Patho - Class 12 (Part 1)

Diabetes Canada estimates that in 2020 Canada had a ___ prevalence rate of diabetes

10%

By 2030, it is estimated that the prevalence in Canada will have increased to ___

12%

Diabetes rates are ___ times higher in Indigenous populations than in the general population

three to five

Type 1 is the result of ___, usually leading to total insulin deficiency

beta-cell destruction

Type 2 ranges from predominantly ___ with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance

insulin resistance

In some people (1 to 5%) who have diabetes, ___ might be the cause

other conditions

type 2 diabetes makes up ___ of all cases of diabetes

90%

10% of all cases of diabetes is ___

type 1

Peak onset of T1 at ___ years, slightly earlier for girls than boys

11-13

T1 is rare in children younger than ___ and with adults older than 30 years

1 year

Canada has one of the ___ incidence rates of type 1 diabetes for children under 14 years of age

highest

Risk of developing T2 diabetes ___ after the age of 40

increases

Currently 29% of Canadians are living with diabetes, ___ diabetes, or pre-diabetes

undiagnosed

T2 has a greater presence in ___ than females

males

T1 has a 1.5-2x higher rate in ___ than visible minorities

Caucasian

T2 rate is 3x higher among ___ people

Indigenous

People with ___ descent have higher rates of childhood type 2 diabetes and type 2 diabetes

South and Southeast Asian, African, and Latin American

T1 affects normal or underweight people while T2…

affects mainly overweight/obese people as it is contributing factor

T1 is thought to be the result of genetic and environment factors resulting in ___ destruction in genetically susceptible individuals

autoimmune

T2 is thought to be caused by genetic and environmental factors, and is also associated with…

long duration obesity

in T1, there are ___ present to insulin and to glutamic acid decarboxylase

autoantibodies

there are ___ autoantibodies in T2

NO

Insulin resistance at T1 diagnosis is ___, but may occur as individual ages and gains weight

unusual

Virtually universal ___ in T2 and multifactorial in origin

insulin resistance

T1 has a severe insulin deficiency or ___

no insulin secretion at all

insulin is typically increased at time of diagnosis in T2, but progressively ___ over course of illness

declines

to diagnose diabetes you need to have 2 or more on two different days

symptoms of diabetes and a bs higher than 11.1, fasting blood sugar level higher than 7, and 2 hour glucose tolerance test higher than 11.1, and A1c result 6.5 or more

Symptoms of diabetes and a blood sugar level equal to or greater than ___ (diagnosis of diabetes)

11.1

Fasting blood sugar level that is equal to or greater than ___

7.0 mmol/L

2-hour oral glucose tolerance test result that is equal to or greater than ___

11.1

Hemoglobin A1c result that is ___ or higher (gold standard)

6.5%

what are the top 3 symptoms associated with diabetes

polyuria, polyphagia, polydipsia

why do you pee more in diabetes

body is dumping excessive sugar

why do you drink more in diabetes

due to increased solutes in body

why do you have increased hunger in diabetes

due to not utilizing sugar properly

what are other signs and symptoms are present with diabetes?

• Fatigue

• Blurred vision

• Cuts/sores not healing

• Very dry skin

• Increased episodes of infection

• Numbness of hands and feet

Fasting blood sugar (FBS) or fasting blood glucose: (FBG) measures blood glucose after you have not eaten for at least __

8 hours

___ measures blood glucose regardless of when you last ate. Several random measurements may be taken throughout the day

Random blood sugar (RBS) or random blood glucose (RBG)

Random testing is useful because glucose levels in healthy people do not ___ throughout the day

vary widely

This test is also called a ___

casual blood glucose test

A __ measures blood sugar exactly 2 hours after you start eating a meal

2-hour postprandial blood sugar test

This 2 hour test is most often done at home when you have diabetes. It can see if…

you are taking the right amount of insulin with meals

The ___ and the oral glucose tolerance test (OGTT) are other tests used to look at blood sugar levels

hemoglobin A1c test

The A1c test can be used to estimate your average blood sugar level over the past ___

2 to 3 months

The OGTT is commonly used to diagnose diabetes that occurs during ___

pregnancy

A1c is how many times RBC was ___ to sugar specifically in a span of months

exposed

The A1C test is a blood test that measures your ___ blood sugar levels over usually a 3 month period of time

average

A1C is a commonly used test to ___ prediabetes and diabetes

diagnose

Normal AIC: A1C level below ___

5.7%

Prediabetic AIC: AIC level of ___ indicates prediabetes

5.7% to 6.4%

the higher your A1C, the greater the risk for developing ___

type 2 diabetes

Diabetes: AIC level of ___ or more indicates diabetes

6.5%

Type 1 Diabetes is caused by ___ reaction

autoimmune

type 1 diabetes includes testing for presence of autoantibodies (islet autoantibodies) as the body is ___

attacking self

Islet ___ are present with type 1 not type 2

autoantibodies

When the immune system attacks beta cells in the pancreas (produces insulin), the beta cells are destroyed and the body cannot ___

produce insulin

___ do not cause type I diabetes

Diet and lifestyle habits

in type 2 diabetes, there is ___, body will still produce insulin, unable to use it properly

insulin resistance

Diabetes Canada estimates that nearly ___ Canadians currently have prediabetes

6 million

Prediabetes includes ___ glucose tolerance (IGT), which results from decreased insulin secretion, and impaired fasting glucose (IFG), which is caused by enhanced hepatic glucose output

impaired

Individuals with impaired IGT and IFG are at increased risk for cardiovascular disease and premature death and carry a ___ 5-year risk of developing diabetes, particularly type 2 diabetes

15 to 50%

Prevention of diabetes with ___ is essential

lifestyle interventions

Type 1 diabetes mellitus is the most common ___, with about 10% of Canadians having this form of diabetes

pediatric chronic disease

Prevalence rate of diabetes in children aged 19 years and under is 0.3%, and the incidence is ___

increasing

Between 10 and 13% of individuals with newly diagnosed type 1 diabetes have a ___ (parent or sibling) with type 1 diabetes

first-degree relative

There is a ___ concordance rate in twins

50%

Diagnosis is rare during the first 9 months of life and peaks at ___

12 years of age

Family history is a risk for T1 including…

genetic links, parent, sibling with Type 1 (due to gene mutation)

___ is a risk for T1 diabetes (usually children, teens, young adults)

age

T1 is NOT ___ unlike T2

preventable

___ type 1 diabetes mellitus is less common than autoimmune diabetes

Idiopathic

IT1DM has a strong ___ and occurs mostly in people of Asian or African descent

genetic link

___ type 1 diabetes mellitus is a slow progressive autoimmune T-cell–mediated disease that destroys beta cells of the pancreas

autoimmune

there are ___ types of Type 1 Diabetes: Idiopathic and Autoimmune

two

autoimmune T1 involves a deficient ___ that is linked to abnormalities in immune cells and changes in beta-cell antigens

immune tolerance

Involves destruction of ___ which is related to genetic and environmental factors

beta cells

As a result of destruction of 80 to 90% of the insulin-secreting beta cells of the islets of Langerhans, the synthesis of insulin ___

decreases

hypoinsulinemia results in an increase in ___ secretion

glucagon

Normally, insulin suppresses glucagon. These two hormones work as ___

opposites

Because insulin normally inhibits glucagon release, when insulin levels drop (hypoinsulinemia), the inhibition is removed. The pancreas senses that there isn’t enough insulin and interprets this as a “low energy” state, so alpha cells increase glucagon secretion to ___ blood glucose

raise

Glucagon, a hormone produced by the ___ cells of the islets, acts in the liver to increase blood glucose level

alpha

Amylin is another beta cell hormone which normally…

acts to suppress glucagon release from the alpha cells

The ___ in secretion of amylin contributes to the increase in glucagon secretion, resulting in increase blood glucose level

decrease

With adults the ___ is longer with onset of type 1 diabetes and often results in misclassification of those affected as having type 2 diabetes

latent period

Glucose builds up in the blood and appears in the urine as the renal threshold for glucose is exceeded. This accumulation produces an ___ and symptoms of polyuria and thirst (T1 symptoms)

osmotic diuresis

Weight loss occurs in type 1 diabetes in response to ___ that occurs because of the lack of insulin

protein and fat breakdown

___ occurs with increased metabolism of fats and proteins that leads to high levels of circulating ketones, and is very dangerous complication of T1DM

Diabetic ketoacidosis

Recurrent infections occur in T1 in response to the increased glucose levels __ growth of microorganisms

stimulating

impaired blood supply hinders ___ in T1DM

healing

Blurred vision: elevated blood glucose levels cause changes in water balance in the eyes that can result in ___ (T1)

diabetic retinopathy

Diabetes contributes to formation of ___ that involve peripheral, and cerebrovascular circulations and alterations in microvessels, causing chest pain

atherosclerotic plaques

Goal with ___ is achieving the optimum glucose levels control that is measured by a persons A1c value

treatment

Insulin therapy, meal planning and ___ are the mainstay interventions for T1

exercise

Many different kinds of therapies are being tested to ___ the autoimmune destruction of beta cells

prevent

islet cell, stem cell, and whole pancreas transplantation has been successful with ___ individuals

some

T2 accounts for ___ of all diabetes in Canada

90%

type 2 diabetes has an ___ among Indigenous people, as well as people of South and Southeast Asian, African, and Latin American descent

increased prevalence

In Canada, the prevalence of diabetes was 17.2% among First Nations individuals living on-reserve, 10.3% among First Nations individuals living off-reserve, and 7.3% among Métis individuals, compared to ___ in the non-Indigenous population

5.0%

There also is an increased prevalence of type 2 diabetes in children, especially those who are ___

obese

Age, obesity, hypertension, physical inactivity, and family history are all risks for ___ diabetes

type 2