Diabetes - pathophysiology

Morgan Morgan
Flashcards by Morgan Morgan, updated more than 1 year ago
Morgan Morgan
Created by Morgan Morgan about 5 years ago
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University Medicine, Surgery & Radiology Flashcards on Diabetes - pathophysiology, created by Morgan Morgan on 12/20/2014.
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Question Answer
The pancreas contains two glands called the? The endocrine gland and the digestive gland.
The endocrine tissue consists of cells called ? What do they do? Islets of Langerhans Discharge secretions directly into the blood stream.
Each islet is composed of three types of cells? Alpha, beta and delta cells
Alpha cells secrete a hormone called? Which? glucagon, which raises blood glucose.
Beta cells ? Which? Beta cells secrete insulin in response to a rise in blood glucose after eating - this restores blood glucose to normal.
Delta cells produce a hormone called ? Which? somatostatin which inhibits secretion of both glucagon and insulin.
Insulin promotes entry of glucose into ...................................... and stores the glucose as..................... liver and muscle cells glycogen
Where is glucose stored? Liver
In adipose tissue, insulin converts glucose into? fat (triglyceride) and storage of the newly formed triglyceride within fat cells.
Insulin dependent diabetes (type 1) usually results from? Damage or destruction of the pancreatic islets, leading to reduction or absence of insulin secretion.
Diabetes is associated with which disease? The onset of diabetes follows a ? Specific human leuckocyte antigen autoimmune disease. Viral infection in some cases
Insulin also promotes the entry of ? amino acids into the cells and stimulates protein synthesis.
Insulin cannot be given to ? Pregnant women, as it is a growth hormone.
Type 1 diabetes occurs primarily in ? There is a ................................. .............................. to type 1 diabetes. Body weight? Children and young adults. Hereditary predisposition. Usually normal or underweight;often recent weight loss.
Diabetic Ketoacidosis is caused by a? What happens? Lack of insulin This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, and will cause the body to become acidic – hence the name 'acidosis'.
In patients with diabetic ketoacidosis their breath smells of? Pear drops
Non-insulin-dependent (type 2) usually affects ? older overweight and obese adults
The islets secrete? but the tissues are? normal or increased amounts of insulin but the tissues are relatively insensitive to the action of insulin and are unable to respond appropriately (Insulin Resistance).
The impaired response to insulin is linked to? Obesity
A hyperosmolar coma results from ? marked hyperglycemia.
Type 2 is a? hereditary disease.
Treatment for Type 1 patients? Treatment for Type 2 patients? Patients require treatment with insulin. Patients require treatment with healthy eating and activity, plus oral medication and/or insulin as the disease progresses.
Random or 2 hour post glucose load test? The doctor gives the patient a litre of a sugary drink and 2 hours later he tests the patient's blood glucose levels.
What is the main test to diagnose diabetes? HbA1c or glycated haemoglobin
HbA1c measures? Average plasma glucose concentration. The control of the sugar level for the 3 months prior to testing.
The ideal level is? There is a ... to....% reduction in risk of ..................disease with every....% (10mmol/mol) reduction of hemoglobin A1c. Less than 7%/<53 mmol/mol 10 to 20%, vascular disease, 1%
Symptoms of Hyperglycaemia in Type 1 diabetes? Polyuria Polydipsia Lethargy Weight loss
Polyuria going to the loo a lot. Glucose above renal threshold.
Polydipsia Dehydration. Thirst.
Proteinuria Protein in urine.
Lethargy Hyperglycaemia
Weight loss due to? Fat and protein breakdown
Type 2 diabetes is associated with? obesity (truncal), hypertension, lipid abnormalities (high cholesterol) and low levels of physical activity.
Patients with Type 2 are on? aspirin, anti-hypertensions and statins.
Recommendations? Blood pressure? Cholesterol? HbA1c? <130/80MMhg <4.5 <53 mmol/mol (7%)
Insulin resistance precedes Type 2 diabetes by up to 20 years. >......% of Type 2 diabetes patients are insulin resistant. 90%
Secondary causes of diabetes 4 Pancreatic, e.g. cancer, cystic fibrosis, surgery Drug induced, e.g. corticosteroids, thiazide diuretics Endocrine, e.g. acromegaly, Cushing's syndrome Associated with stress, e.g. myo cardial infarction, CVA, severe infection
Gestational diabetes What type of test is required? Treated with? Aim? Appears during pregnancy Oral glucose tolerance test is needed for diagnosis. Healthy eating +- insulin. Tight blood glucose control.
The overall effect of diabetes? Social Psychological Physical Management Career choice/work Social events Changes to routine Complications Depression Fear of hypos Threat of stigma Disease process/management Complications Adopting health behaviour Self-adjustment to treatment Self-monitoring Identifying hypo and hyper Surveillance
MODY stands for? What type of diabetes? Onset (age)? Cause? Maturity Onset Diabetes of the Young Rare subgroup of Type 2 diabetes Onset generally <25 years old Primarily due to an islet beta cell defect
What are the three main drug options for treating type 2 diabetes? Metformin A Sulfonylurea A thiazolidinedione
METFORMIN activates? The enzyme AMP-kinase, which is involved with regulating cellular energy metabolism.
How do you administer insulin? By a pen injection device into the fat below the skin on the abdomen, thighs or upper arms. The needle is usually inserted to its full length.
What is hypoglycemia? Hypoglycemia occurs when the level of glucose present in the blood falls below a set point: Below 4 mmol/L (millimoles per litre)
How to treat hypoclycemia? Mild case? Serious case? A mild case of hypoglycemia can be treated through eating or drinking approximately 10-20g of sugar (i.e. carbohydrates). Some diabetics carry glucose tablets for this express purpose. Serious hypoglycemia will require medical attention. In this instance, paramedics will use glucagon or provide glucose intravenously. Some diabetics have glucagons injections at home, in the form of glucagons kits. This allows immediate treatment and the possibility of avoiding hospital. For those diabetics that experience regular hypoglycemia, blood sugar levels should be tested regularly.
Low density lipids function? The main carrier of cholesterol, and deliver it both to the liver and to peripheral cells. They need to be minimised as they are a risk factor for cardiovascular disease.
High density lipids are produced in? It transports ? High density lipids are produced in both the liver and intestine. It transports cholesterol away from the periphery.
Which drug minimises LDL? Statins
Polyol pathway steps Hyperglycaemia results in the production of: Aldose Reductase (enzyme found in nerve cells, retinal cells, glomerulus and kidney tubules and blood vessel walls) Which reduces to Sorbitol (oxidised by sorbitol dehydrogenase to fructose) Sorbitol does not easily diffuse across the cell membrane and this causes damage due to osmotic stress. The damage causes activation of protein Kinase C and the promotion of advanced glycation endproduct formation (AGEs). AGEs are formed by the reaction of glucose and other glycating compounds with proteins. Early glycation products are reversible. But eventually they undergo irreversible change through cross-linking. *Leading to thickening and stiffening of blood vessels (less permeable and elastic). *Proteins bind to specific receptors - monocytes, macrophages, glomerular cells, endothelial cells
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