Introduction to Diabetes Flashcards
(35 cards)
How has diabetes increased in America and worldwide?
- America: 5.0% in 1980 up to 8.3% in 2014
- Worldwide: 4.7% in 1980 up to 8.5% in 2014
Why is diabetes taking epedemic proportions?
It is fueled by obesity which is a huge risk factor and hence why it is increasing → it mirrors obesity
What is the expected increase in diabetes worldwide?
46% by 2045
Social and economic burden of diabetes
- affects 8% of the world (both type I & II)
- 10% of healthcare dollars (25% of taxes goes towards healthcare so 2.5 towards diabetes)
Prevalance of diabetes in Canada
- > 8% of Canadians have been diagnosed with diabetes → an additional one million Canadians have undiagnosed diabetes.
- Diabetes Canada estimates that 20% of the population has pre-diabetes.
- This number is expected to double in the next 20 years.
- In Canadian hospitals, one bed out of five is currently occupied by a diabetic patient.
Costs of diabetes in Canada
The costs to treat diabetes and its complications are estimated at $16B, annually, in Canada
* health concern, economic concern, social burden
How does diabetes prevalence change with age and gender?
More at risk for develop diabetes with age and males more prone
Where is diabetes most prevalent in Canada
Newfoundland and Labradour with 6.5%
Where we donate disease vs. disease that kills us
Major discrepancy with little money raised even though it is a leading cause of death
* May be because it is the individual fault and may be reluctant to put money towards research or treatment
The thrifty gene hypothesis
Ancient humans in Africa migrated and populated globe and throughout journey suffered famine and scarcity and posed that selection for individuals to accumulate energy fast and retain it and survive times of scarcity so we were selected for our ability for fat reserves. Now know hypothesis is wrong and have sequenced the human genome and know there is not a thrifty gene nor a combination to drive you to accumulate fat or obesity.
* Proposed by geneticist James Neel (U. Michigan) in 1962 in the American Journal of Human Genetics.
Other hypothesis of diabetes
- thrify phenotype
- drifty gene hypothesis (mutations)
- unknown foods
- aggression control (psychological)
How has nutritional intake changed?
We eat more food and more calories and more nutrients of lesser quality
Describe the Land of Cokaigne picture
Painting from medieval times and depicts heaven showing paradise with foreign merchant with different spices and 3 different individual of people classes (soldier, peasant, noble) that just had a feast together and abundance of food with pig running with knife etc. shows at thi time that the only thing in their mind is food, harvesting, planting and life revolved around agriculture. Different from our times because we can get food very easily
* Pieter Bruegel, 1567
Ancient history of diabetes
- Described in ancient egypt
- Hindu physician first to describe sweetness of urine
- term diabetes was coined by Aretaeus c. 250 BC (from Greek = syphon); insipidus, tasted nothing; mellitus tasted sweet
History of diabetes from 17th century
- In the 17th century, authors reported on the increased prevalence of the disease.
- Matthew Dobson was the first to described hyperglycemia after he evaporated the urine of one of his patient to a “white cake” that could not be distinguished from sugar (1776).
- In the 19th century: first use of the adjective “mellitus” (vs insipidus).
- In the 1870’s, Claude Bernard, a French physiologist posited that diabetes could have a pancreatic origin after noticing atrophy or injury in post-mortem exams.
- Around that time, Etienne Lancereaux was the first to distinguish between Diabète maigre (lean) and Diabète gras (fat)
Dont need to know names and dates, just general idea
Breakthrough of diabetes
A breakthrough occurred in 1889, when Joseph von Mering and Oskar Minkowski performed total pancreatectomy on dogs. The dogs displayed all the symptoms of diabetes and died shortly afterwards showing it was a pancreatic disease
* 4 years later, Gustave Laguesse speculated on the putative “internal secretions” produced by these “islands” previously discovered by Paul Langerhans.
Discovery of insulin
Insulin was discovered in Toronto in 1921 by Frederick Banting (surgeon) and Charles Best (student) reversed diabetes in dogs by giving them a pancreatic extract.
* First patient treated with insulin in 1922.
Simple definition of diabetes
High concentrations of circulating glucose
Clinical definitions of diabetes
Needs a particular window to be optimal
* low- can go to coma
* High - lots in circulation
What is considered pre-diabetes?
impaired fasting glucose → means fasting glucose is a tiny bit elevated
Tests to diagnose diabetes
Always need to be done at least twice and fail consecutively to be diagnosed accurately
* fasting glucose test
* OGTT → Oral Glucose Tolerance Test
* HbA1c → Glycated Hemoglobin
OGTT
Oral glucose tolerance test → show up fasted and drink sweetened beverage and test glucose at different time points and what should happen is it will go up and then body will use it and store it and should go down to normal levels. Measured after 2 hours
* Would run this test twice and would need to fail twice
What is HbA1c?
glycated hemoglobin → Glucose in circulation is sticky so it can bind Hb proteins (through collision) and so the more you have the more collision and glycation that can occur and so lots of proteins can become glycated
* non-enzymatic and slow process, and its intensity mirrors glucose levels
* Glycated hemoglobin reflects the circulating concentrations of glucose over the last 3 months (half-life)
What are the negatives of HbA1c?
costs, influenced by conditions that affect blood cell turnover (ethnicity, diseases, etc.), availability
