Type 2 Diabetes Mellitus Flashcards
- Is T2 Diabetes common?
- Is it serious?
- Yes - common
- very serious problem
Lifetime cost of diabetes in USA is … billion
815 billion dollars
What is diabetes mellitus?
A condition where the blood glucose is above an internationally accepted level
Diabetes - Diagnostic terms: Usual clinical diagnosis:
- Blood:
- Glucose = or > … mmol/l + symptoms
- Glucose = or > …mmol/l x 2
- HbA1c = or > 48 mmol/mol (…%)
- Lower value does not exclude diabetes
- Glucose = or > 11.1 mmol/l + symptoms
- Glucose = or > 11.1 mmol/l x 2
- HbA1c = or > 48 mmol/mol (6.5%)
- Lower value does not exclude diabetes
Diabetes - Diagnostic terms: 75 Glucose Tolerance Test
- Diabetes Mellitus:
- Fasting plasma glucose = / > … mmol/l
- 2 hour plasma glucose = / > … mmol/l
- Impaired glucose tolerance
- 2 hour glucose between …-… mmol/l
- Impaired fasting glucose
- fasting glucose between …-… mmol/l
- Diabetes Mellitus:
- Fasting plasma glucose = / > 7 mmol/l
- 2 hour plasma glucose = / > 11.1 mmol/l
- Impaired glucose tolerance
- 2 hour glucose between 7-11 mmol/l
- Impaired fasting glucose
- fasting glucose between 6-6.9mmol/l
What is the gold standard test for diabetes?
75g Glucose Tolerance test
What exactly is Type 2 diabetes?
- “A … condition where there is a … cells abnormality resulting in insuffient … to keep the … … normal in the context of … resistance”
“A common condition where there is a Beta cells abnormality resulting in insuffient insulin to keep the blood glucose normal in the context of insulin resistance”
What cells are in the pancreas? (shown on histological slide)
Islet cells
In the picture the islet cells are stained, what condition does this happen in?
T2 diabetes
Cause of B cell problems in Type 2 diabetes
- Genetics
- … (+ / - 60 genes)
- … programming (epigenetics)
- maternal hyper…
- intrauterine growth …
- Genetics
- polygenic (+ / - 60 genes)
-
Fetal programming (epigenetics)
- maternal hyperglycaemia
- intrauterine growth retardation
Type 2 diabetes is seen in a high percentage of …
identical twins
Other possible aetiological factors of Type 2 diabetes include… (3)
- old age
- change in the gut microbiota
- glucotoxicity and lipotoxicity (later effects)
What is this showing? (what condition)
Type 2 diabetes
Why are people insulin resistant?
- relates to …
- Many years of coping to deal with …
- Now, we have plenty of … available
- relates to obesity
- Many years of coping to deal with famine
- Now, we have plenty of calories and food sources available
- Fat in the … laid down as it should be = no harm
- If it spills out (‘run out of room’) it spills and becomes … fat
- Fat in the buttocks laid down as it should be = no harm
- If it spills out (‘run out of room’) it spills and becomes visceral fat
… fat is a strong risk factor for vascular disease
epicardial fat is a strong risk factor for vascular disease
Excess fat in the diabetic … is specific to type … diabates and important in preventing normal … production
Excess fat in the diabetic pancreas is specific to type 2 diabates and important in preventing normal insulin production
Ectopic fat - a problem
- It is acting like an … organ producing
- free … …
- causing … resistance
- … lipids
- cytokines
- causing … resistance
- pro … situation
- pro… factors (PAI1)
- free … …
- It is acting like an endocrine organ producing
- free fatty acids
- insulin resistance
- atherogenic lipids
- cytokines
- insulin resistance
- pro inflammatory situation
- procoagulant factors (PAI1)
- free fatty acids
This shows the problems caused by what type of fat?
ectopic fat
Study - looking at CVS disease - 3 patients
- P1 - Individual of normal body weight - not much visceral. CVS issues at follow up?
- P2 - Lots of non visceral fat - fat in places designed to be lad down (some visceral fat) CVS issues at follow up?
- P3 - lots of visceral fat - (also ectopic fat in abdomen) - also fat around muscle - CVS issues at follow up?
- P1 - Individual of normal body weight - not much visceral. CVS issues at follow up? - no
- P2 - Lots of non visceral fat - fat in places designed to be lad down (some visceral fat) CVS issues at follow up? - no
- P3 - lots of visceral fat (ectopic fat in abdomen) - also fat around muscle - CVS issues at follow up? - yes - risk of developing hypoglycaemia because of their insulin resistance and this also compounds the whole situation
This graph shows people with … syndrome vs people without it
metabolic syndrome
Metabolic syndrome: other associations
- Fatty liver disease with …
- Hepatocellular carcinoma and intrahepatic cholangiocarcinoma
- Chronic … disease
- Polycystic … …
- …-disordered breathing
- Hyperuricemia and g…
- An increased risk of … decline and …
- Fatty liver disease with steatosis
- Hepatocellular carcinoma and intrahepatic cholangiocarcinoma
- Chronic kidney disease
- PCOS - polycystic ovarian syndrome
- Sleep-disordered breathing
- Hyperuricemia and gout
- An increased risk of cognitive decline and dementia
Diagnosis of metabolic syndrome and insulin resistance
- Important physical sign is what?
- How do we measure it?
Important physical sign is what? - substantial abdominal obesity - measure and record via waist circumference
What is this graph showing? (increasing … in young people)
What is this graph showing? (increasing obesity in young people)
Microvascular damage to small blood vessels in the eye and the retina - leading to haemorrhages and exudate - macula - enables you to see clearly - if these get into centre person may lose vision
- What condition may this happen in?
- Why does this happen?
- What condition may this happen in? - Type 2 diabetes
- Why does this happen? - blood glucose too high for too long
- … shown in the image are much more common in individuals with …
- There is an increased generation of polyols from …
- 1% reduction in … reduces … risk by 19%
- Cataracts - common in diabetes
- There is an increased generation of polyols from glucose
- 1% reduction in HBA1c reduces cataract risk by 19%
Another tissue which is damaged in T2 diabetes is the … - longest ones suffer most - these are where? what develops? Do you notice it easily?
- Another tissue which is damaged in T2 diabetes are the nerves - longest ones suffer most - in the feet
- develop neuropathic ulcer
- dont always notice it
Another problem with blood sugar being too high for too long in T2 diabetes is … of connective tissue
Another problem with blood sugar being too high for too long in T2 diabetes is glucosylation of connective tissue
Treatment of hyperglycaemia reduces … disease
microvascular disease
Treatment of hyperglycaemia reduces larger blood vessel diseases such as …. and …. by a much smaller amount
Treatment of hyperglycaemia reduces larger blood vessel diseases such as stroke and myocardial infarction by a much smaller amount
The major cause of death of people with T2 diabetes is what?
heart attacks
Why do people with T2 diabetes have heart attacks?
- Many people with diabetes have a lot of these inflammatory type …. particles circulating (more than those with normal BG)
- ‘Bad’ cholesterol (called …) - when you glycosalate it - with high BG this happens - becomes more …genic and pro-…
- Good cholesterol - known as … - is lower in these individuals
- Many people with diabetes have a lot of these inflammaotry type lipoprotein particles circulating (more than those with normal BG)
- Low density lipoprotein‘bad’ cholesterol - glycosalate - with high BG this happens - becomes more atherogenic and pro-inflammatory
- ‘Good’ cholesterol - HDL - lower in these individuals
Atherosclerotic lesion - how does a MI happen?
- … plaque - if stable what happens?
- If you have pro-inflammatory like proteins and other inflammatory substances being produced by the … fat - inflammatory reaction inside the plaque - dissolves the cap - pro inflammatory material leaks into … … causing blood …
- How do we fix this?
- atheromatous plaque - if stable what happens? - not much
- If you have pro-inflammatory like proteins and other inflammatory substances being produced by the ectopic fat - inflammatory reaction inside the plaque - dissolves the cap - nasty pro inflammatory material leaks into coronary artery causing blood clot
- Give clot blusters - restore blood flow and prevent MI
Large blood vessels in feet are affected by pro-inflammatory process (in T2 Diabetes)
- What disease?
What disease? - Peripheral vascular disease
- What is this device for (left)? (Screening for…)
- What about right device?
- How often should we examine this area?
- Microfilament - screen for Neuropathy (use on feet)
- Right - feel pedal pulses - absent - check with handheld doppler - if absent pulses and peripheral vascular disease - at risk for ulcers and amputation - serious coronary artery disease
- How often should we examine this area - feet examined once a year - avoid these issues
