BCH 313 Diabetes Mellitus Flashcards
(26 cards)
What is diabetes mellitus
It is not a disease but a heterogeneous group of multifactorial syndrome it is characterized by the elevation of fasting blood glucose caused by absolute or relative deficiency of insulin
Diabetes mellitus is the leading cause of what?
Blindness and amputation in adults and the major cause of renal failure heart attack and nerve damage
What is the aeitology of type one diabetes
Destruction of beta cells of the pancreas initiated by viral attack or environmental toxins on the pancreas this results in an auto immune attack on the beta cells hence auto immune antibodies T cell insights can be demonstrated in the serum of such individuals
What is the chance of the other monozygotic a twin developing the disease?
30-50%
Characteristics of patients with type one diabetes
Virtually no functional beta cells
can neither respond to variations in circulating fuels (food nutrients) nor maintain a based secretion of insulin
Diagnosis of diabetes mellitus
Adolescent young individual or child
Sudden and rapid onset of symptoms may be triggered by in some stress
symptoms weakness and weight loss
fasting blood sugar less than or equal to 12 pmg/dl
Surgical test demonstrates islet cells antibodies
Principal symptoms of diabetes mellitus type one
Polyuria polydipsia polyphagia
What happens when blood glucose levels exceed renal threshold
Glucose is excreted in urine (glucosuria)
Due to osmotic affects more water is excreted with glucose (polyuria)
To compensate for the loss of glucose and proteins the patient will want more food (polyphagia)
Discuss hyperglycemia as a metabolic change in diabetes mellitus type 1
Increased blood glucose results from gluconeogenesis in the liver and decreased glucose uptake by the insulin sensitive GLUT of full of adipose tissue and muscle for utilization (peripheral glucose utilization)
Discuss Ketoacidosis as a metabolic change in diabetes mellitus type 1
Keto acidosis results from increased mobilization of fatty acids from adipose accelerated beat oxidation of FFA on synthesis of ketone bodies in the liver since glucose cannot be to lysed resulting in DKA (diabetic ketoacidosis)
What happens to excess FFA that are not used to synthesize ketone bodies
The excess are converted to triglyceride (TG) in very low-density lipoprotein (VLDL) hence high levels in plasma hands hypertriglycerolemia
Treatment of diabetes mellitus 1
DM 1 requires exogenous insulin injection to control Hypoglycemia and prevents keto acidosis.
Glycemic control impacts the development of microvascular complications in diabetic patients hence the need for adequate and optimum control of blood glucose
Types of treatments in DM 1
Stand Treatment
1 or 2 daily injections achieves glycemic level still above 200 mg/dl and HbAic of 8-9%
Intensive Treatment
3 to 4 daily injections a cheese glycemic level of about 100mg/dl HbAic of 7%
Discussed intensive treatment for DM 1
Intensive reaction is aimed at achieve in a tights control of blood glucose but is more prone to the therapeutically hypoglycemia than the standard treatment
Achieves another level of the glucose and glycated hemoglobin values
However intensive reaction is contradicted in children and the elderly
It is meant for me to age people with long-term complications are being avoided
Prevalence of type 2 DM
90% prevalence
Aetiology of type 2 PM
A combination of dysfunctional beta cell action resulting in lowered insulin levels and peripheral resistance to insulin action
Usually oral hypo are not enough to control the disease but insulin may be in administered in the long run to achieve better control of hypoglycemia and glycated hemoglobin (HbAic) at optimum level (less than 7%)
Describe metabolic changes in DM 2
Metabolic changes are milder in DM 2 than DM1 because insulin secretion (though inadequate) is enough to restrain ketogenesis and blunt development of DKA
Diagnosis of DM 2
Diagnosis is mainly based on the presence of hyperglycemia greater than 126 MG/100 ML in fasting blood.
No autoimmune antibodies are seen in patients serum
 In Monozygotic twins birthday develop DM 2 true or false
True
Discuss insulin resistance
The reduced ability of insulin to affect uptake action by target tissues e.g. muscle liver and adipose
It is the decreased ability of target tissues to respond properly to normal/elevated levels of insulin and this result in increased hepatic glucose production and decrease glucose uptake by muscle
Explain the relationship between obesity and Insulin resistance
Obesity is the most common cause of insulin resistance
Obese people may not be diabetic because in normal functional beta cells nondiabetic obese individuals have compensatory elevated levels of insulin, to nullify the effects of the peripheral resistances and produce similar blood glucose levels of that of the lean persons
Cost of insulin resistance
- Weight gain increases resistance
- percentage fat accumulation is important in insulin resistance
- leptin and adiponectin hormones produced by fat cells also contributes to insulin resistance
Metabolic changes in insulin resistance
Hyperglycemia and hypertriglycerolemia also occur in DM 2 but in a milder form
ketosis is minimal or absent
Treatments of insulin resistance
Weight reduction
exercise
dietary modification
Oral glycemic agents on insulin may be required to achieve satisfactory glucose levels

