Clinical Diabetes Flashcards

1
Q

how can diabetes be diagnosed?

A

fasting blood sugar with venous blood sugar sample

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2
Q

why cant a fingerprick test diagnose diabetes?

A

this is capillary blood sugar

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3
Q

what are normal blood glucose levels compared to diabetic ones?

A

5 mmol/L is normal

7+ is diabetic

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4
Q

what is an oral glucose tolerance test?

A

give 75mg of glucose and test blood sugar again 2 hours later. 11.1 mmol/L + is diabetic

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5
Q

what is polyuria?

A

frequent urination

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6
Q

what is polydipsia?

A

frequent thirst/dehydration

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7
Q

what is glycosuria?

A

excess sugar in urine

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8
Q

what is type I diabetes?

A

beta cell destruction

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9
Q

what is type II diabetes?

A

insulin resistance or deficiency due to beta cell disfunction

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10
Q

most common cause of type I diabetes mellitus?

A

autoimmune destruction of beta cells leading to no beta cell function

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11
Q

what are environmental factors contributing to type I?

A

viruses that can destroy beta cells (mumps, rubella), diet, stress, drugs

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12
Q

what is type II diabetes mellitus linked to?

A

insulin resistance and high BMI

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13
Q

what is the difference between white patients and indian patients in onset of type II diabetes?

A

younger age of onset with earlier proteinuria and renal disease.

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14
Q

what percentage of diabetes incidence is type II?

A

85%

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15
Q

where does insulin act?

A

adipose tissue, muscle and liver

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16
Q

what does lack of insulin lead to?

A

raised blood glucose levels. adipose tissue breaks down leading to diabetic ketoacidosis

17
Q

what can intensive insulin treatment lead to?

A

hypoglycaemia

18
Q

what would be an ideal diabetes treatment?

A

pancreatic transplant or beta cell transplant

19
Q

what is type II diabetes mellitus a combination of?

A

insulin resistance and beta cell dysfunction

20
Q

how does beta cell dysfunction come about?

A

genetic/environmental factors lead to insulin resistance so the beta cells release very large amounts causing hyperinsulinaemia . eventually beta cells stop working and cannot cope so they begin to dysfunction. the beta cells work so hard, they cant cope and dysfunction –> hyperglycemia

21
Q

which type has more severe insulin deficiency?

A

type I

22
Q

what are aims of treatment in type II diabetes mellitus?

A
  • abolish symptoms/complications of hyperglycemia
  • reduce threat of complications
  • increase life expectancy
  • restore life quality
23
Q

what are early treatments of diabetes?

A

encourage patients to lose weight and exercise

24
Q

what are insulin sensitisers?

A

decrease insulin resistance at target tissues so pancreas produces more insulin

25
Q

what do effects of insulin sensitisers achieve?

A
  • decrease plasma glucose levels
  • decrease excessive lipolysis and reduce FFAs
  • decrease hepatic gluconeogensis
  • improve insulin mediated glucose uptake
26
Q

what are the steps of treatment?

A

diet and exercise –> oral monotherapy –> oral combination –> insulin +- oral agents

27
Q

what is metformin?

A

decreases hepatic glucose output and decreases fatty acid oxidation

28
Q

how does metformin work?

A

increases kinase activity of insulin receptor and increases expression of GLUT-4 transporter and increases glycogen storage

29
Q

what are glitazones (thiazolidnediones)?

A

oral insulin sensitising agents that lower blood glucose and insulin levels

30
Q

what is glitazone mechanism of action?

A

PPAR- gamma

31
Q

what do both metformin and glitazones do?

A

increase sensitivity of body to insulin

32
Q

what do sulphonylureas do?

A

help beta cells produce insulin. they block K+ ATP channels –> depolarisation –> increase insulin release

33
Q

what happens if you stop type I DM insulin treatment?

A

diabetic ketoacidosis

34
Q

what happens if you stop type II DM treatment?

A

HONK hyperosmolar non-ketotic coma

35
Q

what are complications of undiagnosed type 2?

A

cerebrovascular disease, retinopathy, cardiovascular disease, nephropathy, neuropathy, peripheral vascular disease

36
Q

what are microvascular complications (directly related to blood sugar)?

A

nephropathy, retinopathy, neuropathy

37
Q

what are macrovascular complications (where other things like cholesterol are important)?

A

CHD/Stroke, Peripheral vascular disease, blood pressure