Intro to Diabetes Flashcards
LADA
happens later in life, destruction of beta cells but a a slower rate
Risk factors for diabetes
male, age, ethnicity, aboriginal, overweight, low income,
undiagnosed diabetes
27.4% living with it or many years - uncontrolled blood glucose levels which can have detrimental effects
Type 1 causes
body produces islet cell auto-antibodies
- still not sure why this starts; some gene involved but not sure which one; is it environmentally triggered?- virus, toxins and stress.
steps: genetic predisposition leads to islet cell auto-antibodies if exposed to environmental factors ( virus, toxins, stress), net other causes will cause B cell injury and there will be no insulin
symptoms of diabetes
polydipsia, polyuria, polyphasic, weight loss ( T1) or weight gain ( T2)
where are symptoms more severe?
T1
clinical lab test results indicating diabetes
glycosuria
hyperglycaemia
abnormal glucose tolerence (GTT)
diagnosis criteria:
-A1C
-FPG
for T1 need to measure antibodies
what does insulin do?
promote glucose uptake
stimulate glycogenesis (making glycogen) making protein and making TG (lipogenesis)
decrease gluconeogenesis, glycogenolysis, lipolysis and proteolysis
total def in insulin (type 1) leads to what in terms of glucose metabolism? (talk through table)
1) in terms of glucose metabolism = less uptake in HAM (GLUT 4)- leads to intracellular glucose def= polyphasic. In contrast there is greater hepatic glucose output ( highest rate of gluconeogenesis from lipids and aa’s)
- these both lead to hyperglycaemia in which some spills into the urine. bc glucose is osmotic ( attracts water) –> polyuria which can lead to dehydration–> polydipsia ( always thirsty). with dehydration we can have cell shrinking and therefore NS malfunction ==> death
there may also be a decrease in blood volume-> increase HR, peripheral circulatory flare and low blood flow and renal failure==> death
describe how polyuria happens in type 1
hyperglycaemia leads to glycosuria which attracts water and leads to polyuria
How does total deficiency in insulin (type 1) fat metabolism? (talk through table)
Cells fell starved–> increase in gluconeogenesis–> lipolysis and decreases in TG synt, which ultimately leads to increase in blood FFA ( used as an alternate fuel source = ketosis => which may lead to metabolic acidosis –> increased ventilation and diabetic coma and death
why is there increase in ventilation in T1 DM?
increase in blood FA leads to ketosis and metabolic acidosis; therefore, to excrete more H+ ( more CO2 and H2O in breath) fall in plasma H2CO3
is ketosis state a big deal in T1?
not a big deal, but the issue is when ketosis is prolonged and develops into metabolic acidosis
what is metabolic acidosis
ketone bodies 10x higher than in ketosis
why is metabolic acidosis so bad?
affects the respiratory system –> increased ventilation to excrete CO2 and decrease in pH and metabolic imbalances that accompany could lead to diabetic coma
when do most ppl find out they have T1
administered to hospital with symptoms of diabetic coma ( increased ventilation, decrease in pH )
how does Type 1 affect protein metabolism?
less aa uptake in cells and increase protein catabolism –> muscle wasting and weight loss
- more aa in circulation causes more gluconeogenesis, aggravating hyperglycaemia
diabetes fasted state
exacerbated fasted state due to lack of insulin
- lots of gluconeogenesis, proteolysis and lipolysis
- cause negative nitrogen balance due to non-gluconeogenic AA’s getting catabolized and broken down
what happens when type 1 fed?
worsens the situation
- increases the substrates to the liver- more hyperglycaemia as cells can still not uptake glucose(none getting converted to glycogen ) more glucosuria
ER type 1 blood sugar is normally at?
above 25mmol/L and mediate insulin infusion, electrolytes and potassium
cause of T2DM?
major cause is obesity and inflammation ( which goes hand in hand with obesity)
- obestity caused by genetics, lack of exercise and excess calories
- this leads to IR= hyperglycaemia and the pancreas trying to overcompensate and secreting more insulin.
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is sugar a cause of diabetes?
no
when IR develops is this diabetes?
NO, bc the hyperinsulinemia will work to control blood glucose
- officially have diabetes when there is B-cell destruction and the pancreas can no longer compensate with enough insulin
what causes the transition from IR to B-cell destruction leading to diabetes?
may be genetic component or lipotoxicity
high levels of lipids in the blood that impact cell function and causes inflammation
