Lecture 6: Diabetes Flashcards
1
Q
Pancreas
A
- Pancreas is both an endocrine and an exocrine gland
- Houses the islets of Langerhans
- Secretion of glucagon and insulin
- Cells:
- Alpha—glucagon (catabolic)
- Beta—insulin (anabolic) and amylin
- Delta—somatostatin and gastrin
- F cells—pancreatic polypeptide
2
Q
Endocrine Pancreas: Insulin
A
- anabolic hormone
- Synthesized from pro-insulin
- Secretion is promoted by increased blood levels of glucose, amino acids, GI hormones
- Facilitates the rate of glucose uptake into the cells of the body
- Anabolic hormone
- Synthesis of proteins, lipids, and nucleic acids
3
Q
Endocrine Pancreas: Amylin
A
- Peptide hormone co-secreted with insulin
- Delays nutrient uptake
- Suppresses glucagon secretion
4
Q
Endocrine Pancreas ans Insulin Action on Cells
A
- Diagram showing the effective of insulin
- Glucose plays a role in anabolic process – synthesize tissues in the body
- In healthy adults – able to sit in the plasma membrane and can take glucose into the cell
- The transporter can be deferred
5
Q
Endocrine Pancreas: Glucagon
A
- Secretion is promoted by decreased blood glucose levels
- Stimulates glycogenolysis, gluconeogenesis, and lipolysis
6
Q
Diabetes
A
- Group of metabolic disorders that share a common feature of HYPERGLYCEMIA
- Type 1 DM: absolute deficiency of insulin cause by beta cell destruction- autoimmune disorder
- cells of the pancreas are attacked and destroyed (beta cells)
- Type 2 DM: combination of peripheral resistance to insulin action and inadequate secretory response
- Type 1 DM: absolute deficiency of insulin cause by beta cell destruction- autoimmune disorder
7
Q
Diabetes In Canada
A
- Diabetes prevalence is growing at epidemic levels across Canada.
- Currently, one in four Canadians have diabetes or prediabetes.
- Diabetes cost Canada $11.7 billion in 2010, and is projected to rise to $16 billion by 2020
- Complications from diabetes account for 80% of diabetes costs.
8
Q
In Canada, People with Diabetes Account For…
A
9
Q
Classification of Diabetes
A
10
Q
Diagnosis of Diabetes
A
FPG ≥7.0 mmol/L
Fasting = no caloric intake for at least 8 hours
or
A1C ≥6.5% (in adults)
Using a standardized, validated assay in the absence of factors that affect the accuracy of the A1C and not for suspected type 1 diabetes
or
2hPG in a 75 g OGTT ≥11.1 mmol/L (done for all pregnant women – sugary drink & look at glucose after a certain time period)
or
Random PG ≥11.1 mmol/L
Random = any time of the day, without regard to the interval since the last meal
11
Q
Confirmatory Test Required
A
- In the absence of symptomatic hyperglycemia, if a single lab test result is in the diabetes range, a repeat confirmatory lab test (FPG, A1C, 2hPG in a 75 g OGTT) must be done on another day
- Repeat the same test (in a timely fashion) to confirm
- But a random PG in the diabetes range in an asymptomatic individual should be confirmed with an alternate test
- If results of two different tests are available and both are above the diagnostic thresholds, the diagnosis of diabetes is confirmed
12
Q
Diagnosis of Prediabetes
A
13
Q
A1C Level and Future Risk of Diabetes: Systematic Review
A
14
Q
Definition of Metabolic Syndrome
A
- Clustering of risk factors is defined as metabolic syndrome
- Need at least three to be indicative of metabolic syndrome
15
Q
AC1 Targets
A
16
Q
Prevalence of Type 1 Diabetes
A
- 300,000+ Canadians may have T1D.
- 25% of people with T1D are diagnosed as adults.
- 10X risk of developing T1D if family has a positive history
17
Q
Type 1 Diabetes Mellitus
A
- Pancreatic atrophy and specific loss of beta cells; hyperglycemia when 80 to 90% cells lost
- Macrophages, T-cytotoxic cells, antibodies
- Alterations in insulin, amylin, glucagon
Mistakenly makes antibodies that attack the beta cells in pancreas - less insulin produced
18
Q
Genetic Susceptibility In T1D
A
- Human leukocyte antigen (HLA) region on chromosome 6
27
Q
Epiology of Type 2 Diabetes
A
41
Q
Initial Choice of Therapy for Diabetes
A
42
Q
Management of T2D
A
- This is the updated algorithm for management of type 2 diabetes in people with type 2 diabetes.
- At the time of diagnosis of type 2 diabetes, healthy behaviour interventions should be initiated. This is new preferred term over “lifestyle modification”. These include nutritional therapy, weight management, and physical activity. This is also an option to start metformin.
- A change from the 2013 guidelines is the next step is based on the patients individualized A1C target rather than an absolute value.
- If the A1C is less than 1.5% above the patient’s target A1C, if they are not at glycemic target within 3 months of healthy behaviour interventions, metformin should be started or increased.
- If the A1C is greater than or equal to 1.5% above target A1C, metfomin should be started immediately. A second concurrent antihyperglycemmic agent antihyperglycemic agent should be considered.
- If the patient has symptomatic hyperglycemia and/or metabolic decompensation, insulin should be initiated alone or in combination with metformin. This includes patients with dehydration, diabetic ketoacidosis or hyperosmolar hyperglycemic state.
- If the patient remains not at glycemic target, the first question to ask in choosing the second antihyperglycemic agent is whether the patient has clinical cardiovascular disease. Clinical cardiovascular disease is defined as history of myocardial infarction, coronary artery disease on angiography, unstable angina, stroke, peripheral artery disease)
- If the patient has clinical cardiovascular disease, an antihyperglycemic agent with demonstrated CV benefit should be added. This recommendation is based on several cardiovascular safety outcome studies.
