These comprehensive set of notes are concise and detailed for medical, biochemistry and biomedical students. These notes are written according to a UK medical school covering the medicine syllabus. They cover the basics from insulin signalling pathways to the treatment with different drugs includi...
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Treatment of Diabetes
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Diabetes Introduction
Diabetes; chronic hyperglycaemia with disturbances to carbohydrate, fat and protein
metabolism. Associated with the risk of developing late diabetic complications
Type 1
§ Autoimmune response; destruction of beta cells no insulin secretion
§ Childhood and early adolescent (90% of patients)
§ Triggered possibly by a viral infection
Type 2
• Hyperglycaemia due to impaired insulin secretion
• Hyperglycaemia due to receptor and post receptor defects (moving glucose into cells)
• Hyperglycaemia due to increased hepatic glucose production; over activity of alpha
cells increases the amount of glucagon. The more obese you are the greater the
degree of insulin resistance
• Hypertension more common in these patients
• NASH (non alcoholic steatohepatitis); biggest cause of cirrhosis
• LADA (latent autoimmune diabetes); 6-10% of type 2 diabetes actually have LADA
• Suspect if they are not overweight.
• Poor glucose control with oral agents
• There is evidence of autoimmune disease (thyroid disease and pernicious anaemia).
• Anti-GAD antibodies is a marker for autoimmune disease
Diabetes is associated with the risk of developing late diabetic complications
• Microvascular e.g. Retinopathy; damage of the retina causing vision loss.
Nephropathy; kidney damage, Can lead to renal failure
• Macrovascular; development of atherosclerosis, narrowing of arterial walls
• Neuropathy; peripheral nerve dysfunction causing weakness, numbness, pain
usually in hands and feet
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