T2DM lecture Flashcards
what is the definition of Diabetes mellitus ?
Diabetes Mellitus is defined as a metabolic disorder of
multiple aetiology characterised by chronic hyperglycaemia
with disturbances of carbohydrate, protein and fat
metabolism, resulting from defects in insulin secretion, insulin action, or both.
list the progression and development of T2dm
1) Genetic predisposition
2) Greatest trigger = weight gain
3) Dyslipidemia
4) Hypertension
5) Hyperglycemia
List the adipokines which are involved in insulin resistance and describe their roles
Leptin: tells hypothalamus about amount of stored fat
Adiponectin: reduces levels of free fatty acids
TNFα: insulin receptor signalling interference
Resistin: enhances hypothalamic stimulation of glucose production
what effect do insulin receptor gene mutations have?
Causes severe Hyperinsulinemia, associated with acanthosis nigricans and hyperandrogenism
what is acanthosis nigricans?
skin disorder characterized by velvety hyperpigmentation of the skin
what effect does glucotoxicity have?
impairs beta cell function
what effect do glucokinase defects have?
impaired insulin secretion
What effect do Pancreatic beta cell transcription factor mutations have?
reduced insulin production in response to glucose
how can the risk of diabetic cardiovascular complications be reduced?
By reducing HbA1c
what effect does the enzyme acarbose have in treating type 2 DM?
Reduces absorption of carbohydrate from bowel- slows post-prandial rise in blood glucose
how is metformin more effective than sulphonylurea?
Metformin has better CV benefit and a lower hypoglycaemic risk
what cell type secretes GLP-1?
Intestinal L cells
what effect does GLP-1 have on pancreatic Beta cells, alpha cells, liver, stomach and brain when it is secreted after a meal?
pancreatic Beta cells: It provides as stimulus for Beta cells to secrete insulin
alpha cells: It suppresses glucagon levels that are inappropriately elevated in patents with type 2 DM
liver: lower glucagon levels reduce hepatic glucose output
stomach: slows the rate of gastric emptying which reduces the rate at which meal derived glucose appears in circulation
Brain: GLP-1 promotes satiety and reduces appetite, which leads to a feeling of fullness and a reduction in food intake
which SGLT transporter reabsorbs most of the glucose?
SGLT2
what risk does the use of SUs pose?
Hypoglycaemia
