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PBL > Unit 8: Type 2 diabetes and obesity > Flashcards

Unit 8: Type 2 diabetes and obesity Flashcards

1
Q

How are type 2 and type 1 diabetes different?

A

Both present with too high blood glucose.
type 1: presents earlier in life, genetic autoimmune conditions, insulin producing cells are attacked so unable to produce insulin
type 2: presents later in life, lifestyle related, body does not make enough insulin or the insulin you make is ineffective.

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2
Q

How are the risk factors for type 2 diabetes?

A

Obesity BMI>30
Ethincity = more common in black,asian or caribbean ethnic groups.
Age - more commonly diagnosed in people aged 40yrs or above
Family history of type 2 diabetes
non alcoholic fatty liver disease

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3
Q

What is the treatment for type 2 diabetes?

A

Lifestyle modification - exercise and diet to maintain a healthy BMI
Medications - atorvastatin and metformin
May need to monitor blood glucose levels

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4
Q

What are the physiological impacts of obesity?

A

Diabetes link
Increased BP
Increased risk of stroke - LDL cholesterol more common
Increased risk of cadiovascular disease
Increased risk of musckulosketal disorders
Increased risk of Cancers
Increased risk of infertility
Increased risk of depression
reduced lung function - flat reduces expansion of diaphragm and lungs
Increased risk of alzhiemers

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5
Q

What are the symptoms of type 2 diabetes?

A

Increased thirst
Glucose in urine
Frequent urination
Genital itching and thrush - glucose creates envioronment for fungal infections
Tiredness
Weightloss - as gluconeogenesis
Increased wound healing - blood sugar reduced nutrients flow
Blurry eye sight - blood sugar build up in the retina

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6
Q

How can you differentiate between type 1 and type 2 diabetes on a symptoms level basis?

A

Type 1 - symptoms are more acute and noticeable
Type 2 - symptoms develop more slowly

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7
Q

What are the links between obesity and type 2 diabetes?

A

Increased inflammatory response - diminish response of target cells to insulin
Changes fat metabolism - fat molecules are released into blood streem, affects responsiveness to insulin
Hihger insulin demand to cope with increased blood glucose levels from dietary intake can lead to pancrease fatigue and insulin resistance

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8
Q

What is the basic concept of the use of metformin?

A

Is an anti-hyperglycemic
Inhibits intestinal absoprtion of glucose
inhibits hepatic glucose production
Facilitates blood glucose uptake into tissue
Improves insulin sensitivity

May also dealy gastric emptying decreasing appetite and encouraging weight loss

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9
Q

What is the mechanism of action of metoformin?

A

Target hepatocyte cell - uptake by OCT1 channel protein
Accumulates in cytoplasm and between mitochondrial membranes
Reduces the production of ATP
Causes an increase in AMP/ADP: ATP ratio
This activates AMPK enzyme which suppresses gluconeogenesis in the liver by phosphorylating transcription factors
Also increases levels of NADH encouraging pyruvate to be recycled back to lactate.

AMPK phosphrylates isoforms of acetyl-CoA carboxylase enzyme, reducing fat storage in the liver

In the enterocytes - increases anaoerbic respiration of glucose, so less glucose absorbed, increases lactate absorbed which can then be converted to pyruvate and used in the Krebs cycle.

Increase insulin sensitivty

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10
Q

What are the sides effects of metformin?

A

GI bloating
Indigestion
Long term use may interfere with vitamin B12 absorption
Lactic acidosis

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11
Q

What is the basic concept of the use of atorvastatin?

A

Antiilempic - reduces lipid levels in the blood
Upregulates hepatic LDL receptors
Increases HDL cholesterol concentration
Decreases plaque deposition

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12
Q

What is the mechanism of action of atorvastatin?

A

Inhibits HMG-CoA reducatase in hepatocytes which is needed to produce myalonic acid a precursoe for choelsterol and LDL
Increases LDL receptors to uptake more LDL from blood stream as a consequence.
Less VLDL released from hepatocytes into the blood.

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13
Q

What are the side effects of atorvastin?

A

Headache
GI distrubances
Muscle aches
Serious mypothay
Rise in liver enzymes

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14
Q

What is the recommended diet for weight loss?

A

High in protein
Low in fat
Low in calories
Low in carbs

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15
Q

What drugs can be used in weight management?
What is the basic concept of how they work?

A

Semaglutide/liraglutide - Glucagon-like-peptide1 receptor agonist, increases insulin secretion and improving blood glucose level control. Also delays gastric emptying reducing apetitie. May also effect neurones to alter food preferences.
Orilstat - binds to serine in gastric and intestinal lipase, reduces fat metabolism, less absorption of fats

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16
Q

What are the different surgical methods of weight loss?

A

Gastric band - reversible band placement near top of stomach to reduce stomach size
Gastric bypass - staples create pouch at the top of the stomach, pouch connected to section of the small intestine, bypass rest of stomach
Sleeve gastrectomy - large part of the stomach is surgically removed to make it smaller
Intragastric balloon - reduce volume of the stomach

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17
Q

What additional checkups does a diabetic require?

A

Every 3 months - HbA1C test
Every year - check feet for sensation loss, ulcers and infection
Blood pressure
Cholesterole
Kidney function tests

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18
Q

What is a well man clinic?

A

Full physical health exam from a qualified doctor
Includes medical history
Blood tests
ECG
Lifestyle assessment
Prostate specific antigen testing
Private £90 minute appointment
Some occupations will fund an annual wellman clinic appointment

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19
Q

What are the drawbacks of the lifestyle model of health?

A
  • victim blaming - increases stigma around indivduals with obesity adntype 2 diabetes, this may deter people from seeking support for these conditions
    -fails to recognise the social determinanats of health
    -promotes intervention at the individual level which has a smaller effect than intervention at the community based/environmental level
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20
Q

How have the rates of diabetes changed over time?

A

Rates have qaudrupled between 1980 and 2014

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21
Q

What is the link between body fat distribution and diabetes?

A

A larger weight cirumference is associated with an increased risk of diabetes.
Typically due to inflammation and threat from the adipose tissue on the endocrine organ mainly the pancreas
Large diameter would be considered - 80cm in men and 94cm in women

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22
Q

What is meany by an obesegenic environment?

A

The role environmental factors play in determining nutrition and exercise levels, this includes access to highly processed, high calorie low nutrional value food and increased sedentary lifestyle

23
Q

What is the link between type 2 diabetes and ethnicity?

A

South asian minorities are 6 times as likley to have type 2 diabetes.
Black and Caribeean - 3 times are likley
Associated with lower levels of potassium ions which typically decreases insulin production

24
Q

What are some of the secondary complications of type 2 diabetes?

A

Macrovascular disease
Nerve damage - due to high blood glucose
Blindness - diabetic retinopathy
Kidney disease and failure
Diabetic foot disease

25
Q

What it the link between diabetes and psycholsocial outcomes?

A

2/3 experienced mental health struggles
Stuggle to feel in control of thier life decisions, mental struggles increase the risk of low compliance to treatment
Affects of social, work and home life.

26
Q

What organisations overview the ICS in England?

A

NHS England -progress montioring and supports NHS bodies in the ICS, provide a national continuiity and encourage following of the NHS long term plan
Care Quality Comission Boards - independelty reviews and rates ICS

27
Q

What are the two different components of an ICS?

A

IC board - typically mainly NHS organisations and GPs, implement services and delegate NHS funding and resources. Develops a five year system plan

IC partnership - NHS, local authorities and other organisation get together to identify help priorities, plan stratergies but do not implement services

28
Q

What is the filtering of health provision from a system to a neighbourhood appraoch?

A

provider collaborates - 1 to 2 million, often NHS trusts
Place level - up to 250,000
Health and wellbeing boards
Place based partnerships
Neighbourhood - up to 50,0000
Primary care services e.g GP surgeries

29
Q

On a public health perspective what is important to note about most diabetes cases?

A

Are preventable

30
Q

What is polyuria and what are the consequences?

A

Increased urination
Loss of water and loss of electrocytes

31
Q

WHat is the term for increase thirst?

A

Polydipsia

32
Q

How does type 2 diabetes lead to increased hunger?

A

Polyphagia
Increased hunger due to increased insulin levels
Glucose can not enter cells so the cells are depleted of energy, signals to the brain to eat more food in order to increase the energy available, this is still not effective.

33
Q

How can type 2 diabetes lead to renal failure?

A

Dehydration thorugh polyurea = decreased blood flow and perfusion to the kidney

34
Q

How can insulin levels change over the progression of type 2 diabetes?

A

Originally increase in compensation for insulin resistance
Eventually decrease due to beta cell atrophy as overworked become exhausted,

35
Q

Explain why glucagon can be released during type 2 diabetes?

A

alpha cells become resistant to insulin

36
Q

What are some of the psychological effects of obesity?

A

Increased risk of depression/anxiey - chicken and the egg theory
Social isolation - stigma and shame from bias and victim blaming
Decreased confidence
Body dysmorphia

37
Q

What are some of the pathological effects of obesity

A

Secretion of adipokines and pro-inflammatory cytokines - leads to chronic low grade inflammation
Increased serum fatty acids - promotes VEGF leading to tumour development
Increase reactive oxygen species - promote DNA damage and cancer
Insulin resistance affect on nephron - increase RAAS activation

38
Q

What are the benefits of exercise?

A

Improved cardiovascular health, helps maintain a healthy weight
Strengthen muscle mass
Short term peak in cortisol - anti-inflammatory
Rise in endoprhins - imporve mood and reduce pain.

39
Q

What are the normal levels of blood glucose?

A

Fasting blood glucose - 3.9 to 5.6 mmol/L
Blood glucose 2hrs after a meal - 7.8 mmol/L

40
Q

How does diabetes increase your risk of cardiovascular disease?

A

High blood glucose damages the blood vessels and nerves supplying the heart.
Can lead to decreased blood supply hence ischemic damage or result is cardiac arrythmias

41
Q

What are the risk factors for cardiovascular disease?

A

High blood pressure
Smoking
Obesity
Diabetes
Ethnicity
inactivity
male
Excess alcohol consumption
Diet - high in LDL, fats

42
Q

How is cardiovascular risk assessed?

A

In england the QRISK2 and JBS3 calculators are used to assess the likleihood of developing cardiovascular disease
These take into account the patients age, ethnicity, gender, diabetes diagnosis, kidney disease, lipid profile, BP, smoking status, social status and mnay other factors.

43
Q

What is the role of a diabetes nurse?

A

Motivating patients
Lifestyle advice - for patients and family members with similar risk factors
Community or at home diabetes check ups

44
Q

What is the role of a diabetologist?

A

Specialise in patients with diabetes or high risk assocaited lipid metabolism disorders, obesity and high BP.
They aid treatment and diagnosis. Will exam for and try to prevent secondary conditions of diabetes such as peripheral artery disease, neuropathy and diabetic foot syndrome.

45
Q

What health professional might a diabetic work with?

A

GP
Diabetic nurse specialist
Diabetologist
Podiatrist
Optician
Dietitian

46
Q

What resources are available to help patients with diabetes?

A

The healthy living programme - accessed online, educational information about diabetes and the appropriate interventions.
DESMOND for newly diagnosed diabetics - require GP referall, NHS course in person or online
Diabetes UK - Local support groups

47
Q

What resources are availabe for obese patients?

A

NHS weight loss plan app - tailored weight loss plan for 12 weeks, suggest foot intake, records level of activity
EatWellGuide booklet - help manage diet
Obesity UK support groups on Facebook

48
Q

What additional screening tests will a diabetic patient need?

A

Every 3 months - HbAC1 test
Diabetic Eye Screening - every year, image the back of the eye, test for glucoma and cataractst
Diabetic foot screening - every year, looks for injuries and test sensation of the foor

49
Q

What is diabetic retinopathy?

A

When high blood glucose levels damage the small blood vessels, can lead to blindness, causes bulding and bleeding of small blood vessels in the back of the eye.
High blood vessels can also thicken the retina leading to cataracts

50
Q

How does diabetes affect your feet?

A

Nerve damage due to high blood glucose - loss of sensation, cause pain and tingling in the foot
Poor circulation from hypotension - increases healing time for injuries or ulcers
Charcot foot - nerve damage but continue walking, change in teh structure, colour of foot, increase risk of ulcers, can lead to amputations

51
Q

What are some public health campaigns tackling obesity/type 2 diabetes?

A

Better Health Campaign: watershed ban on adverts, calorie labelling, ban on buy one get one free on fast food
NHS diabetes prevention programme: referall by GP for pre-diabetics 9 month, 13 class education and health behaviour session

52
Q

In a glucose tolerance test what level indicates diabetic or pre-diabetic?

A

Diabetic above or equal to 7.00 mmol/L
Prediabetic = 5.5 to 6.9 mmol/L

53
Q

What are some tests that will be done in the diagnosing of a type 2 diabetic?

A

eGFR - expect increased rate
HbAc1 - increased levels
Albumin: Creatine - expect increased levels as indicates kidney damage

PBL (23 decks)

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