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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
21
Q

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

  1. UKPD34
  2. STENO-2
  3. 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
23
Q

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

  1. UKPD34
  2. UKPD38
  3. STENO-2
24
Which trial aimed for: * BP \< 130/80 * HbA1c \<6.5 mmol/L * cholesterol \<4.5 mmol/L in diabetes?
STENO-2
25
What is the 1st line therapy for DM2 after lifestyle advice?
Metformin
26
What is the major SE of metformin?
GIT disturbances
27
What is the major risk of metformin therapy?
lactic acidosis
28
At which measurement of eGFR should metformin be stopped?
30ml/min/1.732
29
What is the 2nd line added on treatment of DM2?
Sulphonylureas - e.g. gliclazide
30
What is the MOA of gliclazide?
* 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
What is the major SE of gliclazide which should be monitored?
hypoglycaemia
32
What is the 3rd line add-in treatment for DM2?
NPH insulin
33
What type of drug are repraglinide and netaglinide e.g.s of? When should they be taken?
* metaglinides * potentiates the effect of glucose * take before meals
34
Name an eg of an α-glucosidase inhibitor
acarbose
35
What is the MOA of the α-glucosisade inhibitor acarbose?
* reversibly bind to pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolases * inhibit hydrolysis of disaccharides to glucose
36
Which group of diabetic drugs causes weight gain due to increased salt and water retention? 1. Metaglinides 2. SGLT-2 inhibitors 3. Thiazolidinediones
3. Thiazolidinediones ## Footnote
37
What type of diabetic drug are rosiglitazone and pioglitazone e.g's of?
Thiazolidinediones
38
What is the MOA of Thiazolidinediones (e.g. like rosaglitazone and pioglitazone)?
* 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
Which drug has a SE of meteaorism?
acarbose
40
Which glucose transporter do canagliflozin, dapagliflozin and ipragliflozin inhibit?
SGLT-2
41
Of the following 3 SGLT2 inhibitors, which has a risk of hypoglycaemia? * canagliflozin * dapagliflozin * ipragliflozin
canagliflozin
42
Of the following SGLT2 inhibitors, which one has a risk of UTIs and genital infections? * canagliflozin * dapagliflozin * ipragliflozin
Dapagliflozin
43
Where are neuropathic ulcers normally found on diabetic foot?
Over the metatarsal heads
44
What is the other name for the neuropathic arthropathy which affects diabetics?
Charcot foot
45
What is the adverse effect of insulin injections?
Lipohypertrophy/lipoatrophy at the site of injection --\> must alternate sites
46
What is the target BP for a diabetic patient?
140/80
47
What is the target BP for a diabetic following a vascular event?
130/80
48
Which factor is the most important for reducing cardio vascular risk in a diabetic patient?
cholesterol level
49
What is the target LDL cholesterol level for diabetic patients?
2.0mmol/L
50
What is the target total cholesterol level for a diabetic patient?
4.0mmol/L

JG Year 1 (27 decks)

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