Lecture 6- Diabetes Flashcards
How is insulin secreted by the pancreatic Beta cell?
- Glucose enters Beta cell
- Glucose is used to generate ATP
- rise in ATP closes ATP dependent K+ channels
- membrane depolarises
- VGCC open and Ca2+ influx
- vesicles containing insulin fuse with membrane + exocytosis
Name two monogenic types of diabetes
Maturity onset diabetes of the young (MODY)
Permanent neonatal diabetes (PND)
What is the inheritance of MODY?
Autosomal dominant monogenic
Name two genes that might cause MODY and explain their function
HNF-1alpha (hepatic nuclear factor) = TF
Glucokinase = Enzyme
What is the function of HNF1-alpha?
A transcription factor stimulating insulin production
What happens when HNF1-a is mutated?
- Insulin production is reduced because ATP sensitive K+ channel doesn’t close
- Manifests in adulthood when B-cell function declines naturally
What can be used to manage MODY?
sulphonylurea- which causes the K+ channel to close
May require insulin therapy
What might be the complications of MODY?
microvascular and microvascular complications
What is the function of glucokinase?
- An enzyme converting glucose to G6P which works around 4mmol/l
- involved in Beta cell glucose sensing
What do mutations in glucokinase cause?
Higher set point at which insulin secretion is triggered
What are the clinical features of gluocokinase MODY?
- stable, mild hypoglycaemia
What is the treatment for GCK MODY?
- Do not need treatment, don’t really have long term complications
- Diagnosis of GCK MODY instead of T1D means treatment can be stopped
Name two rarer types of mutations causing MODY and their clinical manifestations
1) HNF4-a: older age of onset, low renal glucose threshold, macrosomia and transient neonatal hypoglycaemia
2) HNF-1B: Renal cysts and diabetes, genital tract mutation
What is Permanent Neonatal Diabetes?
- Diabetes in the first 6 month of life
Which genes are mutated in PND?
KCNJ11, ABCC8 and INS