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Management of GI and Endocrine Conditions > Lecture 16 - Insulin and Diabetes > Flashcards

Lecture 16 - Insulin and Diabetes Flashcards

1
Q

When was diabetes mellitus first described?

A

c1500 BCE as too great emptying of urine

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2
Q

when was the term diabetes introduced?

A

250 BCE, meaning “siphone”

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3
Q

When was mellitus introduced?

A

1600s, meaning from honey

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4
Q

What did the introduction of diabetes mellitus allow?

A

the distinction from diabetes insipidus

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5
Q

What is the most common endocrine disorder?

A

Diabetes

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6
Q

what is diabetes?

A

an insufficiency in the production or action of the pancreatic hormone insulin on target cells

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7
Q

Who identified insulin

A

Banting and Best in the McLeod lab

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8
Q

who and when was the first person to receive insulin?

A

Leonard Thompson, 1922

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9
Q

What is diabetes characterised by?

A

abnormal fuel metabolism, which results most notably in hyperglycaemia and dyslipidaemia due to defects in insulin production/secretion, insulin action or both

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10
Q

What causes hyperglycaemia?

A

loss of insulin stimulated glucose uptake and loss of insulin repression of gluconeogenesis and glycogen breakdown

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11
Q

What causes dyslipidemia?

A

loss of insulin repression of lipolysis

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12
Q

What is type 1 diabetes?

A

loss of insulin production

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13
Q

What is type 2 diabetes?

A

insulin resistance; insufficient secretion of insulin

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14
Q

What is T1D sometimes referred to as?

A

insulin dependent diabetes

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15
Q

What % have T1D?

A

5-10%

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16
Q

When does T1D typically develop?

A

in children and young adults

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17
Q

What is the peak age for diagnosis of T1D?

A

10-14 years

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18
Q

Insulin secretion in T1D?

A

pancreas produces little or no insulin

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19
Q

What causes T1D?

A

it is an autoimmune disorder

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20
Q

What do T1D patients need as treatment?

A

insulin injections

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21
Q

When does type 2 diabetes occur?

A

when the body is in an insulin resistant state and pancreatic beta cells cannot release sufficient insulin to compensate for the resistance

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22
Q

What % have type 2?

A

90-95% of diabetic people

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23
Q

When is type 2 typically diagnosed?

A

Later in life, but disease onset is getting earlier

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24
Q

What is type 2 largely a result of?

A

lifestyle - obesity, lack of exercise, diet

genetic factors are also important

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25
Q

what % of patients with type 2 are overweight?

A

International Diabetes Federation - 80% of people with type 2 are overweight or obese at the time of diagnosis

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26
Q

How is type 2 picked up?

A

can develop without the person knowing and is usually picked up during routine medical screening

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27
Q

How is type 2 managed?

A

by oral medications or insulin injections, with diet and exercise contrl

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28
Q

How many people does gestational diabetes affect?

A

18 in every 100 women during pregnancy

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29
Q

When does gestational diabetes develop?

A

in the 2nd trimester and disappears after the child is born

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30
Q

What causes gestational diabetes?

A

not clear but thought to be due to various hormonal changes that occur during pregnancy, many of which can block the action of insulin

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31
Q

In 2018, how many people in the UK were diagnosed with diabetes?

A

6% (~3.8 million people)

this figure has more than doubled since 1996

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32
Q

How many people in the UK have undiagnosed diabetes?

A

~1 million

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33
Q

What % of NHS budget is spent on diabetes?

A

~10% (£10 billion = £192 million per week)

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34
Q

How many hospital beds are occupied by someone with diabetes?

A

1 in 7 beds

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35
Q

How many prescription items dispensed for diabetes?

A

52 million items in England, 3.6 million in Scotland

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36
Q

What are most cases of diabetes?

A

type 2 - due to ageing population and increasing numbers of overweight and obese people

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37
Q

What are the 3 main tests for diagnosis of diabetes?

A

Fasting glucose test/random glucose test

glucose tolerance test

HbA1c

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38
Q

What is the fasting glucose test?

A

no food or drinks (except water) for 8-10 hours

values for fasting plasma glucose taken

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39
Q

what is a normal fasting plasma glucose level?

A

below 6.1mmol/L (110mg/dL)

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40
Q

What fasting glucose level is impaired?

A

6.1-6.9mmol/l

111-125mg/dL

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41
Q

What fasting glucose levels indicates diabetes?

A

> 7.0 mmol/l (126mg/dL and above)

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42
Q

What is the random glucose test?

A

Regardless of when a person last ate, a random plasma glucose value of 11.1mmol/l (100mg/dL) indicates diabetes

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43
Q

What is the oral glucose tolerance test?

A

Subject fasts for at least 8 hours, plasma glucose is measure immediately before and 2 hours after drinking 75g of glucose dissolved in water

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44
Q

What plasma glucose 2 hours after glucose indicates diabetes?

A

> 11.1mmol

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45
Q

What plasma glucose level 2 hours after glucose indicates impaired glucose tolerance?

A

7.9-11mmol/l

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46
Q

What is haemoglobin A (HbA)?

A

the major form of haemoglobin

47
Q

What does HbA1c form as?

A

a result of slow and irreversible reaction between HbA and glucose

48
Q

What is the amount of HbA1c formed proportional to?

A

the amount of glucose present

49
Q

What do HbA1c levels give a measure of?

A

the average blood glucose levels over the previous 3 months (the average life-time of red blood cells)

50
Q

What do HbA1c levels indicate?

A

how well blood glucose is being controlled (long term trend)

51
Q

What can HbA1c levels be used as?

A

a diagnostic test for type 2 diabetes

52
Q

HbA1c results…?

A

> 48mmol/mol (6.5%) indicates type 2 diabetes

42-47 mmol/mol (6-6.4%) indicates a risk of developing diabetes

53
Q

For most adults with diabetes, what is the HbA1c target?

A

48mmol/mol (6.5%)

54
Q

Why can HbA1c not be used to diagnose type 1 diabetes?

A

these symptoms can develop very rapidly, a rapid increase of blood glucose levels over a short period of time would not be picked up by HbA1c because it is a long term trend

55
Q

Diagnosis of diabetes?

A

Made by classic acute symptoms of hyperglycaemia (excess urination, thirst, fatigue) and an abnormal blood test

56
Q

In patients without classic symptoms, how is a diagnosis made?

A

by two abnormal blood tests on separate days

57
Q

How are type 2 asymptomatic patients diagnosed?

A

through opportunistic screening of high risk groups during routine medical visits

58
Q

Why is early diagnosis important?

A

diabetes will get progressively worse if not treated correctly

59
Q

What is diabetes associated with?

A

significant morbidity and mortality due to both acute and chronic effects

60
Q

What are the acute complications due to?

A

hyperglycaemia

61
Q

What do chronic complications arise due to?

A

damage to various organs (eyes, kidneys, nerves, heart, brain)… the main reason is vascular damage

62
Q

What are some of the chronic complications of diabetes?

A

blindness, stroke, kidney disease, nerve damage, amputation, heart attack, loss of circulation in arms and legs

63
Q

What are the acute symptoms of diabetes?

A

frequent urination (polyuria)

increased thirst (polydipsia)

tiredness

unexplained weight loss

extreme hunger

blurred vision

cuts or wounds that heal slowly

genital itching/frequent episodes of thrush

64
Q

Why do patients have polyuria?

A

amount of glucose filtered by the kidney exceeds the maximal capacity for reabsorption, resulting in glucose entering the urine (glycosuria) and drawing water with it by osmotic diuresis

65
Q

Why do patients have increased thirst?

A

as a result of urinating more

66
Q

Why are diabetic patients tired?

A

the cells do not get the energy they need as the glucose is not taken up

cells cannot use glucose as a metabolic fuel to make ATP

67
Q

Why is there unexplained weight loss?

A

the fat stores are broken down and used to supply energy

68
Q

Why is there extreme hunger?

A

glucose is not utilised for energy

69
Q

Why is there blurred vision?

A

lens of eye becomes dry due to dehydration and glucose build up

70
Q

Why do cuts or wounds heal slowly in diabetic patients?

A

damage to blood vessels limits the flow of oxygen and nutrients needed for repair

71
Q

Why do patients get genital itching/frequent episodes of thrush?

A

yeast infections caused by high glucose in blood/urine (supports yeast growth)

72
Q

How do acute symptoms of type 1 develop?

A

rapidly

73
Q

How do acute symptoms of type 2 develop?

A

over a number of years

74
Q

What is diabetic ketoacidosis?

A

a potentially life threatening complication of type 1 diabetes

75
Q

What does absence of insulin enhance?

A

free fatty acid (FFA) release from adipocytes

76
Q

What are FFAs converted to?

A

ketone bodies by the liver, which serve as an energy source

77
Q

Give examples of ketone bodies

A

acetoacetate and beta-hydroxybutyrate

78
Q

What do ketones cause?

A

the pH of the blood to become acidic

79
Q

What does the liver do in diabetic ketoacidosis?

A

continue to synthesise glucose so the blood glucose rises

80
Q

What does high glucose in the urine cause?

A

takes water and solutes such as sodium and potassium with it, causes dehydration

81
Q

What does a lack of insulin limit?

A

the use of glucose as an energy source

82
Q

Early signs of diabetic ketoacidosis?

A

feeling very thirsty, urinating often, high blood glucose levels, high ketone levels in the urine

83
Q

Later, extreme signs of DKA?

A

feeling weak and constantly sleepy, dry/flushed skin, nausea, vomiting and abdominal pain, difficulty breathing, fruity smelling breath

84
Q

Treatment of DKA?

A

fluid replacement, insulin, mineral replacement

85
Q

When does DKA usually develop?

A

at the time of diagnosis of diabetes, during illness, during growth spurt/puberty, when insulin has not been taken correctly

86
Q

Why does DKA not occur in type 2?

A

the metabolic changes are not usually severe enough

87
Q

When do chronic complications of diabetes develop?

A

gradually, over decades

88
Q

What are chronic complications due to?

A

due to vascular damage

89
Q

What can the vascular damage be?

A

either microvascular or macrovascular

90
Q

What is microvascular damage?

A

damage to small blood vessels (capillaries)

91
Q

What is macrovascular damage?

A

damage to larger blood vessels (arteries and veins)

92
Q

What is hyperglycaemia associated with?

A

damage to blood vessels and atherosclerosis

93
Q

What do diabetics have an increased risk of?

A

developing high blood pressure

94
Q

What is diabetic retinopathy?

A

leading cause of blindness in adults

caused by damage to vessels in the eye

95
Q

What is diabetic nephropathy?

A

leading cause of end-stage renal disease

caused by damage to small blood vessels in the kidney

96
Q

What is diabetic neuropathy?

A

leading cause of non-traumatic lower extremity amputation, causes sensory loss and impotence

caused by hyperglycaemia and damage to blood vessels

97
Q

What increased risk of stroke to diabetics have?

A

2-4 fold increase in CV mortality and stroke

98
Q

How many diabetics die from CV events?

A

8 out of 10

99
Q

what % of mortality does diabetes account for globally?

A

14.5% in the age group of 20-79

100
Q

What is diabetic foot?

A

nerve damage or poor blood flow to feet increases risk of various complications

101
Q

What can happen to cuts/blisters of diabetic patients?

A

they become serious infections, which often heal poorly and may ultimately need toe, foot or leg amputation

102
Q

What is the most common cause of lower limb amputations?

A

diabetes

~7,400 leg, toe and foot amputations happen each year in England alone

103
Q

Diabetes and dementia?

A

people with diabetes are at a 1/5-2/5 fold increase of dementia

104
Q

Pregnancy complications to child?

A

increased risk of miscarriage, still birth and birth defects when diabetes is not well treated

105
Q

Pregnancy complications for mother?

A

increased risk of DKA, retinopathy, pregnancy induced high blood pressure and pre-eclampsia

106
Q

What is the key to preventing acute and chronic diabetes complications?

A

good control of blood glucose

patient education is key

107
Q

What is the estimated diabetes prevalence?

A

for adults ages 20-70 is 422 million

108
Q

How many people is diabetes expected to affect?

A

1 in 10 people by 2040 (642 million)

109
Q

How many adults with type 2 are undiagnosed?

A

1 in 2

110
Q

10 countries with highest diabetes prevalence?

A

Tokelau, Nauru, Mauritius, Cook Islands, Marshall Islands, Palau, Kuwait, Saudi Arabia, Qatar, New Caledonia

111
Q

WHO Fact 6?

A

people with diabetes can lead a long and healthy life when their condition is detected and well managed

112
Q

WHO Fact 7?

A

early diagnosis and intervention is the starting point for living well with diabetes

113
Q

WHO Fact 10?

A

type 2 diabetes can be prevented and cured by lifestyle changes

Management of GI and Endocrine Conditions (24 decks)

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