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TMS exam > 1 - diabetes and its treatment > Flashcards

1 - diabetes and its treatment Flashcards

1
Q

negative consequences of diabetes

A

decreases life expectancy

contributes to kidney failure and CV diseases (MI and stroke)

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2
Q

diabetes mellitus type 1

A

hyperglycemia due to insufficient insulin secretion by the pancreas

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3
Q

relative percentages of people with T1 or T2 diabetes

A

10% of people with diabetes are Type 1

90% are T2

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4
Q

monogenic causes of diabetes

A

single gene defects of beta cells

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5
Q

MODY

A

maturity onset diabetes of the young

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6
Q

types of monogenic causes of diabetes

A 
MODY (autosomal dominant gene mutation)
neonatal diabetes (e.g. mutation in K+ATP channel)
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7
Q

properties of people with T2 diabetes

A

often older, overweight, commonly genetic cause
thirsty
polyuria
tiredness

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8
Q

lifestyle treatment for T2 diabetes

A

better diet

more exercise

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9
Q

pharmaceutical treatment for T2 diabetes

A

drugs to improve insulin sensitivity
e.g. metformin

drugs to stimulate insulin secretion
e.g. GLP-1 agonist

drugs to promote glucose excretion via kidneys

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10
Q

type 2 diabetes

A

long-term metabolic disorder characterized by high blood sugar, insulin resistance, and relative lack of insulin

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11
Q

type 1 diabetes

A

autoimmune destruction of insulin-producing pancreatic beta cells

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12
Q

signs of T1 diabetes

A

presence of autoantibodies and autoreactive T cells

total loss of beta cells within an islet
alpha cells remain intact

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13
Q

targets of autoreactive T cells in T1 diabetes

A

islet cells or their antigenic constituents

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14
Q

properties of people suffering from type 1 diabetes

A

young
rapid onset
thin/underweight at diagnosis

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15
Q

treatment of T1 diabetes

A

insulin replacement therapy
- injections or pump

monitoring of blood glucose

carbohydrate counting

transplantation of pancreas/islets

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16
Q

biomarkers for diabetes

A

HbA1c
anti-GAD
serum c-peptide

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17
Q

HbA1c testing

A

long-term –> tests average blood glucose over last 2-3 months

high HbA1c –> too much blood glucose

normal range for diabetes = 48 mmol/mol

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18
Q

who gets their HbA1c tested

A

patients that know they have diabetes already

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19
Q

what is HbA1c

A

Haemaglobin A1c
(glycated haemaglobin)

secreted when glucose builds up and sticks to blood vessels

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20
Q

anti-GAD as a diagnostic test

A

presence of anti-GAD identifies someone with T1 diabetes
–> suggestive of autoimmunity

blood test (from the arm) measuring whether the body is producing antibodies targeted to destroy its own GAD cells

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21
Q

what is GAD

A

glutamic acid decarboxylase enzyme

acts as an autoantigen –> stimulates antibodies to be released

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22
Q

which test determines which type of diabetes someone has

A

anti-GAD blood test

serum c-peptide test

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23
Q

what does serum c-peptide test for

A

shows how well the body is making insulin

24
Q

how is serum c-peptide tested

A

blood or urine sample taken

25
Q

what is c-peptide

A

released by beta cells when they make insulin

proinsulin + c-peptide = insulin

26
Q

why is c-peptide a good biomarker for insulin production

A

C-peptide and insulin are present in pancreatic beta cells in equal amounts

C-peptide remains in your blood for approximately 5 times as long as insulin, and is therefore present in your blood at approximately 5 times the concentration

27
Q

normal serum c-peptide range

A

0.5-2.0 ng/ml

28
Q

what c-peptide results would indicate T1 diabetes

A

low serum c-peptide levels and high blood glucose

29
Q

what c-peptide results would indicate T2 diabetes

A

high serum c-peptide levels and low blood glucose levels

30
Q

most common mutation causing MODY

A

glucokinase mutation

MODY 2

31
Q

alternative mutation causing MODY

A

HNFa mutation
(hepatocyte nuclear factor)

(MODY 1 and 3)

32
Q

which type of diabetes is associated with insulin resistance

A

type 2

33
Q

method and advantages of most common method of insulin delivery

A

insulin pen

insulin injected into subcutaneous tissue

little pain, easy, accurate therefore good for kids

34
Q

disadvantages of insulin pen

A

exPENsive

not all insulin types available

35
Q

alternative methods of insulin delivery

A

implantable insulin pump
external insulin pump
‘smart insulin’
insulin inhaler

36
Q

methods of blood glucose monitoring

A

finger pricks (most common)
non-invasive monitoring (measures interstitial fluid)
flash glucose monitor (scan small white disk)
continuous glucose monitor

37
Q

what is an artificial pancreas

A

system that measures blood sugar levels using a continuous glucose monitor (CGM)

transmits information to an insulin pump that calculates and releases the required amount of insulin into the body

38
Q

benefits and disadvantages of artificial pancreas

A

no immunosuppressants required
little risk of infection

hard to connect glucose monitor to insulin pump

39
Q

2 methods of beta cell replacement therapy

A

regeneration of remaining beta cells

islet transplants

40
Q

process of regeneration of beta cells

A

some T1 diabetes patients still have detectable levels of c-peptide
chemicals can be used to enhance proliferation of beta cells
(transdifferentiation)

41
Q

advantages and disadvantages of islet transplants

A

+
effective treatment –>reduces hypoglycaemic events

-
potential immune rejection
injecting islets into the liver can cause clots
insulin dependence may not last that long –> requires repeats

42
Q

what is iPS cell treatment

A

induced pluripotent stem cell treatment

reverts cells back to stem cells so specialised cells can then be derived from them

43
Q

advantages and disadvantages of iPS cell treatments

A

+
don’t need an embryo
fewer ethical issues

-
expensive

44
Q

what is ES cell-based generation

A

embryonic stem cell-based generation

hijacking normally occurring differentiation pathways and replicating them in culture to produce specific specialised cells

45
Q

how does ES cell-based generation work

A

replicate differentiation pathways of embryo from endoderm stage into mature pancreatic tissue

transcription factors change at every stage of differentiation therefore can be used as markers of specific stage

46
Q

disadvantages of embryonic stem cell-based generation

A

difficult to generate fully functional cells in vivo

ethical issues from source of cells

47
Q

transdifferentiation in mice

A

inject specific transcription factors to convert liver cells to beta cells or alpha cells to beta cells

48
Q

importance of changing properties of insulin

A

changes the rate of absorption

49
Q

properties of naturally occurring insulin

A

stored in the pancreas in tetramer crystals

tetramers broken up into monomers

50
Q

rapid acting insulin

A

usually taken straight before a meal
peaks after 1 hour

often used with long-acting insulin

51
Q

short-acting insulin

A

taken 30 mins before a meal
peaks after 2-3 hours

often used with long-acting insulin

52
Q

intermediate acting insulin

A

covers glucose elevations when rapid-acting stops working

peaks after 4-12 hours

53
Q

long-acting insulin

A

sustained basal insulin rate throughout day
can lower glucose levels for 24 hours

taken before bed

54
Q

artificial pancreas is an example of …

A

a closed loop insulin delivery system

55
Q

where does the artificial pancreas get its name?

A

it monitors and adjusts insulin levels just as the pancreas does in people without diabetes.

56
Q

evidence that the artificial pancreas is effective

A

People using the system spent 14% more time with their glucose levels in the ideal range, compared to people using standard insulin therapy

They also had lower average overnight blood glucose levels without increasing hypos.

TMS exam (22 decks)

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