Zusammenfassung der Ressource
Diabetes
- prediabetes
- intermediate metabolic states between
established diabetes& normal glucose balance
- represent risk categories for
future diabetes&/or
macrovascular complications
- can lead to any
type of diabetes
- increased risk of
CV disease
- little of no risk for
microvascular
disease
- increased risk of
progression to diabetes
- Type 1
Anmerkungen:
- -10% of diabetic population
-rapid onset of symptoms
-may start at any age: usually <30
- absolute insulin deficiency due to beta-cell destruction
- Type 2
Anmerkungen:
- -90% of diabetic population
-'silent' onset
-75% obese
-insulin resistance
-low levels of insulin
- relative insulin deficiency due to disorder of
insulin action or secretion
- A chronic disease characterised by
hyperglycaemia resulting from defects in
insulin secretion, insulin absorption or both.
- insulin is a polypeptide
hormone synthesized
in Beta-cells of the pancreas
- stored as pro-insulin in
granules in Beta-cells
- normal daily
insulin secretion:
0.5 to 0.7/kg/24h
Anmerkungen:
- 1. K diffused down its conc gradient via ATP gated K channels:
-intracellular potential mainteined at fully polarised -ve level - min insulin secretion
2. high blood glucose levels around beta-cells
3. glucose enters beta-cells
4. increased production of ATP
5. Katp channels close - depolarisation of the cell
6. voltage gated Ca++ ch open
7. Ca influx into the cell
8. increased insulin secretion out of cell into portal circulation
- glucose levels
3.5 to 8mmol/L
- liver is a
major organ
for glucose
homeostasis
- absorbs and stores
glucose as glycogen
- gluconeogenesis
- insulin action:
reduces
glucose levels
- counter
regulatory
hormones
- glucagon
- alpha cells in
the pancreas
- growth hormone
- cortisol
- adrenaline
- stimulants
- glucose and other sugars
- amino acids
- glucagon-like peptide-1
- glucose dependent
insulinotrophic
peptide
- glucagon
- insulin targets
- liver
- skeletal muscle
- adipose tissue
- lack of insulin
- breakdown of
fats-increased
levels of free fatty
acids(FFA)
- liver converts FFA
to ketone bodies
- energy source
for: brain, heart,
skeletal muscle
- acetone excreted by
lungs - fruity smell
- excess ketone
bodies in blood
- ketoacidosis
- DEATH if
left
untreated
- low and constant
level of basal insulin
- slight rise at night to suppress
glucose output by the liver
- complications of diabetes
- neuropathy - peripheral nerver
- erectile dysfunction
- chronic foot complications
- autonomic
neuropathy - chronic
constipation
- gestational diabetes
- diabetes first discovered in pregnancy
irrespective of cause
- older women
- women with previous history
of large babies
- insulin resistance and relative
impairment of insulin secretion
- high risk ethnic groups