BY2EN2 Endocrinology Diabetes (week 5) Please make sure you have done any of the asynchronous work required before the synchronous session to make the most of it! When you are watching recordings, please do pause and make notes as well as clarifying things that you don't understand. The slides are all available on Blackboard. Asynchronously before the lecture Watch the recording entitled "Introduction to Diabetes Mellitus". This will introduce the different types of diabetes and how insulin is secreted Read the section entitled "THE INCRETIN HORMONES" in the review article found at the link below: https:ttttdiabetes.diabetesjournals.orgttcontenttt53tt Watch the recording entitled "Pathology of Diabetes Types". This will explain the causes of the two main types of diabetes mellitus Read the section on reversing diabetes found at: https:ttttwww.diabetes.co.ukttreversing- diabetes.html Decide which approach is the one you would recommend if you were commissioning NHS services. Try to think about the endocrinological basis for each intervention working (i.e. does it improve insulin sensitivity?) Watch the recording entitled "Treatment and Complications". This will go through the different treatment options and their endocrinological basis, as well as covering the complications of poorly controlled blood glucose., Synchronous session - Attend the synchronous session (and take part!).
Introduction to Diabetes: What is Diabetes Mellitus? · Collection of diseasesttconditions due to loss of glucose homeostasis. o Type 1 and 2 diabetes. o Type 3c diabetes o MODY o Gestational Diabetes o T2DMY -type 2 diabetes in young adults o Others · Accounts for 10% of the entire NHS budget. · Associated with serious complications. · Shortens lifespantt accelerates ageing. Diabetes Diagnosis- FBGttOGTT: There is a 'pre-diabetes' stage, which is important as at this point clinicians can intervene and prevent a person from becoming completely diabetic- however we are bad at this. Number of people Normal Impaired fasting glycaemia Diabetes If a person has an oral glucose tolerance test (OGTT) falls in the middle blue stage, known as impaired fasting glycaemia, this is the 'pre diabetic stage'. This is a stage where glucose is high but not high enough to be classed as diabetes. 2 3 4 5 6 Glucose (mmol/L) 7 8 Diabetes Diagnosis- HbA1c: · Can also diagnose diabetes by measuring the amount of glycated haemoglobin (HbA1c). · Glucose binds irreversibly to Hb in erythrocytes, forming HbA1c. · The higher the glucose, the higher the HbA1c. . Because erythrocytes live for 100-120 days we know that this gives us an indication of blood glucose levels over 2-3 months. o Normal HbA1c levels less than 42 mmolttmol o 'Prediabetes' levels 42-47mmolttmol o Diabetes levels 48mmolttmol or greater Normal Glucose Homeostasis: If Diabetes Mellitus is loss of normal glucose homeostasis, what is normal glucose homeostasis? . Insulin is the key hormone- released by pancreatic beta cells and binds to the insulin receptor. (glucagon and somatostatin are also involved). These hormones interact in different cells in the body to maintain normal glucose homeostasis. · In a fed state: o Glucose is delivered from GI tract via SGLT1 (glucose transporter).
o Glucose