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JG Year 1 > 141 Diabetes > Flashcards

141 Diabetes Flashcards

0
Q

Above what level of fasting plasma glucose is diabetes diagnosed?

A

7.0 mmol/L

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1
Q

Above what level is diabetes diagnosed in a random plasma glucose?

A

11.1 mmol/L

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2
Q

What is the dose of glucose given in an OGTT?

A

75mg

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3
Q

What 5 things can influence a HbA1c level?

A
  • haemolysis
  • iron deficiency anaemia
  • renal impairment
  • pregnancy
  • blood transfusion
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4
Q

How much glucose is produced by the liver and kidney per day?

A

70g

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5
Q

Where is insulin produced?

A

β cells in the pancreas

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6
Q

Where is glucagon produced?

A

α cells of the pancreas

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7
Q

What is the effect of glucagon secretion from the pancreas?

A

Stimulation of hepatic glycogenolysis and gluconeogenesis

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8
Q

When are incretin hormones released?

A

Following ingestion of food

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9
Q

Name 2 incretin hormones

A
  1. GLP-1 (glucagon-like peptide 1) 2. GIP (gastric inhibitory peptide)
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10
Q

Which hormone do incretins inhibit the release of?

A

Glucagon

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11
Q

What effect do incretins have on insulin production?

A

Increases the amount of insulin produced by β cells of the pancreas

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12
Q

Where is glucose reabsorbed?

A

In the proximal tubules of the nephron

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13
Q

Which transport protein reabsorbs glucose from the proximal tubule of the nephron?

A

SGLT2 mostly but a bit by SGLT1 too.

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14
Q

Which transporter is more abundant in the proximal tubule of the nephron in DM2?

A

SGLT2

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15
Q

What are the macrovascular complications in diabetes? (3 listed)

A
  • CAD
  • cerebrovascular disease
  • peripheral artery disease
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16
Q

What are the microvascular complications of DM2?

A
  1. retinopathy
  2. neuropathy
  3. nephropathy
  4. cognitive impairment
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17
Q

Why is vision affected in early DM2?

A

Glucose in the lens causes influx of H2O into it which changes its refraction

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18
Q

Name some symtoms of DM2 (11 listed)

A
  • gustatory sweating
  • thirst
  • CR arrest
  • postural hypotension
  • gastroparesis
  • neuropathic bladder –> polyuria
  • diabetic diarrhoea
  • erectile failure
  • neuropathic oedema
  • necrobiosis
  • charcot foot
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19
Q

At what age should statins be prescribed in dyslipidaemia?

A

40years

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20
Q

Which trial showed that DM is a progressive disease?

  1. UKPD33
  2. ACCORD
  3. UKPD38
A
  1. UKPD33
21
Q

Which trial showed a 25% reduction in microvascular disease and a legacy effect in diabetes?

  1. UKPD34
  2. STENO-2
  3. UKPD33
A
  1. UKPD33
22
Q

Which trial had to be stopped as the intensive group on diabetic controlling drugs had a higher mortality than the control?

  1. UKPD34
  2. ACCORD
  3. UKPD38
A
  1. ACCORD
23
Q

Which trial showed that there was no benefit in reducing diabetics BP to <120/80?

  1. UKPD34
  2. UKPD38
  3. STENO-2
A

2.UKPD38

24
Q

Which trial aimed for:

  • BP < 130/80
  • HbA1c <6.5 mmol/L
  • cholesterol <4.5 mmol/L

in diabetes?

A

STENO-2

25
Q

What is the 1st line therapy for DM2 after lifestyle advice?

A

Metformin

26
Q

What is the major SE of metformin?

A

GIT disturbances

27
Q

What is the major risk of metformin therapy?

A

lactic acidosis

28
Q

At which measurement of eGFR should metformin be stopped?

A

30ml/min/1.732

29
Q

What is the 2nd line added on treatment of DM2?

A

Sulphonylureas - e.g. gliclazide

30
Q

What is the MOA of gliclazide?

A
  • Gliclazide binds to the β cell sulfonyl urea receptor (SUR1).
  • binding blocks the ATP sensitive potassium channels –> closure of the channels –> decrease in potassium efflux –> depolarization of the β cells.
  • This opens voltage-dependent calcium channels in the β cell resulting in calmodulin activation –> exocytosis of insulin containing secretorty granules.
31
Q

What is the major SE of gliclazide which should be monitored?

A

hypoglycaemia

32
Q

What is the 3rd line add-in treatment for DM2?

A

NPH insulin

33
Q

What type of drug are repraglinide and netaglinide e.g.s of? When should they be taken?

A
  • metaglinides
    • potentiates the effect of glucose
  • take before meals
34
Q

Name an eg of an α-glucosidase inhibitor

A

acarbose

35
Q

What is the MOA of the α-glucosisade inhibitor acarbose?

A
  • reversibly bind to pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolases
  • inhibit hydrolysis of disaccharides to glucose
36
Q

Which group of diabetic drugs causes weight gain due to increased salt and water retention?

  1. Metaglinides
  2. SGLT-2 inhibitors
  3. Thiazolidinediones
A
  1. Thiazolidinediones
37
Q

What type of diabetic drug are rosiglitazone and pioglitazone e.g’s of?

A

Thiazolidinediones

38
Q

What is the MOA of Thiazolidinediones (e.g. like rosaglitazone and pioglitazone)?

A
  • increase peripheral sensitivity to intrinsic insulin production
  • agonist at the PPAR receptors in target tissues for insulin - action to increase transcription of insuline responsiveness genes
39
Q

Which drug has a SE of meteaorism?

A

acarbose

40
Q

Which glucose transporter do canagliflozin, dapagliflozin and ipragliflozin inhibit?

A

SGLT-2

41
Q

Of the following 3 SGLT2 inhibitors, which has a risk of hypoglycaemia?

  • canagliflozin
  • dapagliflozin
  • ipragliflozin
A

canagliflozin

42
Q

Of the following SGLT2 inhibitors, which one has a risk of UTIs and genital infections?

  • canagliflozin
  • dapagliflozin
  • ipragliflozin
A

Dapagliflozin

43
Q

Where are neuropathic ulcers normally found on diabetic foot?

A

Over the metatarsal heads

44
Q

What is the other name for the neuropathic arthropathy which affects diabetics?

A

Charcot foot

45
Q

What is the adverse effect of insulin injections?

A

Lipohypertrophy/lipoatrophy at the site of injection –> must alternate sites

46
Q

What is the target BP for a diabetic patient?

A

140/80

47
Q

What is the target BP for a diabetic following a vascular event?

A

130/80

48
Q

Which factor is the most important for reducing cardio vascular risk in a diabetic patient?

A

cholesterol level

49
Q

What is the target LDL cholesterol level for diabetic patients?

A

2.0mmol/L

50
Q

What is the target total cholesterol level for a diabetic patient?

A

4.0mmol/L

JG Year 1 (27 decks)

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