Type 2 Diabtetes Flashcards
What is decompensation and when does it occur?
It is the point at which the beta-cells are no longer able to produce enough insulin to combat the insulin resistance. At this stage it is clinical diabetes
What is insulin resistance classified as and how does it present?
It’s the need of more insulin to achieve the same physiological function.
It presents as lowered glucose utilisation at all levels of insulin concentration.
What are some of the physiological ways in which an insuline resistance acts?
A decrease in the number of insulin receptors
An increase in post-receptor defects, such as decreased action of glucose transporters
Why is there such a large link between obesity and insulin resistance?
Adipose tissue is a primary mediator of insulin resistance
- free FAs have a toxic affect on muscle insulin sensitivity by interfering with the IRS signals
- there is a dysregulation in the secretion of adipokines (such as leptin), which have been shown to increase insulin resistance
Name some of the adipokines
TNF-alpha Leptin Adiponectin PPAR-gamma Resistin
What happens to insulin production as the disease progresses?
Impaired insulin production intensifies as the disease progresses
People with the disease have an absent first phase insulin response and a diminished second phase response
What are first phase and second phase insulin responses?
First phase is when the insulin already in the beta-cells is immediately released in response to glucose
Second phase happens in the next few hours, after more insulin has been produced, and the body can properly regulate the blood sugar levels
Defects in what inhibits insulin secretion?
Glucokinase
What happens to glucagon secretion?
It increases (absolutely or relatively) to insulin
What symptoms does T2DM have in common with T1?
Polyuria Noctouria Polydispepsia Polyphagia Fatigue Slow healing cuts and wounds Blurred vision Hyperglycaemia
What symptoms are just T2DM patients likely to have?
Certain skin disorders (psoriasis or acanthosis nigricans)
Genital itching
Weight gain - due to presence of endogenous insulin suppressing lipolysis
What are the risk factors for T2DM?
Weight - the more fat you have, the more insulin resistant you are likely to be
Fat distribution - abdominal stores carry greater risk
Inactivity - activity increases insulin sensitivity
Family history
Race - blacks, Hispanics, south Asians
Age - over 45
Prediabetes
Gestational diabetes
Polycystic ovary syndrome - maybe because it increases weight?
In what two ways can patients with T2DM present?
-Insulin resistant
-Relative impairment of insulin secretion
This means, people with T2DM have a relative insulin deficiency.
People are usually skewed more towards one or the other
