Lecture 2 - Introduction to disorders of the endocrine system - Diabetes 1 and 2 Flashcards
Define the role of the pancreas
Sense levels of glucose in the bloodstream
What does insulin decrease in plasma?
Glucose
Amino acids
FFAs
‘anabolic’
What does glucagon increase in plasma?
Glucose, ketones, ‘catabolic’
What does glucagon do?
Can mobilise glycogen to release glucose into the bloodstream and keep your blood glucose levels normal
Catabolic hormone
Breaks down storage molecules to release glucose and provide energy for the body
Name the three types of diabetes mellitus
Type 1 diabetes
Type 2 diabetes
Gestational Diabetes
Define type 1 diabetes
the body is unable to produce any insulin
appears in childhood and before the age of 40
sudden onset
autoimmune disease of the pancreatic beta islet cells
What are the symptoms of type 1 diabetes?
Increased urination
Increased thirst
Weight loss
Fatigue
Nausea and vomiting
Coma
What are the benefits of islet cell transplantation for type 1 diabetes?
live without insulin injections
Improved blood glucose control
more stable control
What are the risks of islet cell transplantation for type 1 diabetes?
Transplantation surgery risk
Immunosuppressant drugs side effects - to prevent your body from rejecting the islet cells
Need 2-3 transplants to have enough mass to produce insulin effectively
Define type 2 diabetes
The body can’t produce enough insulin or the body cannot respond to insulin = insulin resistance
More common in people >40
Symptoms of type 2 diabetes
Increased urination
increased thirst
Increased appetite
Fatigue
Blurred vision
Slow healing infections
Impotence in men
Slower onset than type 1
Risk factors for T2DM
Family history
Age
Ethnicity
Weight
Blood pressure
High Cholesterol lipids
Sedentary lifestyle
Gestational diabetes
Define insulin
Anabolic hormone
Activates a reactor tyrosine kinase
Levels may be low, normal or high in insulin resistance
Cells are able to carry out a certain amount of glucose metabolism
Consequences of insulin resistance
Associated with metabolic syndrome, PCOS
Inflammation of liver
Hypertension
Atherosclerosis and increased risk of CVD
Low HDL ‘good’ cholesterol
Increase in fat stores (abdominal)
Elevated triglycerides
Fatigue and changes in appetite
Increased thirst and increased urination
Elevated blood sugar
Hyperglycaemia
Excess weight, genetic factors, sedentary lifestyle
Define pre eclampsia
high blood pressure in pregnancy
Name the tests for diabetes
Glycosylated haemoglobin (HbA1c)
Fasting plasma glucose test (FPG)
Oral glucose tolerance test (OGTT)
Urine analysis
Define glycosylated haemoglobin (HbA1c)
When glucose attaches to proteins they become glycated (glycosylated)
HbA1c is a test that measures glycated haemoglobin
What levels of HbA1c suggests diabetes?
> 48mmol/mol type 2
between 42-48mmol/mol risk of developing diabetes
Explain the fasting glucose test (FPG)
Fast for 8hours blood sample taken
Blood sugar >7mmol/l in fasted state - diabetes
Explain the oral glucose tolerance test (OGTT)
Fast for 8 hours, blood sample taken, drink sugary drink, 2hours later blood sample taken
Blood glucose 7.9-11 mmol/l - impaired glucose tolerance (IGT)
Blood glucose >11mmol/l - diabetes
Explain the glycosuria urine analysis
Quick and simple ‘dipstick’ test
Less accurate than HbA1c or GTT
Kidney normally reabsorbs glucose into the body - excess glucose appears in urine
Explain the ketone bodies urine analysis
Quick and simple ‘dipstick’ test
Body can switch from using glucose to using fats to provide cellular energy and produce ketones
Ketones can change blood pH leading to diabetic ketoacidosis particularly in type 1
State the metabolic complications
Hypoglycaemia or hyperglycaemia
Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycaemic state (HSS) - associated with dehydration
State the microvascular complications
Damage to small blood vessels - arterioles, capillaries and venues
Retina (retinopathy)
Kidney (nephropathy)
Nerves (neuropathy)
State the macro-vascular complications
Damage to larger arteries
Brain - leading to stroke
Heart - leading to CHD
Legs and feet - leading to peripheral vascular disease
Define diabetic microangiopathy
End up with fragile, leaky blood vessels - become smaller and smaller, blood flow disrupted
Explain diabetic nephropathy
Damage to the capillaries in the glomerulus leads to breakdown of filtration barrier and more protein than normal collects in the urine
Exacerbated by hypertension
Develops slowly
Protein in urine - kidney dysfunction
BP increases so more proteins leaked from the blood vessels in kidney, kidney function can completely decline leading to chronic kidney failure
Define neuropathy
Peripheral nerve dysfunction
Capillary damage - leads to nerve damage and loss of sensation
Begins loss of sensation in the toes and leads to injury
Increased risk of infection (ulcers, gangrene) - diabetic foot
