Diabetes Mellitus Overview
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Questions and Answers

Definition of Diabetes Mellitus

A group of metabolic diseases characterized by an inability to produce sufficient insulin or use it properly, resulting in hyperglycemia, or elevations in blood glucose

Elevations in blood glucose associated with uncontrolled diabetes, increase the risk for acute and chronic health issues including…

-CVD -microvascular diseases like retinopathy and nephropathy, -nerve damage (both autonomic and peripheral neuropathy)

What type of disease is diabetes type 1 considered?

Autoimmune because the body attacks its own beta cells

Which type of diabetes was formally, known as juvenile onset or insulin dependent diabetes?

<p>Type 1 immune-mediated</p> Signup and view all the answers

Which type of diabetes appears more frequently in childhood and adolescence, but can still occur at any age?

<p>Type 1 immune-mediated</p> Signup and view all the answers

What are the two most common features of type 2 diabetes?

<p>Insulin resistance of peripheral tissues and defective insulin secretion</p> Signup and view all the answers

Patients with diabetes who do not have obesity or overweight may have an increased what?

<p>% of BF distributed mainly around the abdomen</p> Signup and view all the answers

What are four factors that lead to increased blood glucose?

<p>-Increased CHO intake -increased hepatic glucose production -decreased peripheral glucose uptake -decreased insulin secretion</p> Signup and view all the answers

Which type of diabetes sees the pancreas, fail to produce or make less insulin

<p>Type 1</p> Signup and view all the answers

Name 4 non-genetic influences of type two diabetes

<p>-increased age -lack of physical activity -history of gestational diabetes -presence of hypertension or dyslipidaemia</p> Signup and view all the answers

What is gestational diabetes?

<p>Diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type one or type two diabetes</p> Signup and view all the answers

Name three risk factors that contribute to gestational diabetes

<p>Family, history of gestational, diabetes, previous delivery of large birthweight, and obesity.</p> Signup and view all the answers

For women that have had gestational diabetes what happens after delivery?

<p>Glucose tolerance usually returns to normal after delivery, but they have a greatly increased risk of conversion to type to diabetes overtime</p> Signup and view all the answers

What are two acute complications of diabetes

<p>Hyperglycaemia and Hypoglycaemia</p> Signup and view all the answers

Define diabetic ketoacidosis

<p>Occurs in pateints whose diabetes is in poor control and in whom the amount of effective insulin is very low or absent</p> Signup and view all the answers

What is a by product of fat metabolism in the absence of adequate carbohydrates?

<p>Ketone body formation by the liver. This causes an increased risk of coma and death</p> Signup and view all the answers

Match correctly

<p>Ketosis- ketone levels = Low Ketoacidosis- ketone levels = Extremely high Ketosis = Safe function of low-carb diet Ketoacidosis = Occurs in diabetics who don’t take enough insulin</p> Signup and view all the answers

What is the main characteristic of Type 2 diabetes?

<p>High blood sugar levels and insulin resistance</p> Signup and view all the answers

How is Type 1 diabetes different from Type 2?

<p>Type 1 involves autoimmune destruction of pancreatic beta cells</p> Signup and view all the answers

What is the primary factor contributing to the development of Type 2 diabetes?

<p>Sedentary lifestyle and obesity</p> Signup and view all the answers

Which statement is true regarding Gestational Diabetes Mellitus (GDM)?

<p>It is a temporary condition during pregnancy</p> Signup and view all the answers

What is Ketosis

<p>Ketosis is a metabolic process that occurs when the body breaks down fat for energy if it's not getting enough carbohydrates.</p> Signup and view all the answers

Ketones are a direct result of ____

<p>Low glucose</p> Signup and view all the answers

What are Ketones

<p>They are a chemical byproduct created when your body breaks down fat for energy</p> Signup and view all the answers

Why don’t we see increases in ketone body production in healthy individuals when following a low carb diet?

<p>Ketone levels do not become elevated or result in ketoacidosis because insulin levels are still sufficient</p> Signup and view all the answers

Exercise is contraindicated in anyone experiencing diabetic ketoacidosis

<p>True</p> Signup and view all the answers

What is Hyperglycaemia hyperosmolar non-ketotic syndrome

<p>Occurs in type 2 when Hyperglycaemia is prolonged and profound</p> Signup and view all the answers

When is Hyperglycaemia hyperosmolar non-Ketotic syndrome most likely to happen?

<p>During period of illness or stress, in the elderly, or undiagnosed people</p> Signup and view all the answers

Severe dehydration that results from hyperglycaemic hyperosmolar non-ketotic syndrome is attributable to what?

<p>Rising blood glucose levels, causing excessive urination. Eventually leads to mentation and possible coma</p> Signup and view all the answers

Name some acute complications associated with hyperglycaemia

<p>Ketoacidosis and hyperosmolar non-ketotic syndrome,</p> Signup and view all the answers

Which of the following is not a factor that can occur in the presence of hypoglycaemia

<p>Too much CHO intake</p> Signup and view all the answers

Hypoglycaemia can occur either during exercise or hours to days later

<p>True</p> Signup and view all the answers

During what sort of exercise do we typically see ‘late onset post exercise hypoglycaemia’

<p>Moderate to high intesnity lasting longer than 30 min</p> Signup and view all the answers

What factors play a role in Late-onset post-exercise hypoglycaemia

<p>-increase insulin sensitivity -ongoing glucose use -physiological replacement of glycogen stores through gluconeogenesis</p> Signup and view all the answers

Name some potential consequences of hypoglycaemia following sympathetic activation of the adrenal glands. These all increase the risk of clot formation

<p>-arrhythmias -ischemia -abnormal coagulation -Inflammation -endothelial dysfunction -platelet activation</p> Signup and view all the answers

name the 2 symptoms of hypoglycaemia

<p>Adrenergic and neruoglycopaenic</p> Signup and view all the answers

What is the role of the kidneys during periods of high blood glucose

<p>It excretes excess glucose and water by increasing urine production and excreting it that way</p> Signup and view all the answers

For chronic complications stemming from diabetes, what factor do patients need to have a chronic exposure to?

<p>Hyperglycaemia</p> Signup and view all the answers

What is the primary mechanism by which hypoglycemia occurs in individuals with diabetes mellitus?

<p>Incorrect insulin dosing or decreased carbohydrate intake</p> Signup and view all the answers

Which of the following is NOT a symptom of diabetic ketoacidosis?

<p>Hypotension</p> Signup and view all the answers

What is the primary mechanism underlying hypoglycemic unawareness in individuals with diabetes mellitus?

<p>Defective counterregulatory hormone release</p> Signup and view all the answers

What is the primary underlying mechanism that leads to the development of a hyperosmolar hyperglycemic state?

<p>Deficient insulin secretion or insulin resistance</p> Signup and view all the answers

Which of the following statements regarding the treatment of diabetic ketoacidosis is INCORRECT?

<p>Oral hydration is recommended as the primary treatment</p> Signup and view all the answers

Which symptom is NOT typically associated with hyperosmolar hyperglycemic state?

<p>Deep sighing breaths</p> Signup and view all the answers

What is a key factor that differentiates diabetic ketoacidosis from hyperosmolar hyperglycemic state?

<p>Diabetic ketoacidosis results from insufficient insulin, while hyperosmolar hyperglycemic state is due to excess insulin.</p> Signup and view all the answers

Which statement accurately describes the development of hypoglycemic unawareness?

<p>Hypoglycemic unawareness may lead to fainting or seizures without warning signs.</p> Signup and view all the answers

What is the initial cause of damage in the retinal microvasculature in diabetic retinopathy?

<p>Basement membrane thickening</p> Signup and view all the answers

Which of the following is a common feature of all three microvascular complications of diabetes?

<p>Thickened basement membrane</p> Signup and view all the answers

How does hyperglycemia damage nerves in diabetic neuropathy?

<p>By increasing oxidative stress levels and forming advanced glycation end products</p> Signup and view all the answers

How can diabetic retinopathy be screened?

<p>With regular eye examinations</p> Signup and view all the answers

What is essential for the prevention and reduction in progression of neuropathy in diabetic patients?

<p>Intensive management of glucose, blood pressure, and lipids</p> Signup and view all the answers

Name the 3 categories of chronic conditions relating to diabetes

<p>Microvascular, macrovascular, neuropathy</p> Signup and view all the answers

What are examples of macrovascular complications

<p>Coronary artery disease with or without angina, myocardial infarction, cerebrovascular accident and peripheral arterial disease</p> Signup and view all the answers

what are some examples of microvascular disease

<p>Diabetic retinopathy and diabetic nephropathy</p> Signup and view all the answers

What does neuropathy involve?

<p>Involves both the peripheral and autonomic nervous system</p> Signup and view all the answers

define retinopathy and its results

<p>High blood glucose and high BP cause abnormal function and damage to the small vessels of the eyes. Can result in blindness</p> Signup and view all the answers

Define nephropathy and its results

<p>High BP damages kidney and excess blood glucose overworks the kidneys where end-stage is renal failure</p> Signup and view all the answers

What do the large number of lower limb amputations from diabetes result from?

<p>Loss of sensation that places the patient at risk for injury and from diminished circulation attributable to peripheral artery disease</p> Signup and view all the answers

Name the 2 categories of symptoms of hypoglycaemia

<p>Adrenergic and Neruoglycopaenic</p> Signup and view all the answers

Name a few adrenergic symptoms of hypoglycaemia

<p>Shakiness, weakness, sweating, nervousness, anxiety, tingling of mouth and fingers, hunger</p> Signup and view all the answers

Name a few Neuroglycopaenic symptoms of hypoglycaemia

<p>headache, visual disturbances, mental dullness, confusion, amnesia, seizures, coma</p> Signup and view all the answers

which of the following is the primary cause of adrenergic hypoglycaemic symptoms?

<p>increased epinephrine release</p> Signup and view all the answers

What type of mutation occurs in reproductive cells and can be inherited?

<p>Germline mutation</p> Signup and view all the answers

The NF-κB pathway regulates cell proliferation and differentiation.

<p>False</p> Signup and view all the answers

What is an oncogene?

<p>A gene that promotes cell growth and division.</p> Signup and view all the answers

Tumor suppressor genes can become ______________________ in cancer.

<p>mutated or inactivated</p> Signup and view all the answers

Match the following DNA repair mechanisms with their function:

<p>Base excision repair (BER) = Repairs small DNA lesions Nucleotide excision repair (NER) = Repairs larger DNA lesions Mismatch repair (MMR) = Repairs mismatched DNA bases Homologous recombination (HR) and non-homologous end joining (NHEJ) = Repair double-strand DNA breaks</p> Signup and view all the answers

What is the consequence of a mutated gene that no longer functions properly?

<p>Loss of function</p> Signup and view all the answers

The PI3K/AKT pathway regulates cell proliferation and differentiation.

<p>False</p> Signup and view all the answers

What is the result of disruptions in cell signaling pathways?

<p>Uncontrolled cell growth and proliferation, resistance to apoptosis, and increased angiogenesis.</p> Signup and view all the answers

Defects in DNA repair mechanisms can lead to ______________________ and accumulated mutations.

<p>genetic instability</p> Signup and view all the answers

Which of the following is an example of an oncogene?

<p>HER2</p> Signup and view all the answers

Study Notes

Acute Complications of Diabetes Mellitus

  • Hypoglycemia occurs when blood sugar falls below normal levels, triggered by incorrect insulin dose, excessive exercise, or reduced carbohydrate intake.
  • Symptoms of hypoglycemia include irritability, sweating, blurred vision, headache, dizziness, pale skin, tears, trembling, convulsions, confusion, and loss of consciousness.
  • Treatment of hypoglycemia involves ingestion of glucose or intravenous administration if the patient is unconscious.

Diabetic Ketoacidosis

  • Diabetic ketoacidosis occurs when insulin deficiency leads to severe hyperglycemia, causing the body to break down fat for energy and produce excessive ketones, leading to metabolic acidosis.
  • Symptoms of diabetic ketoacidosis include signs of dehydration, deep sighing breaths, acetone on the breath, and possible abdominal pain.
  • Urgent hospitalization is necessary for fluid and electrolyte replacement, insulin therapy, and close monitoring.

Hypoglycemic Unawareness

  • Hypoglycemic unawareness is a condition where patients are unable to sense hypoglycemia despite low blood sugar levels due to reduced symptoms or lack of consciousness.
  • Treatment of hypoglycemic unawareness involves maintaining strict glycemic control by adjusting insulin doses, lifestyle changes, and consistent carbohydrate intake.

Hyperosmolar Hyperglycemic State

  • Hyperosmolar hyperglycemic state is a less common acute complication that occurs when blood glucose rises rapidly, causing an osmotic diuresis, leading to dehydration and electrolyte imbalance.
  • Symptoms of hyperosmolar hyperglycemic state include extreme thirst, frequent urination, lethargy, confusion, and neurological complications such as seizures and coma.
  • Immediate hospitalization is required for aggressive fluid replacement, insulin therapy, and symptomatic treatment.

Chronic Complications of Diabetes Mellitus

  • Chronic complications of diabetes mellitus include diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy, which affect the eyes, kidneys, and nervous system.

Diabetic Retinopathy

  • Diabetic retinopathy is the most common microvascular complication of diabetes, leading to blindness if left untreated.
  • It occurs when hyperglycemia causes damage within the retinal microvasculature, resulting in basement membrane thickening, increased capillary permeability, and the formation of microaneurysms.

Diabetic Nephropathy

  • Diabetic nephropathy is a condition where persistent proteinuria, hypertension, and a low glomerular filtration rate (GFR) are present.
  • Approximately 25-45% of Type 1 DM patients and 50% of Type 2 DM patients develop nephropathy in their lifetime.

Diabetic Neuropathy

  • Diabetic neuropathy includes various forms such as sensory, motor, or mixed neuropathy.
  • The exact mechanism of how hyperglycemia damages nerves is unclear, but it is believed to involve oxidative stress and advanced glycation end products.

Prevention and Management of Chronic Complications

  • The management of chronic complications involves tight control of blood sugar levels, blood pressure, and lipids.
  • Early detection of microvascular complications is crucial for effective management.
  • Prevention and management strategies involve lifestyle modifications, such as regular physical activity, healthy diet, and smoking cessation.

Preventive Approaches

  • Preventive approaches to reduce the risk of cardiovascular complications include careful screening, focusing on symptoms of atherosclerotic disease, and lifestyle modifications.

Microvascular Complications

  • Microvascular complications affect small blood vessels and can lead to long-term damage or dysfunction in various organs.
  • Common microvascular complications include retinopathy, nephropathy, and neuropathy.

Macrovascular Effects

  • Macrovascular complications can manifest as peripheral vascular disease, stable angina, heart failure, myocardial infarction, and unstable angina.
  • Addressing both microvascular and macrovascular complications is crucial for improving outcomes in patients with diabetes mellitus.

Cardiovascular Complications

  • Cardiovascular complications are among the most common and serious consequences of diabetes mellitus.
  • They include coronary artery disease, peripheral arterial disease, and cerebrovascular disease.

Diabetes Mellitus

  • Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia, defined as elevated blood sugar levels.
  • There are three main categories of diabetes: Type 1, Type 2, and Gestational Diabetes Mellitus (GDM).
  • Type 1 diabetes is an autoimmune condition where the body's immune system attacks and destroys the beta cells of the pancreas, responsible for insulin production.
  • Type 2 diabetes is a metabolic disorder characterized by a combination of insulin resistance and defective insulin secretion.

Cellular Mutations

  • Cancer occurs due to altered gene expression
  • Two ways cellular mutations occur:
    • Somatic mutations: non-reproductive cells, not inherited
    • Germline mutations: reproductive cells, can be inherited
  • Mutation types:
    • Point mutations: affect single nucleotide
    • Frameshift mutations: affect genetic code reading frame
    • Chromosomal mutations: affect entire chromosomes or regions
  • Consequences of mutations:
    • Loss of function: gene no longer functions properly
    • Gain of function: gene acquires new, abnormal function

Cell Signaling Pathways

  • Normal cell growth and division regulated by cell signaling pathways
  • Cancer occurs when these pathways are disrupted or altered
  • Key pathways involved in cancer:
    • PI3K/AKT pathway: regulates cell survival and proliferation
    • RAS/RAF/MAPK pathway: regulates cell proliferation and differentiation
    • NF-κB pathway: regulates inflammation and cell survival
  • Disruptions in cell signaling pathways lead to:
    • Uncontrolled cell growth and proliferation
    • Resistance to apoptosis (programmed cell death)
    • Increased angiogenesis (formation of new blood vessels)

Oncogenes

  • Oncogenes promote cell growth and division
  • Normally, oncogenes are tightly regulated in cell growth and division
  • In cancer, oncogenes become:
    • Overexpressed: produce too much protein
    • Mutated: produce hyperactive or constitutively active protein
  • Examples of oncogenes:
    • HER2 (human epidermal growth factor receptor 2)
    • RAS (rat sarcoma)
    • MYC (v-myc avian myelocytomatosis viral oncogene homolog)

Tumor Suppressor Genes

  • Tumor suppressor genes regulate cell growth and division, preventing cancer
  • Normally, tumor suppressor genes prevent uncontrolled cell growth and division
  • In cancer, tumor suppressor genes become:
    • Mutated: produce non-functional or less active protein
    • Inactivated: silenced or deleted
  • Examples of tumor suppressor genes:
    • TP53 (tumor protein p53)
    • BRCA1 and BRCA2 (breast cancer susceptibility genes 1 and 2)
    • PTEN (phosphatase and tensin homolog deleted on chromosome 10)

DNA Repair Mechanisms

  • DNA repair mechanisms maintain genome stability
  • Cancer occurs when DNA repair mechanisms are defective or impaired
  • Types of DNA repair mechanisms:
    • Base excision repair (BER): repairs small DNA lesions
    • Nucleotide excision repair (NER): repairs larger DNA lesions
    • Mismatch repair (MMR): repairs mismatched DNA bases
    • Homologous recombination (HR) and non-homologous end joining (NHEJ): repair double-strand DNA breaks
  • Defects in DNA repair mechanisms lead to:
    • Genetic instability
    • Accumulation of mutations
    • Increased cancer risk

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Learn about the different types of diabetes, including Type 1, Type 2, and Gestational Diabetes Mellitus (GDM). Explore the characteristics and causes of Type 1 diabetes, an autoimmune condition affecting insulin production.

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