Session 8: Type 1 and 2 Diabetes Mellitus Flashcards
What is Diabetes Mellitus?
Disease in which body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood.
Type 1 vs type 2 diabetes
What is Prediabetes?
Higher than normal blood sugar level - more likely to develop type 2 diabetes.
What is Type 1 diabetes?
Autoimmune destruction of beta cells in the pancreas by the immune system.
What is Type 2 diabetes?
Beta cells gradually lose ability to produce insulin.
What happens upon diagnosis of diabetes?
There is a >85% loss of pancreatic islet cell loss.
How does diabetes present (symptoms)?
- Polyuria
- Dehydration
- Polydipsia
- Glycosuria
- Lethargy
- Weight loss
- Blurred vision
- Nausea
- Headache
What is the aetiology of type 2 diabetes?
- Genetic
- Environmental: diet, obesity, lifestyle
What is a catabolic crisis in diabetes?
Diabetic ketoacidosis (DKA)
- Mitochondrial oxaloacetate depleted
- Acetyl-CoA reacts with itself to form acetoacetate and 3-hydroxybutyrate (ketone bodies)
- Body in desperate need for fuel sources.
In diabetes, coughing can be a symptom of…
High blood sugar levels.
What is Polydipsia?
Excessive thirst.
What is Hyperosmolar hyperglycemic state?
Serious condition characterized by hyperglycemia, hyperosmolarity and dehydration and the absence of ketoacidosis that may occur in type 2 diabetes.
What are the long-term effects of hyperglycaemia?
1) Glycation of proteins
2) Formation of ROS.
What is Diabetic peripheral neuropathy?
Progressive deterioration of peripheral nerve function that results in loss of sensory perception.
- Ulcers
- Gangrene
What is Diabetic retinopathy?
Complication of uncontrolled diabetes.
Blood vessels in the eye can become damaged, leading them to leak proteins. Nerves in the eye progressively deteriorate, leading to sight loss.
What is Diabetic nephropathy?
Kidney disease resulting from late-stage diabetes mellitus.
What are the macrovascular complications of diabetes?
- Stroke
- Heart attack
- Intermittent claudication
- Gangrene
- CVD
Why is the incidence of diabetes increasing?
- Obesity
- Longevity
- Diet
- Sedentary lifestyle
- Urbanisation, economic development.
What are the diagnostic criteria for diabetes?
- Fasting plasma glucose concentration ≥ 7.0 mmol/L
- Random venous glucose ≥11mmol/L
- Two-hour plasma glucose concentration ≥ 11.1 mmol/L after oral glucose tolerance test (OGTT).
What is Haemoglobin A1C (HbA1C)?
- Glycated plasma proteins in diabetes causes sticky blood.
- HbA1C measures glycated protein.
- Level of HbA1C tells us cumulative exposure to plasma glucose concentration (over past 120 days).
What are the treatments for type 1 diabetes?
- Insulin injections
- Pancreas transplants
- Immunosuppressant drugs (autoimmune).
What are the treatments for type 2 diabetes?
- Lifestyle
- Non-insulin therapies
- Insulin
- Patient education & active monitoring.
What are insulin secretagogues for type 2 diabetes?
- Biguanides (metformin)
- Sulphonylureas
- GLP1 analogues.
What are the risks of hypoglycaemia?
- Brain damage
- Cardiac arrest
- Coma
- Death.
What is involved in the monitoring of patients with diabetes?
- Wellbeing monitoring
- Glucose control: capillary blood glucose testing, urine glucose testing
- HbA1c glycated haemoglobin
- Other vascular risk factors: smoking, exercise, diet, BP
- Complication surveillance.
What is the pathophysiology of Type 1 diabetes?
Autoimmune destruction of insulin secreting beta cells in pancreas (islets of Langerhans).
What is the pathophysiology of Type 2 diabetes?
- Peripheral insulin resistance
- Impaired regulation of hepatic glucose production
- Declining beta-cell function leading to failure of beta-cells.
What are the shared symptoms of both T1D and T2D?
- Polyuria
- Polydipsia
- Extreme hunger
- Unintentional weight loss
- Blurry vision
- Sores or wounds that heal slowly
- Numbness/tingling in hands and feet (peripheral neuropathy).
What lifestyle modifications can benefit both T1D and T2D?
- Healthy diet
- Physical activity
- Blood sugar level monitoring
- Stress management.
In pre-diabetes, there is an impaired glucose tolerance and an ___% loss of pancreatic islet cells.
80%.
Which organs take up glucose to convert this to glycogen?
Liver and muscle.
What happens when glycogen stores are full in the liver and muscle?
- Liver metabolises glucose to triacylglycerols
- Carried to adipose tissues as VLDLs for storage.
What is the normal blood glucose range in the blood?
3.6-5.8 mM.
What is the diagnosis for Katie, a 7 year old girl who has recently started feeling very tired and sleepy, passing urine more frequently, seems thirsty all the time, and started losing weight?
Type 1 diabetes.
Why might Katie suffer from Type 1 Diabetes rather than Type 2 Diabetes?
Young age.
What key tests can be used to confirm diabetes diagnosis?
- Blood finger prick test for initial level of glucose
- Urine dipstick test for glucose and ketones
- Blood sample for glucose and electrolytes
- Breath test for smell of acetone.
What is the term for the presence of glucose in urine?
Glycosuria.
What is the term for the presence of ketones in urine?
Ketonuria.
What triad of symptoms do patients with type 1 diabetes present with?
- Polyuria
- Thirst
- Weight loss
- Polydipsia.
What are the key differences between type 1 and type 2 diabetes?
- Causes = genetic, environmental, immune (autoimmune)
- Need of immediate insulin treatment
- Ketoacidosis is common
- Rapidly fatal if untreated.
What is one example of a microvascular complication of diabetes?
Retinopathy.
Which region(s) is damaged in type 1 diabetes?
C.
Increased levels of insulin are associated with ___ and increased levels of glucagon are associated with ___
Increased levels of insulin are associated with hypoglycaemia and increased levels of glucagon are associated with hyperglycaemia.
Name two processes which lead to increased availability of glucose in the body.
- Gluconeogenesis
- Glycogenolysis.
What is the presentation of type 1 diabetes?
- Tiredness
- Polyuria
- Polydipsia
- Weight loss
- Ketones on breath
- Risk of ketoacidosis.
Type 2 diabetes is more prevalent in which two ethnic groups?
South Asian, Afro-Caribbean.
What are the long-term microvascular complications of Type 2 Diabetes?
Eyes = retinopathy, cataracts
Kidneys = nephropathy, renal failure
Nerves = neuropathy, pain.
What are the long-term macrovascular complications of Type 2 Diabetes?
- Brain = stroke, transient ischaemic attack (TIA)
- Heart = coronary heart disease, heart attack
- Extremities = peripheral vascular disease.
What is involved in the management of Type 2 diabetes?
- Weight loss
- Regular exercise
- Reduce cardiovascular risks: smoking, cholesterol, BP, renal function
- Oral medications: insulin
- Regular monitoring.
What are the differences between Type 1 and Type 2 Diabetes Mellitus?
