ALO 1: Review the biology of the pancreas and describe pancreatitis.
ALO 2: Understand the difference between the three main types of diabetes.
ALO 3: Describe the pathogenesis of Type 2 diabetes.
ALO 4: Explain the main symptoms of Type 2 diabetes.
ALO 5: Outline the steps in diagnosis and treatments of diabetes.
ALO 6: Describe preventative approaches for type 2 diabetes.
The pancreas has a long, flat structure located behind the stomach and is involved in both endocrine and exocrine functions.
Aids in digestion by producing digestive enzymes.
Regulates blood sugar levels through hormone secretion.
Digestive Enzymes: Secreted into the duodenum via the main pancreatic duct. Includes:
Lipase: Digests fats by breaking them down into fatty acids and glycerol.
Amylase: Digests carbohydrates into simple sugars.
Proteases (e.g., trypsin, chymotrypsin): Digests proteins into peptides and amino acids.
Produces and secretes hormones into the bloodstream specifically from the Islets of Langerhans:
Alpha Cells: Release glucagon, which raises blood sugar levels.
Beta Cells: Release insulin, which lowers blood sugar levels by facilitating cellular glucose uptake.
Delta Cells: Release somatostatin, which regulates the secretion of other hormones and slows down digestive processes.
The pancreas is surrounded by a thin connective tissue capsule with septae for structural support.
Distinct lobules can be observed microscopically.
Beta Cells: Crucial for insulin production and regulation of glucose levels in the body, thus playing an essential role in glucose metabolism.
Inflammation of the pancreas which can be acute or chronic.
Can cause swelling, sharp abdominal pain, vomiting, and functional changes in the pancreas such as malabsorption of nutrients.
Acute pancreatitis is often sudden and intense, while chronic pancreatitis leads to persistent abdominal pain and digestive issues.
Diabetes occurs due to the inability to transport sugar (glucose) from the blood into cells, which leads to chronic hyperglycemia.
Type 1 Diabetes (T1DM): Autoimmune destruction of beta cells, resulting in no insulin production and requiring lifelong insulin therapy.
Type 2 Diabetes (T2DM): Characterized by insulin resistance followed by reduced insulin production; accounts for over 90% of diabetes cases. Often related to lifestyle factors such as obesity.
Gestational Diabetes: Triggered by pregnancy-related hormone changes, increasing risks for Type 2 diabetes in later life.
Symptoms may develop slowly and include:
Discolored skin patches in the armpits or neck (acanthosis nigricans).
Neuropathy characterized by pain or numbness in extremities (feet).
Unlike Type 1 diabetes, Type 2 may not present with rapid symptoms such as weight loss or diabetic ketoacidosis.
Involves:
Impaired function and loss of islet beta-cells.
Increased alpha-cell mass and inappropriate glucagon secretion which contribute to hyperglycemia.
Changes at the cellular level negatively affect insulin release and action on glucose uptake by tissues.
Symptoms to monitor include:
Polydipsia: Excessive thirst due to dehydration from urination.
Polyphagia: Excessive hunger because cells are unable to utilize glucose properly.
Polyuria: Frequent urination, leading to further dehydration.
Additional Symptoms: Drowsiness or fatigue, skin issues including slow-healing sores, and blurred vision.
Age of onset varies, with Type 1 typically presenting in youth and Type 2 in older adults, although increasingly noted in younger populations due to lifestyle changes.
Factors influencing risk include:
Obesity: Excess body weight is the most significant risk factor.
Sedentary Lifestyle: Lack of physical activity increases the risk.
Poor Diet: High in processed foods, sugars, and fats.
Family History: A child with a parent with T2DM has a 40% chance of developing diabetes, indicating a genetic connection.
Lipid Profile: Assessment for proteinuria & ketones which are elevated in T1DM.
Blood Tests:
HbA1C: Measures the average blood glucose over the past 2-3 months.
Fasting Blood Sugar Test: Measures glucose levels after fasting.
Oral Glucose Tolerance Test (OGTT): Assesses the body's response to sugar.
Random Blood Sugar Test: Checks current blood sugar levels.
Drug Classes and Examples:
Biguanides (Metformin): Increases insulin sensitivity and decreases hepatic glucose production.
Thiazolidinediones (e.g., Pioglitazone): Improve insulin sensitivity similarly.
Sulfonylureas (e.g., Glipizide): Stimulate insulin secretion from beta cells.
SGLT-2 Inhibitors (Dapagliflozin): Promote glucose excretion in urine leading to weight loss but may cause increased thirst.
DPP-4 Inhibitors (Sitagliptin): Help modulate incretin hormones to improve glucose control.
GLP-1 Mimetics (Exenatide): Help stimulate insulin secretion while inhibiting glucagon release.
Consistently high blood sugar can lead to:
Atherosclerosis: Increases risks of cardiovascular diseases, heart attacks, and strokes.
Chronically elevated blood sugar may damage small blood vessels leading to:
Diabetic Retinopathy: Can result in vision loss.
Diabetic Nephropathy: May lead to renal failure requiring dialysis.
Diabetic Neuropathy: May result in foot ulcers, leading to severe complications and potential amputations.
Diet: Increase intake of fiber-rich fruits, vegetables, and whole grains; reduce consumption of refined carbohydrates and sugars.
Exercise: Aim for at least 150 minutes of moderate aerobic exercise weekly, with resistance training 2-3 times a week to improve insulin sensitivity.
Monitoring: Regular HbA1C tests to assess control over blood glucose levels; daily blood sugar monitoring may be necessary depending on treatment strategies.
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