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+ CAPS 301: Respiratory, Renal, GI, Endocrinology, Reproduction > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is diabetes mellitus?

A

chronic metabolic disorder characterized by increased blood glucose (hyperglycemia) resulting from impaired insulin secretion and/or action

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2
Q

What is diabetes a risk factor for?

A

cancer, Alzheimers, digestive, and more

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3
Q

What is impaired glucose tolerance?

A

between ‘normal’ and ‘diabetes’ in level of blood glucose

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4
Q

What was type I diabetes previously called?

A

insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes

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5
Q

What was type 2 diabetes previously called?

A

non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes

  • people now end up on insulin
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6
Q

When do people get type I vs. type 2 diabetes?

A

type 1: can get at any age, but most commonly at 14

type 2: generally occurs in adulthood (adult-onset), but more and more children are being diagnosed

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7
Q

Which type of diabetes is the non-autoimmune form?

A

type 2

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8
Q

Which type of diabetes is most often associated with obesity?

A

type 2

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9
Q

What is gestational diabetes?

A

occurs during some pregnancies (related to type 2 diabetes)

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10
Q

What is gestational diabetes caused by?

A

caused by hormonal changes, leading to excess stress on beta cells (from burden from carrying fetus)

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11
Q

What are people who had gestational diabetes more susceptible to later in life?

A

type 2 diabetes

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12
Q

What are other rare forms of diabetes caused by?

A

single gene mutations

  • neonatal diabetes (permanent or transient)
  • maturity onset diabetes of the young (MODY) (2-5 % of diabetes)
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13
Q

Which type of diabetes is more common?

A

type 2 (90%)

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14
Q

What is type I diabetes characterized by?

A

lack of beta cells (and therefore insulin secretion)

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15
Q

What is the likely cause of type 1 diabetes?

A

combination of genetic susceptibility and ‘environmental’ triggers and suppressors

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16
Q

What happens if type 1 diabetes is not treated?

A

ketoacidosis and eventually death follows

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17
Q

What do type 1 diabetes patients require for survival?

A

require exogenous insulin (insulin-dependent diabetes)

but using insulin to manage glucose levels does NOT cure diabetes

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18
Q

How effective is type 1 diabetes treatment?

A

aggressive insulin therapy (better glucose control) reduces diabetes complications by 50%

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19
Q

What is type 1 diabetes?

A

autoimmune disease involving selective destruction of pancreatic beta cells by inappropriately activated T lymphocytes

tricks pancreatic beta-cells into committing cellular suicide

cause of autoimmune attack is not well understood, but it appears that both genetic and acquired (environmental) factors are important

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20
Q

What is found in type 1 diabetic patients?

A

several circulating autoantibodies against beta-cell proteins (including insulin itself)

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21
Q

What are ‘environmental’ factors (acquired factors) involved in type 1 diabetes?

A

factors still unclear, but several candidate triggers have been investigated:

  • viruses
  • sources of non-human insulin
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22
Q

What is the greatest risk factor of type 1 diabetes?

A

(genetic) alleles of major histocompatibility complex (MHC) genes (encoding human leukocyte antigens, HLA)

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23
Q

What do HLA-DR and HLA-DQ alleles do?

A

can either increase risk of diabetes, or protect against disease

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24
Q

What are the genetic factors that contribute to genetic risk of type 1 diabetes?

A
  • MHC genes

- insuline gene

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25
Q

What are MHC genes?

A

important in processing and presentation of foreign antigens by macrophages

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26
Q

How does the insulin gene itself contribute genetic risk to type 1 diabetes?

A
  • both protective and ‘at-risk’ alleles exist

- mechanism is unknown

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27
Q

What are some acute symptoms/complications of diabetes? (5)

A
  • glucosuria
  • polyuria
  • polydipsia
  • polyphagia
  • ketoacidosis
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28
Q

What is glucosuria?

A

blood glucose level exceeds renal threshold for glucose absorption and glucose appears in urine

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29
Q

What is polyuria?

A

(frequent urination) glucose in urine causes osmotic diuresis

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30
Q

What is polydipsia?

A

(excessive thirst) excess fluid lost from body leads to dehydration

31
Q

What is polyphagia?

A

(excessive food intake) despite increased food intake, cells are starved due to lack of insulin (insulin is required for glucose uptake)

32
Q

What is ketoacidosis caused by?

A

lack of insulin increases lipolysis, increases triglyceride breakdown, increases plasma fatty acids, which liver turns into ketone bodies, leading to ketoacidosis

33
Q

Are chronic complications more often see in type 1 diabetes or type 2 diabetes?

A

type 1 diabetes (which is often longer-term)

34
Q

What are some chronic complications of diabetes? (5)

A
  • neuropathy
  • cardiovascular disease
  • microvascular disease
  • nephropathy
  • retinopathy
35
Q

What is neuropathy?

A

loss of sensation especially in periphery

36
Q

What is cardiovascular disease?

A

cardiovascular problems – atherosclerosis, high blood pressure

leading cause of heart disease

37
Q

What is microvascular disease?

A

common in foot

diabetes is leading cause of non-traumatic amputations

38
Q

What is nephropathy?

A

has slow onset but is leading cause of kidney failure

39
Q

What is retinopathy?

A

diabetes is leading cause of adult blindness

40
Q

Are complications reduced when glucose levels are controlled?

A

Diabetes Control and Complications Trial (DCCT/UKPDS) Major Findings:

  • maintaining tight control of blood glucose levels slows or prevents development of diabetic complications in this group of post-pubertal subjects
  • tight glucose control does not completely prevent complications, and is associated with 3x increased risk of hypoglycemia (hypoglycemia is usually what takes people to the hospital)
41
Q

How does type 2 diabetes affect insulin?

A
  • insulin resistance
  • decreased response to insulin in insulin target tissues (liver, muscle and adipose tissue)
  • specific defects in glucose-stimulated insulin secretion
42
Q

What is hyperinsulinemia?

A

in type 2 diabetes, basal insulin secretion is increased early in disease

some believe hyperinsulinemia is compensation for insulin resistance, but mechanism linking these features remain unclear

43
Q

What factors are important in causing type 2 diabetes?

A

early life (and prenatal) factors

44
Q

Does type 2 diabetes have a slow or fast onset?

A

slow

45
Q

Is type 1 or type 2 diabetes more severe?

A

type 1

46
Q

Is ketoacidosis common in type 2 diabetes?

A

no

47
Q

Do most type 2 diabetic patients initially require exogenous insulin?

A

no – (non-insulin-dependent)

48
Q

How does type 2 diabetes affect glucose?

A
  • decrease in glucose uptake (muscle, fat)

- increase in glucose production (liver) associated with insulin resistance results in hyperglycemia

49
Q

What is important in the etiology of type 2 diabetes?

A

both loss of functional beta-cells and insulin resistance are important

  • mechanisms underlying insulin resistance and beta-cell dysfunction are not clear
50
Q

What might contribute to insulin resistance?

A

insulin receptor and post-insulin receptor defects

51
Q

What are genetic factors of type 2 diabetes?

A
  • diabetes is polygenic

- thrifty gene hypothesis

52
Q

What does it mean for diabetes to be polygenic?

A
  • most of these genes play important roles in beta-cell
  • each gene contributes very little risk on its own
  • much of inheritability of diabetes is unaccounted for
53
Q

What is the thrifty gene hypothesis?

A

genetic susceptibility has little effect in absence of ‘environmental stress’

54
Q

What are environmental factors of type 2 diabetes? (2)

A
  • increase in sugar consumption is associated with increase in obesity and diabetes
  • saturated fats are also on the rise and may play a role
55
Q

What is the critical role for insulin in physiological mechanisms of obesity?

A

lower insulin prevents hyperinsulinemia, which causes obesity

56
Q

How does obesity affect insulin and beta cells?

A

larger weight…

  • increasing predisposition to hyperinsulinemia and insulin resistance
  • increasing predisposition to beta cell failure
57
Q

Is gestational diabetes similar to type 1 or type 2 diabetes?

A

type 2

58
Q

What is gestational diabetes characterized by?

A
  • abnormal glucose-tolerance test

- slightly higher levels of insulin

59
Q

Why are women less sensitive to their own insulin during pregnancy?

A

several hormones partially block actions of insulin

60
Q

Can gestational diabetes be well-managed?

A

yes – by special diet and/or supplemental injections of insulin

61
Q

What are the main treatments for type 1 diabetes (and advanced type 2)? (2)

A
  • insulin

- pancreatic islet transplantation (still experimental)

62
Q

What are future therapies for type 1 diabetes (and advanced type 2)? (3)

A

beta-cell regeneration
stem cell therapy
gene therapy

63
Q

Insulin as Treatment for Type 1 Diabetes (and Advanced Type 2)

A
  • patients administer exogenous insulin by multiple daily injections or pumps
  • insulin cannot be currently administered as pill since it would be degraded in GI tract, but some companies are working on it
  • engineered insulins are now used – may include glucose sensitive and liver-specific insulins in the future
  • inhaled powder insulin could eventually replace injections, although disadvantage of unpredictable absorbance from lungs has not been overcome
64
Q

Pancreatic Islet Transplantation as Treatment for Type 1 Diabetes (and Advanced Type 2)

A

(still experimental)

  • isolated islets from pancreas are transplanted to diabetic patient
  • more long-term studies required to show efficacy
65
Q

What is the advantage of pancreatic islet transplantation?

A

provides endogenous source of insulin

66
Q

What is the disadvantage of pancreatic islet transplantation?

A

needs life-long immunosuppressive therapy – insufficient donor islets

67
Q

What are the main treatments for most type 2 diabetes? (3)

A
  • exercise, diet, and weight loss
  • oral hypoglycemic drugs
  • injectable anti-diabetic drugs
68
Q

Oral Hypoglycemic Drug

What do biguanides do?

A

suppress liver glucose output

ie. metformin

69
Q

Oral Hypoglycemic Drug

What do DPP IV inhibitors do?

A

are enzyme that breaks down GLP-1

70
Q

Oral Hypoglycemic Drug

What do SGLT2 inhibitors do?

A

prevent reuptake of glucose at kidney (allow you to urinate more glucose)

71
Q

Oral Hypoglycemic Drug

What do sulfonylureas inhibitors do?

A

work on K+-ATP channel

stimulate insulin secretion from beta cells

ie. glyburide

72
Q

Oral Hypoglycemic Drug

What do thiazolidinediones do?

A

ie. rosiglitazone (increase insulin sensitivity in insulin target tissues, but most have been removed from market)

73
Q

What are the two injectable anti-diabetic drugs used to treat most type 2 diabetes?

A
  • GLP-1 analogs (now produced in oral formulation)

- insulin

+ CAPS 301: Respiratory, Renal, GI, Endocrinology, Reproduction (32 decks)

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