol
Diagnoses of pre-diabetes
- Impaired glucose tolerance: fasting plasma glucose < 7mmol/L and 2h after 75g of glucose 7.8-11.1mmol/L
- Impared fasting glucose: 6.1< fasting glucose < 7 mmol/L
What is haemaglobin A1c?
This is the ammount of glucose bound to haemaglobin
Reaction is slow so elevated HbA1c might take a while
Used to monitor response to treatment and the reference rnage is 22-40mmol/mol
Type 1 diabetes and treatment
Caused by the destruction of pancreatic beta cells hence can’t produce insulin
Treatment by insulin therepy
Tyoe 2 diabetes pathogenesis
- Increased glucos production in the liver
- Increased glucose reapsortion from the kidneys
- Decreased glucose uptake in muscles
- Increased lypolysis
What does metformin do?
- Sensitises insulin action
- Decreases glucagon action
A note of other drug treatments for type 2 diabetes if metformin and insulin isn’t working
The two most common are:
What is lypolysis and how is it affected by insulin?
Lypolysis is the breakdown of lipids into energy
A lack of insulin encourages lypolysis hence why weight loss can be part of type 1 diabetes
What do SGLT2 inhibitors do?
What do GLP-1 agaonists do?
Promotes weight loss
Fundementally what is type 2 diabetes?
Insulin resistance
What leads to insulin resistance?
Genetic is a big factor.
But BMI can lead to inculin resistance because adipocytes require insulin in order to take up glucose. Therefore the more adipocytes you have (particularly around the abdominal region) the more more insulin you require therefore higher levels of insulin can lead to resistance.
Fatty deposits around the organs and cells means they are less responsive to insulin?
Why are blood ketones or ketones int he urine a sign of type 2 diabetes?
When the cells aren’t getting enough glucose they break down fat for energy instead. This also makes acidic ketones which builds up int he blood and urine.
What are Islet autoantibodies?
Islet autoantibodies are markers that appear when insulin producing beta cells in pancreas are damaged.
Why is weight gain a symptom of type 2 but weight loss is a symptom in type 1?
In type 1 there is simply no insulin therefore lypolysis increases and fat is burned.
In type 2 the pancreas releases more and more insulin in response to the hyperglycemia therefore the extremely high levels of insulin actually result in lipogenesis and weight gain.
My take from this is that the resistance effects the storgae of glycogen and usage in muscles more that adipocytes.
Why doesn’t metformin cause hypoglycemia?
Because it only discourages glycogenesis and absorbtion of glucose from the gut but doesn’t encourage uptake in muscles or glycolysis hence it won’t remove it all form the blood.
