Edgu 1003 Notes L5 - compiled from lecture and readings PDF

Preview

Summary

compiled from lecture and readings...

Description

EDGU L5 L5 Diabetes mellitus • A group of conditions characterised by raised blood glucose levels resulting from insulin problems (not working properly or not being made by the pancreas) • Insulin - a hormone that causes liver and muscle cells to take in glucose and store it as glycogen • 2 major types o Type 1 - Insulin dependent diabetes mellitus (IDDM) o Type 2 - Non-insulin dependent diabetes mellitus (NIDDM) • Diabetes - sometimes known as “blood sugar”. Other names include ‘juvenile diabetes’, IDDM, NIDDM • Pre-diabetes precedes diabetes in diagnosis. • Management includes a combination of drugs, injections and careful dietary control. • Potential complications of diabetes are large as well as co-morbidities. • The burden of diabetes in Australia is quite high o Big costs to health care systems, quality of life, aged care burdens Pre diabetes • Diagnosis that means you almost have diabetes – only for Type 2 o A change in diet and medication can prevent this (TYPE 2 – lifestyle) • Approx 2.46 million Australians have pre-diabetes • Occurs when blood sugar levels are higher than normal but not high enough diabetes classification • It’s a warning sign if picked up early enough. • With strict diet control, lifestyle changes and a commitment it can prevent type 2 diabetes diagnosis. • However if left untreated, can develop into type 2 within 5-10 years. Prevalence of diabetes • Type 2 is much more common than Type 1. • Type 2 = 85-90% of all cases. Mostly adults, however more children being diagnosed. • Type 1 = 10-15% of all cases  is one of the most common chronic childhood diseases in developed nations. • World wide increase in prevalence o increased 7.2% per annum since 2000. o By 2018, Diabetes NSW expects diagnosable diabetes to total approximately 2.65 million. • Type 1 diabetes prevalence is increasing at about 3% annually Reasons: o Aging population o Reduced activity o Increased consumption of energy dense food • Diabetes is the 6th highest cause of death by disease in Australia. (heart disease is No.1 cause of death) • People with diabetes are: o Twice as likely to be have high blood pressure o More likely to have elevated blood fats e.g. cholesterol, triglycerides. o Twice more likely to have cardiovascular disease, e.g. heart disease and stroke. o ONE IN FOUR Australian adults has either diabetes or impaired glucose metabolism o Obesity and being overweight increases risk o Amputations, gangrene eye complications People with diabetes in 2005 • 15% were hospitalised with coronary heart disease • 38,700 Australians were hospitalised for eye complications caused by diabetes • 90% undergoing a lower limb amputation had a history of ulceration • 3,400 had amputations (65 a day) • 11% of people with diabetes have had a heart attack & 23% died from kidney disease

Complications of having diabetes Diabetes and heart disease/stroke: • Diabetes is often associated with high blood pressure and high blood fats • It causes an increased risk of heart attack and stroke. • Close to 80% of people with diabetes will die from a heart attack/stroke • 6 times more likely to suffer from atherosclerosis Diabetes and eye disease (Retinopathy) • Reason for this: there’s a lot of capillaries that supply blood to the eyeball, people have high blood pressure, high ocular pressure, makes it difficult to see, glaucoma, fuzzy vision and blindness • Retinopathy (decay in eyes)  major long-term complication of diabetes (affects 1 in 4 people with diabetes) • Development of retinopathy strongly related to the length of time diabetes has been present and the degree of blood glucose control • Regular eye checks and treatment can help prevent retinopathy-caused blindness Diabetes and kidney disease (Nephropathy): • Kidneys produce renin, a hormone which controls blood pressure, people with diabetes are likely to produce more renin • Diabetes is the fastest-growing cause of kidney failure. • It is the leading cause of end stage renal disease (ESRD). (end stage renal disease – kidneys have shut down, you have a high level of toxins in your blood) • Approx. 30% of people with diabetes will develop kidney disease. • May need dialysis Diabetes and lower limbs (Neuropathy): • Because the nerves start to loose their sensitivity • Neuropathy or peripheral nerve disease and blood vessel damage may lead to leg ulcers and serious foot problems • This then may lead to gangrene and amputation of limbs • Nerves will begin to die and lead to decreased reflexes Type 1 diabetes: Cause • Exact cause not known • Destruction of insulin-producing cells in pancreas (islet b-cells), no longer producing insulin • Usually results from an autoimmune process • Possibly triggered by early introduction of cow’s milk? (Exclusive breastfeeding until 6 months of age recommended) • Australia  3.61 million Australians have diabetes. • Worldwide  366 million people worldwide have diabetes (2005) Type 1 diabetes: Characteristics • Pancreas fails to produce insulin • Glucose cannot be transported into cells and levels build up in the blood (hyperglycaemia) • The body’s cells cannot use glucose and begin to burn fats for energy • Unless treated, dangerous chemical substances from the burning of fat accumulate in the blood (ketoacidosis) • Ketone bodies struggle and will make us feel bad, can tell because of bad breath (keto acidosis can lead to unconsciousness) • If left untreated: loss of consciousness potentially fatal • TYPE 1 DIABETICS ARE UNDERWEIGHT • Type 1: people inject themselves with insulin because their body can’t produce it • Glucagon is used where an individual doesn’t have carbs and sugars

Type 1 diabetes: Symptoms • Sudden onset (during childhood/adolescence) • Markedly raised blood glucose levels • Feeling constantly thirsty • Passing urine frequently, including bedwetting • Excessive hunger • Blurred vision • Unexplained weakness and fatigue • Weight loss • Nausea and vomiting Type 1 diabetes: Treatment • Type 1 diabetics depend on up to 4 insulin injections every day of their lives • Long acting insulin – about 8 hours • Short acting insulin – need regular injections, 2 hours window (stay in body for abt 2 hrs) • Blood glucose levels tested several times daily. Vital to monitor the complex interaction of food and exercise with insulin injections • Diabetes "control" means keeping the blood glucose level as close to normal as possible (3 - 8mmol/L) • The three elements of "control“: o 1)food, 2) exercise, 3) insulin Type 2 diabetes: Cause • Body cells are resistant to the action of insulin  Insulin Resistance • or doesn’t produce enough insulin to maintain normal glucose levels. • Produces the insulin from the ฀฀ cells • Normal body - insulin binds to the insulin receptor, glut4 moves to the surface of the cell, once it moves, insulin can move from the outside of the cell to the inside, means you can use the glucose for energy • Type 2 – insulin can’t bind to the receptor, glut 4 stays inside the cell, glucose can’t go to the inside, leads to insulin resistance Type 2 diabetes: characteristics • Insulin levels may be elevated as ฀฀ -cells produce more insulin in an attempt to overcome the insulin resistance (overproduces, high levels of glucose and insulin, insulin is obesogenic) • ฀฀-cells may become “exhuasted” and die • Glucose builds up in the blood (hyperglycaemia) • Some glucose appears in urine (glycosuria) • Symptoms come on gradually (usually after age 50 years, but starting younger and younger) • Often no symptoms (diagnosed after a blood glucose test) Type 2 diabetes: symptoms • Feeling tired • Constantly thirsty • Passing urine frequently • Blurred vision • Itching of the skin or genital area • Numbness and tingling in hands or feet • Slow healing infections/ wounds • Weight gain • Sometimes no symptoms at all

Type 2 Diabetes Type 2 diabetes: treatment • Healthy eating and regular exercise can control blood glucose levels  focus on ↓ weight o Exercise and ↓ weight result in improved insulin sensitivity and may reduce the need for drugs • Oral hypoglycaemic drugs such as biguanides includes metformin (insulin may also be necessary), salty tablets, mimic the action of the insulin and clear glucose from the blood Type 2 diabetes: risk factors • Modifiable and non modifiable factors Modifiable risk factors: o Weight (Visceral fat (apple shape) more dangerous than subcutaneous pear fat) o Lifestyle changes o Healthy eating (reduce saturate fat to...