KCP: Diabetes Mellitus & Obesity

Question 1

Risk factors for diabetes mellitus

Answer 1

1. Obesity
2. Age
3. Sendenty lifestyle
4. High sugar diet
5. Smoking
6. Genetics

Question 2

What might be the reasons for genotypes and phenotypes susceptable to diabetes mellitus?

Answer 2

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

Question 3

Common gut microbiome that is responsible for obesity and why?

Answer 3

Fermicutes

These produce more harvisable energy from foods and more common in obese people

Question 4

Symptoms of Hyperglycaemia?

Answer 4

• Polyuria (passing lots if urine)
• Polydipsia (thirst)
• Fatigue
• Inffections

Question 5

Diagnoses of diabetes

Answer 5

• Random plasma glucose or plasma glucose 2h after 75g of glucose >11.1mmol/L
• Fasting plasma glucose >7mmol/L
• Haemaglobin A1c >48mmol/mol

Question 6

Diagnoses of pre-diabetes

Answer 6

• 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

Question 7

What is haemaglobin A1c?

Answer 7

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

Question 8

Type 1 diabetes and treatment

Answer 8

Caused by the destruction of pancreatic beta cells hence can’t produce insulin

Treatment by insulin therepy

Question 9

Tyoe 2 diabetes pathogenesis

Answer 9

• Increased glucos production in the liver
• Increased glucose reapsortion from the kidneys
• Decreased glucose uptake in muscles
• Increased lypolysis

Question 10

What does metformin do?

Answer 10

• Sensitises insulin action
• Decreases glucagon action

Question 11

A note of other drug treatments for type 2 diabetes if metformin and insulin isn’t working

Answer 11

The two most common are:

Question 12

What is lypolysis and how is it affected by insulin?

Answer 12

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

Question 13

What do SGLT2 inhibitors do?

Answer 13

Question 14

What do GLP-1 agaonists do?

Answer 14

Promotes weight loss

Question 15

Fundementally what is type 2 diabetes?

Answer 15

Insulin resistance

Question 16

What leads to insulin resistance?

Answer 16

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?

Question 17

Why are blood ketones or ketones int he urine a sign of type 2 diabetes?

Answer 17

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.

Question 18

What are Islet autoantibodies?

Answer 18

Islet autoantibodies are markers that appear when insulin producing beta cells in pancreas are damaged.

Question 19

Why is weight gain a symptom of type 2 but weight loss is a symptom in type 1?

Answer 19

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.

Question 20

Why doesn’t metformin cause hypoglycemia?

Answer 20

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.