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B8W4 > CLINICAL DIABETES > Flashcards

CLINICAL DIABETES Flashcards

1
Q

what is diabetes?

A

the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. Characterised by increased blood sugar levels over a period of time.

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2
Q

what are some symptoms of diabetes?

A

polydipsia- thirst no matter how much fluid you have
polyuria- excessive passing of urine
fatigue
sudden weight loss in type 1
increase risk of life threatening illness

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3
Q

what is diabetes insipidus?

A

a diabetes where there is polyuria and excessive thirst due to an ADH deficiency or an insensitivity to ADH

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4
Q

why do we get polyuria in diabetes insipidus?

A

due to osmotic diuresis- increased urine output due to excessive glucose increasing the osmotic pressure and so preventing water absorption in the kidneys

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5
Q

which is more common, type 1 or 2 diabetes?

A

type 2 (90% of cases)

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6
Q

when are type 1 and type 2 diabetes typically diagnosed?

A

type 1- between 5-25 yo

type 2- in adults

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7
Q

what is latent autoimmune diabetes in adults (LADA)?

A

diabetes with late onset due to the pancreas stopping secreting insulin because of damage to the alpha cells

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8
Q

what is gestational diabetes

A

diabetes during pregnancy caused by hormone changes which results in insulin resistance- its normally resolved upon birth of the baby

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9
Q

what is maturity onset diabetes of the young (MODY)?

A

diabetes diagnosed before age of 25 caused by a gene mutation which disrupts insulin production

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10
Q

what is neonatal diabetes mellitus?

A

diabetes that affects an infant and their body’s ability to produce or use insulin

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11
Q

what is the pathophysiology of type 1 diabetes?

A

the immune system targets the beta cells in the pancreas so insulin cannot be produced

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12
Q

what are the multifactorial elements of type 1 diabetes?

A

auto reactive B and T cells
genetic mutation on genes that delete auto reactive B and T cells
environmental factors e.g. infection/early exposure to cows milk

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13
Q

what is insulitis?

A

inflammation of the islets of langerhans

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14
Q

what is the main genetic risk factor of type 1 diabetes?

A

having certain variants of HLA-DQA and HLA-DQB genes

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15
Q

why do autoreactive T cells not get destroyed in type 1 diabetes?

A

because the binding between the T cell and MHC molecule is intermediate/weak so the immune system is fooled into thinking that its not auto reactive - inadequate negative selection

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16
Q

what are some environmental factors that can contribute to causing type 1 diabetes?

A

childhood enteroviruses
bystander activation of auto reactive B and T cells
molecular mimicry activating auto reactive T cells

17
Q

why is it thought that vitamin D may be linked to type 1 diabetes?
how would this work?

A

as the prevalence of diabetes is high in countries in the northern hemisphere
its thought that when vitamin D is metabolised to 1,25 hydroxyvitamin D which can dampen an autoreactive immune response

18
Q

what is the incretin effect?

A

oral glucose elicits higher insulin secretory responses than does intravenous glucose, despite inducing similar levels of glycaemia, in healthy individuals.

19
Q

describe the glucose tolerance test?

A

give a health control an Iv glucose and measure the amount of insulin produced and then an oral glucose and, again, measure the amount of glucose produced. the normal incretin effect should occur

20
Q

what would you see in a glucose tolerance test for someone with type 2 diabetes?

A

a diminished incretin effect

21
Q

what are some risk factors for type 2 diabetes development?

A

genetics
epigenetic changes
gut microbiome (certain bacteria are more prevalent)
ageing
inactivity
obesity
intrauterine envrionment e.g. exposure to pesticides

22
Q

why is obesity such a big risk factor for type 2 diabetes?

A

ingesting too much glucose means beta cells will overproduced insulin and eventually beta cells will become exhausted and start to fail= insulin resistance

23
Q

describe the intracellular mechanism of insulin resistance?

A

insulin binds to its receptor but the mechanism that usually moves GLUT4 to the cell surface is impaired so glucose cannot be taken up by cells

24
Q

why can a high fat diet lead to insulin reistance?

A

FFA can enter the cell and activate protein kinase C and the JNK pathway which impairs the movement of GLUT4 to the cell surface.

25
Q

what role does inflammation play in diabetes?

A

the body becomes less sensitive to insulin and this leads to inflammation which causes more insulin resistance

26
Q

where is lean type 2 diabetes most prevalent?

A

in asia and africa

27
Q

describe why you can get lean type 2 diabetes?

A

as the Asian/African population tend to store most of their fat in their legs and abdomen which is around organs such as the liver (Caucasians tend to store it in legs)

28
Q

what is latent autoimmune diabetes a mixture of?

A

type 1 and type 2 diabetes so its linked to lifestyle and genetic factors

29
Q

how to we look into how well a patient is controlling their blood sugar levels?

A

we look at HbA1c and then again 3 months later when we have new RBCs. if measurements are both high then the patient is not controlling their blood glucose levels well enough

30
Q

what’s an ideal HbA1c level for someone who has diabetes?

A

48 mmol/mol or below

31
Q

what are macrovascular complications of diabetes?

A

diseases of the coronary arteries, peripheral arteries, and cerebrovasculature. e.g. stroke, hypertension, claudication

32
Q

what are microvascular complications of diabetes?

A

long-term complications that affect small blood vessels. These typically include retinopathy, nephropathy, and neuropathy.

33
Q

what is diabetic nephropathy?

A

raised glucose increases reactive oxidative substrates within the kidney which causes cellular stress in the glomerulus and this leads to malfunction and leakage of protein into the urine. eventually, fibrosis occurs in the kidney tissue which can cause kidney failure

34
Q

what is diabetic neuropathy?

A

high blood sugar can damage nerves which can cause changes in ability to sense pain, temperature, vibrations and control body functions

35
Q

what is diabetic foot syndrome?

A

ulceration of the foot associated due to poor wound healing of a cut caused by diabetes.

36
Q

what are signs of diabetic foot syndrome?

A 
changes in skin colour
changes in temperature
swelling
pain in legs
open sores on feel
ingrown toenails
dry cracks in skin
37
Q

what is diabetic retinopathy?

A

high blood glucose can lead to a haemorrhage in the eye which can cause blindness is severe

B8W4 (7 decks)

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