Diabetes

heterogeneous metabolic disorder characterized by hyperglycemia

define diacetates mellitus

macrovascular and microvascular

chronic hyperglycemia is associated with ____ and ___ complications

thirst, frequent urination, weight change, blurred vision, infections, slow healing, numbness, erectile disfunction

what are the symptoms of diabetes

heart and brain disease, kidney disease, eye disease, nerve damage

what are the consequences of diabetes

6 yrs

how much lower is life expectancy of those with diabetes

1 in 9 adults

how many adults have diabetes (ratio)

the ability to use and produce insulin decreases over time

why does the risk of diabetes increase with age

type 1

pancreatic beta cell destruction, usually leading to absolute insulin deficiency

immune mediated

in type 1 diabetes: the destruction of pancreatic beta cells is driven by an autoimmune process mediated by macrophages and T lymphocytes with circulating autoantibodies targeting B cell antigens

type 2 diabetes

may range from predominantly insulin resistance insulin deficiency to a predominantly secretory defect with insulin resistance

gestational

glucose intolerance with onset or first recognition in pregnancy

Glycated hemoglobin

this test measures the level of stickiness where glucose attaches to hemoglobin molecules in the blood

plasma glucose criteria

diagnosis of diabetes is confirmed if: fasting plasma glucose > 1.7 mmol/L, Oral glucose tolerance test >11.1 mmol/L, random plasma glucose > 11.1

beta cells release insulin into the blood

when blood glucose levels rise, what happens in the pancreas

stores glucose as glycogen

when blood glucose levels rise, what happens in the liver

alpha cells release glucagon

when blood glucose levels fall, what happens in the pancreas

breakdown glycogen to release glucose

when blood glucose levels fall what happens in the liver

insulin and glucagon

what are the two main hormones that regulate glucose in the body?

glycogenolysis, gluconeogenesis

what processes does the liver use to produce glucose

gluconeogenesis

what process does the kidney use to produce glucose

fed state

fed or fasted state: high insulin low glucagon

fed or fasted state: low insulin, high glucagon

plasma

where does the brain get its glucose

ketone bodies

after prolonged fasting, ___ ___ are produced and available to the brain for energy

liver, kidney

in fed state, glucose release by ___ is suppressed, glucose released by __ isnt suppressed

glycogenolysis

in the fasted state, the release of glucagon stimulates ___

gluconeogenesis

in fasted state when glycogen stores are depleted, the body relies more on ___

fats and protein

in the starvation state, the body starts to rely on ___ and ____ for energy

ketones

biproduct of breaking down FFA for energy

pancreas

which organ: produces and secretes digestive enzymes and hormones for glucose regulation

glucagon

major counterpart to insulin, increases plasma glucose via stimulation of hepatic glycogenolysis, secretion stimulated by hypoglycemia and inhibited by hyperglycemia

insulin

regulates glucose via direct and indirect mechanisms, secretion regulated by plasma glucose concentration

epinephrine and norepinephrine

catecholamines - increase glucose via glycogenolysis, gluconeogenesis, lipolysis, and are fast acting

growth hormone and cortisol

slow acting, increase glucose via stimulation of gluconeogenic enzymes and reduction of glucose transport, impairs insulin secretion

Free Fatty acids

predominant fuel used by most organs, stimulate glucose production in liver and kidney via gluconeogenesis, impair glucose transport into muscle tissue, regulators are sympathetic nervous system, growth hormone, insulin, hyperglycemia

incretins

hormones secreted by the gut that stimulate insulin release from pancreas

GLP1

which incretin is deficient in type 2 diabetes

GLP1

____ inhibits glucagon secretion, delays gastric emptying, promotes satiety

type 1

pathogenesis of what type: pre-clinical period of autoimmune destruction of beta cells in pancreas, genetic predisposition and immune trigger

type 1

what type: destruction of pancreatic beta-cells, onset is typically rapid, absolute insulin deficiency, exogenous insulin required for survival, accounts for 5-10% of diabetes cases, autoimmune markers often present

islet autoantibody testing

used to distinguish between type 1 diabetes and type 2 diabetes or monogenic diabetes

C-peptide

measure of endogenous insulin secretion, most helpful 3-5 years after diagnosis, high = type 2

Latent autoimmune diabetes in adults

type 1.5, misdiagnosed as type 2, often > 30 years old, slower progression of autoimmune beta cell failure, islet antibodies present at diagnosis

genetics, environment

risk factors of type 1 diabetes

type 2

pathogenesis of what type: predominant relative insulin deficiency or predominant insulin resistance or both

type 2

what type: gradual onset, obese/sedentary lifestyle, older, positive family history, symptoms - may have none

hyperglycemia, acute, chronic

primary goals of therapy:

1. avoid symptoms of ____

2. avoid risk of ___ complications

3. reduce risk of ___ complications

acute complications

hypoglycemia and hyperglycemic emergencies such as diabetic ketoacidosis and hyperosmolar hyperglycemic states are examples of what

chronic complications

microvascular - cerebrovascular disease, coronary heart disease, peripheral vascular disease are examples of what