Complications of diabetes mellitus Flashcards

(41 cards)

1
Q

What are the types of diabetes?

A

Type 1: autoimmune destruction of insulin-producing beta-cells (8%)
• Type 2: combination of insulin resistance and relative insulin
deficiency (90%)
• Gestational diabetes
• Other:
✓ Type 3c – damage to the pancreas (pancreatitis, pancreatic cancer,
hemochromatosis, cystic fibrosis)
✓ Steroid induced diabetes
✓ Maturity onset diabetes of the young (MODY)
✓ Neonatal diabetes

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2
Q

What are type 1 diabetes?

A

autoimmune destruction of insulin-producing beta-cells

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3
Q

What cells produce insulin

A

islet cells

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4
Q

How do you get type diabetes from being fat

A
  • Fatty liver (resistant to insulin)
  • Impaired insulin-mediated suppression of gluconeogenesis
  • Liver paradoxically produces excess of glucose
  • Fatty pancreas
  • Destruction and/or Impaired function of beta-cells
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5
Q

What does insulin do?

A

Icreases glucose uptake
increases glycogen synthesis
Deccreases lipolysis

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6
Q

What does glucagon do?

A

Increase Glycogenolysis
Increase Gluconeogenesis
Increase Lipolysis

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7
Q

What is used as an emergency treatment for type 1 diabetes?

A

Glucagon

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8
Q

What happens if insulin is inhibited in hyperglycemia?

A

High glucose in blood
Protein breakdowwn - muscle wasting
Lipolysis
Formation of ketone bodies

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9
Q

What is an acute complication of Type 1 diabetes ?

A

Diabetes ketoacidosis

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10
Q

What is an acute complication of Type 2 diabetes ?

A

Hyperglycaemic hyperosmolar state HHS

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11
Q

What does an increase in ketone bodies do?

A

Metabolic acidosis
Increase in osmotic diuresis hypovolaemia and less glomerular filtration which leads to hyperosmolality leasds to dehydration

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12
Q

What does increase in hyperglycemia do?

A

Increase in osmotic diuresis hypovolaemia and less glomerular filtration which leads to hyperosmolality leads to dehydration

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13
Q

What are the differences in DKA and HHS?

A

Glucose- Mainly more hyperglycemia in HHS
Osmolality- Serum hyper osmolality in HHS, variable in DKA
Ketonemia- Absence in HHS, + in DKA
Acidosis - Absence in HH, pH< 7.3 / bicarbonate <15mmol/l
Hypovolaemia- Severe in HHS, Less Severe in DKA

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14
Q

What are chronic complications of diabetes?

Microvascular

A

Retinopathy-disease of the small retinal blood vessels(endothelial cells in the retina)
Nephropathy- deterioration of kidney function (attack on cells in renal glomerulus)
Neuropathy- type of nerve damage (neurons and schwaan cells)

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15
Q

What are chronic complications of diabetes?

Macrovascular

A

Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease

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16
Q

What is the polyol pathway?

A

Glucose shunted through aldose reductase into sorbitol -> fructose
all these things are going through reactive oxygen species,cause damage to blood vessels and to endothelium

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17
Q

What do AGE do?

A

Advanced glycation end products cause connective tissue to become stiff therefore:
contractures in collagenous tissue in their hands
lose heparin sulphate proteoglycans important for normal basement membrane drummer of functioning

18
Q

What is the protein kinase C pathway?

A

Increase in vascular endothelial growth factor causes new vessel formation in the back of the eye not useful causes proliferative retinopathy

19
Q

What can treat diabetic retinal disease?

A

anti-VEGF treatment

20
Q

What is the Hexosamine pathway

A

Increase in oxygen reactive series = toxic

21
Q

What treatment is given for someone with protein in urine?

A

ACE inhibitors

22
Q

What do ACE inhibitors do?

A

preferential efferent arteriole vasodilatation

23
Q

What does metformin do?

A

Suppression of hepatic gluconeogenesis

24
Q

What does Sulfonylurea do?

A

Increase in insulin secretion from beta-cells

25
What does Meglitinides do?
Increase in insulin secretion from beta-cells
26
What does DPP-4 inhibitors do?
Inhibit GLP-1 degradation – promotes glucose | dependent insulin secretion
27
What does GLP-1 agonists do?
Promotes glucose dependent insulin secretion
28
What does SGLT-2 inhibitors | do?
Increased glucosuria through inhibition of SGLT-2 in the kidney
29
What does Alpha-glucosidase inhibitors do?
Reduce intestinal glucose absorption
30
What does Thiazolidinediones do?
Reduce insulin resistance
31
What does Amylin analogs do?
Reduce glucagon release, reduce gastric emptying
32
Which drugs suppress hepatic gluconeogenesis
metformin
33
Which drugs increase insulin secretion from beta-cells
Sulfonylurea | Meglitinides
34
Which drugs promotes glucose | dependent insulin secretion by inhibiting GLP-1 degradation
DPP-4 inhibitors
35
Which drugs promotes glucose | dependent insulin secretion
DPP-4 inhibitors | GLP-1 agonists
36
Which drugs increase glucosuria through inhibition of SGLT-2 in the kidney
SGLT-2 inhibitors
37
Which drugs reduce intestinal glucose absorption
Alpha-glucosidase inhibitors
38
Which drugs reduce insulin resistance
Thiazolidinediones
39
Which drugs reduce glucagon release and reduce gastric emptying
Amylin analogs
40
What is the Incretin effect?
oral glucose elicits higher insulin secretory responses than does intravenous glucose for healthy patients
41
What happens to the incretin effect for people with Type 2 diabetes?
Reduced effect