Week 7 Type 2 Diabetes Flashcards
What are the 3 classes of hormones?
- peptides/proteins (these are most hormones - secreted by pancreas, GI tract, hypothalamus, pituatary
- amines (secreted by thyroid and adrenal medulla)
- steroids (from cholesterol, secrete by adrenal cortex, gonads, placenta)
what are the 2 types of cells in the pancreas?
- exocrine cells - 95% (secrete fluids / digestive enzymes)
- endocrine cells - 5% (islets of langerhan. include alpha cells, beta cells, delta cells, F cells)
what are the different types of endocrine cells? what do they secrete?
- alpha cells - secrete glucagon
- beta cells - secrete insulin
- delta cells - secrete somatostatin
- F cells - secrete PP
which 2 hormones are the primary hormones involved in mainting normal blood sugar?
insulin
glucagon
Which hormone inhibits glucagon
GLP1 - signals satiety
How does the body store the carbs that we eat for energy?
- as glycogen
- as circulating glucose
if we eat too many carbs, what happens?
they get stored as triglycerides in adipose tissue and as circulating fatty acid in the blood
what happens to the protein and fat we eat?
Both slow down sugar int he blood stream.
Fat gets stored as fat
Protein is least likely to get stored as fat
Insulin is a ____ hormone, while glucagon was a _____ hormone
Insulin = anabolic (builds up muscle/fat - encourages protein synthesis)
Glucagon = catabolic (break down)
What is glycogenolyis?
breaking down sugar
what is gluconeogenesis?
synthesis of new glucose
what is lipolysis
break down fat
insulin stimulates the uptake of glucose into the following 3 cells, and stimulates the synthesis of the following 3 items:
- liver cells
- fat cells
- muscle cells
- glycogen
- triglycerides
- protein
what is the net effect of glucagon (4 things)
- glucogenoloysis
- gluconeogenesis
- lipolysis
- increases blood sugar
what stimulates insulin secretion?
What stimulated glucagon secretion?
insulin - increase in blood sugar levels
glucagon - a drop in blood sugar levels
what happens if you dont eat enough during the day?
liver turns on early to pump out more sugar than necessary into the bloodstream
both if you dont eat enough food or if you eat too much simple sugar, it can cause blood sugars to rise
why might you feel hungry 30 minutes after eating an apple?
blood sugar spikes. insulin works fast. can make you hungry for more carbs.
how is your blood sugar maintained at night?
the liver maintains it - eating in the morning shuts off the liver
type 1 diabetes is characterised by:
- autoimmune beta cell destruction
- no insulin production
type 2 diabetes is characterised by:
- progressive defective insulin secretion
- insulin resistance
Which trimester / trimesters does gestational diabetes happen in?
2nd or 3rd
what are 2 risk factors for GDM?
35+
2nd pregnancy
it also increases risk for type 2 diabetes
how many people worldwide had diabetes in 2017?
425 million
every ___ minutes, another Canadian is diagnosed with diabetes
3 minutes
what % of canadians are currently living with diabetes or prediabetes?
29% (3.4 million people)
what is the cost of diabetes in Canada every year?
$14 billion per year
1 in ____ deaths in Canadian adults was attibuted to diabetes?
1/10
Diabetes is the leading cause of:
- blindness
- end stage renal disease
- non-traumatic amputation
____ is the 3rd highest risk factor for premature mortality globally (after high bp and smoking) - leads to damaged heart, eyes, kidneys, nerves
high blood sugar
what is the leading cause of death with people with diabetes?
CVD - CVD death is 2-4x higher in people with DM
diabetics have ____ higher risk of death
2x higher risk of death
what is the typical age of onset for type 1 diabetes? types 2 diabetes?
type 1 = < 30
type 2= > 40
type 2 diabetes is associated with these 4 factors:
- aging
- obesity
- inactivity
- inherited factos
type 1 diabetes is associated with these 3 things:
- autoimmune disease
- viral infection
- inherited factors
in type 2 diabetes, what is the typical amount of insulin secretion?
it varies. sometimes normal, sometimes increased, sometimes decreased
what are the main ethnicity factors for type 2 diabtes?
- elderly
- black people
- aboriginal
- asian
- hispanic
- south asian
what are the main risk factors for type 2 diabetes
- obesity
- family history
- pre-diabetes
- history of GDM
- impaired glucose metabolism
- physical inactivity independent of weight
- > 40
- macrosomia (large birth weight over 4kg)
- ethnicity
- hypertension
- low HDL, high triglycerides
type 2 diabetes is a _____ condition
polygenic condition - multiple genetic factors needed for disease manifestation
what are the primary environmental factors for type 2 diabetes?
- obesity
- physical inactivity
- low birth weight
what organs are involved in type 2 diabetes pathophysiology?
- pancreas
- gut
- liver
- muscle
- adipocytes
what happens to the pancreas during type 2 diabetes?
- less insulin secretion
- less beta cell mass
- more beta cell death
- hyperglucanonemia
what happens to the gut during type 2 diabetes?
impaired incretin effect
what happens to the liver during type 2 diabetes?
more insulin resistance
more glucose output
what happens to the liver during type 2 diabetes?
more insulin resistance
what happens to the adipocytes during type 2 diabetes?
more circulating fatty acids
hyperlipidemia
what are the acute symptoms of type 2 diabetes?
- polyuria (excess peeing)
- polydypsia (excess drinking)
- weight change up or down
- extreme fatigue
- blurred vision
- frequent infections
- tingling / numbness
what are the silent symptoms of type 2 diabetes?
- insulin resistance years prior to diabetes onset
- clinical onset correlates to diminshed insulin production by the pancreas
- abnormal blood work
- can be asymptomatic for 6-10 yrs but present with: retinopathy, blurred vision, PCOS
what are the 4 nutritional indicators of a diabetes diagnosis?
- FBG - > 7 mmol/L
- A1C > 6.5%
- 2hPG > 11.1 mmol/L
- random plasma glucose > 11.1 mmol/L (don’t use it)
_____ is impaired glucose homeostasis.
prediabetes
what are the 2 forms of prediabetes?
- impaired Fasting glucose of 6.1-6.9 mmol/L
- A1C of 6.0 - 6.9%
what does A1C measure?
the amount of glucose bound to hemoglobin protein of RBCs
what are the targets for A1C?
< 6.5% - adults with type 2 diabetes who are at risk of CKD and retinopathy
<7% = most adults with type 2 diabetes
7.1%-8% = type 2 diabetics who are functionally dependent
7.1%-8.5% = recurrent severe hypoglycemia, or frail elderly with diemntia
A1C measurements are not recommended at end of life
what are long term complications of diabetes/hyperglycemia?
- macrovascular (CVD)
- microvascular: nephropathy, retinopathy, peripheral neuropathy, autonomic neuropathy
insulin stimulates the uptake of glucose into these 3 places:
the liver
fat
muscle cells
___ % of people with diabetes have detectable nephropathy within 10 years
40-50%
what are the stages of nephropathy?
stage 1: extra filtration
stage 2: because of damage from hyperglycemia, the membrane of the glomulera thickens, which leads to more damage, less filtration, and protein leaking from the urine.
Protein urea in diabetes tells you that kidney function is impared
Nephropathy (impaired kidney function) increases risk for:
- foot ulceration/amputation
- neuropathic pain
- significant morbidity
- usage of healthcare resources
Risk factors for nephropathy with diabetes include:
- high blood glucose
- high triglycerides
- high BMI
- smoking
- hypertension
how do you measure nephropathy in diabetes?
- eGFR (estimated glomerular filtration rate)
- ACR (albumin/creatinine ratio)
what is the most common cause of blindness among working age?
diabetic retinopathy
Symptoms of diabetic retinopathy include:
- floaters
- blurred vision
- fluctating vision
- impaired colour vision
- dark/empty areas in vision
- vision loss
diabetic retinopathy often goes unnoticed until vision loss occurs
Diabetes treatment involves FAME:
- food
- activity
- medication
- education
What are the main types of diabetes medications?
- biguanides
- dpp-4 inhibitors
- glp-1 receptor agonsits
- sglt2 inhibitors
- sulfonylurea insulin secretagogues
- meglatinides
- thiazolidinediones
linagLIPTIN is what type of drug?
DPP-4 inhibitors
metformin is what type of drug?
biguanides
liraGLUTIDE is what type of drug?
GLP-1 receptor agonists
CanaGLIFLOZIN is what type of drug?
SGLT2 inhibitors
Glicazide, glimepiride, and dyburide are what type of drug?
sulfonylurea insulin secretagogues
replaglinide is what type of drug
meglitinides
PioGLITAZONE is what type of drug
thiazolidinediones
What is the nutrition therapy checklist for diabetes?
- refer to dietitan
- follow cda guidelines
- individualize dietary preferences
- choose low GI foods
- know alternative dietary patterns
- encourage matching insulin to carbs
- encourage nutritionally balanced foods
what are the things you have to manage with diabetes
manage blood glucose
manage weight
manage blood pressure
manage cholesterol
What are the ABCDESSS of diabetes care?
A. A1C < 7% or 6.5% to reduce risk of CVD
B. BC < 130/80 mm hg
C. cholesterol - LDL < 2, or 50% reduction from baseline
D. Drugs for CVD risk reduction
E. exercise goals and healthy eating - 150 minutes moderate to vigorous aeroboic activitiy per week
2-3x per week resistance training and mediteranein diet
S. screening for complications - ECG every 3-5 years if 40 or older, foot, kidney, retinopathy
S. smoking cessation - if smoker, ask permission to give advice, arrange therapy
S. self management, stress = set personal goals, assess for stress, mental health and financial or other concerns
what types of drugs are recommended for people with type 2 diabetes?
ACEI/ARB - if CVD or age 55+
Statins - if CVD or age 40+
ASA - if CVD
SGLT2i - if type 2 with CVD but A1C is not a target
What are the 4 recommendations for Canada’s food guide
- have plenty of fruits and veggies
- eat protein
- make water your drink of choice
- choose whole grains
What are the 5 aspects of portfolio diet, daily?
- 45 g nuts
- 50 g plant proteins terol
3.20 g sticky fibre - 2 g plant sterol
- fat free or low fat milk
what are the different GI levels?
Low GI = <55
medium GI = 56-69
High GI = 70 >
what is the recommended macronutrient distribution for people with type 2 diabetes?
carbs = 45-60%
protein = 15-20%
Fat = 20-35%
What are 3 ways of choosing healthy fats?
- avoid trans-fats
- decrease saturated fats <9% of energy
- replace with PUFAs from Omega 3/Omega 6 sources, MUFAs
Extra virgin olive oil
High oleic oils
avocados
are all examples of:
MUFAs
Nuts
Canola oil
Soybean oil
Flaxseed
are all examples of:
PUFAs
Eating fibre is an important part of choosing healthy carbs. How much fibre should be viscous fibre?
1/3 of the fibre we eat (10-20g)
what are practical ways to add fibre to the diet?
- grains
- choose carb foods with 2-4 grams of fibre per serving - add fruit and vegetables
- add legumes to diet
- add nuts and seeds to diet
according to diabetes canada, people with BMI > 25 should aim for ____ % weight loss. this would help with the following 4 things
5-10% weight loss
Would help with:
1. insulin sensitivity
2. glycemic control
3. blood pressure
4. lipid levels
What are the 5 steps to manage hyperglycaemia
Step 1: clinical assessment (healthy behaviour interventions by an RD)
Step 2: initiate intensive healthy behaviour interventions OR energy restriction AND increased PA to achieve a healthy body weight
Step 3: provide counselling on a diet best suited for them
Step 4: if blood glucose is still not at target, continue healthy behaviour interventions and add pharmacotherapy
Step 5: make timely adjustments to healthy behaviour interventions to attain A1C within 2-3 months for healthy behaviour interventions along or 3-6 months for any combo with pharmacotherapy
What are the 5 dietary strategies used for diabetes management?
- basic meal planning (watch portions, healthy carbs, drink water, good fats)
- limit alcohol
- ensure physical activity
- count carbs
how many carbs should you have for snack?
1 15 gram carb choice
how many carbs should you have for dinner?
30-60g carb choices for meals
If you see a nutrition label that says it has 30 grams of carbs, is that what you should use to calculate carbs?
NO, use that number and subtract the amount of fibre
so if there was 5 grams of fibre…
30 grams - 5 grams = 25 grams of available carbs
these items are 15 grams of carbs
1 slice toast
1/2 cup fruit
1 cup milk
How do you calculate available carbs?
available carbs = total carbs - fibre
how do you calculate the amount of ca
What is the recommended PA for diabetes?
- 150 minutes moderate-vigorous intensity aerobic exercise each week
- interval training
- resistance exercise 2-3x week
- step count monitoring
what are the 2 main acute complications of type 2 diabetes?
- hyperosmolar hyperglycemic non-ketotic state (HHNS)
- hypoglycemia
what is hyperosmolar hyperglycemic non-ketotic state (HHNS) characterized by?
What are symptoms?
What is the mortality rate?
It is characterized by:
a) hyperglycemia
2. dehydration WITHOUT ketoacidosis
Symptoms: range from drowsy to comatose, fatigue, weight loss, thirst, dehydration, low BP, high HR, frequent urination, decreased skin turgor
Patients have 50% mortality rate
Someone with HHNS has already been diagnosed with diabetes.
what is the difference between DKA and HHNS?
in both DKA and HHNS, body is starving for energy because it cant use the glucose. so its metabolism responds as if it is starving. Ketogenesis kicks in
HHNS is non-ketotic. most people with HHNS have type 2 diabetes, so their pancreas still produces insulin. so the insulin that is present inhibits the ketogenesis pathway. so the creation of these ketone bodies is minimized
how do you treat hyperosmolar hyperglycemic non-ketotic HHNS?
- IV insulin
- IV rehydration
What is hypoglycemia?
- the development of neurogenic or neuroglycopenic symptoms
- low blood glucose (<4 mmol/L of on insulin)
- it’s a response to carb load
What are the 3 different levels of hypoglycemia?
Level 1
- mild
- 3-3.9mmol
- person can self treat
- autonomic symptoms
Level 2
- moderate
- <3 mmol
- autonomic and neuroglycopenic symptoms
- individuals can self treat
level 3
- severe
- <
- requires assistance
- unconsciousness may occur
What are the 5 steps to address hypoglycemia?
- recognize autonomic or neuroglycopenic symptoms
- confirm if possible (blood glucose < 4.0 mmol/L)
- treat with “fast sugar” (15 g of simple carb) to relieve symptoms
- retest in 15 minutes to ensure the BG > 5 mmol?l and retreat if needed
- eat usual snack or meal due at that time of day with 15g carbs + protein
How do you treat someone with severe hypoglycemia in unconscious person with no IV access?
- treat with 1 mg of glucagon subcutaneously
- call 911
- discuss with diabetes health-care team
