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Year 1 NME > Diabetes > Flashcards

Diabetes Flashcards

1
Q

The pancreas endocrine function is to secrete insulin and glucagon, which cells of the pancreas secrete these?

A
  • alpha cells = glucagon
  • beta cells = insulin
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2
Q

Insulin and glucagon aim to keep the blood glucose levels within what range?

A
  • 3.5-8.0 mmol/L
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3
Q

What organ does glucose homeostasis predominantly occur in?

A
  • liver
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4
Q

Following a meal, what is released by the pancreas that inhibits gluconeogenesis, facilitating glucose uptake of glucose for storage as glycogen in the liver?

A
  • insulin
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5
Q

Following a meal, what is released by the pancreas that inhibits the release go glucagon and gluconeogenesis, facilitating glucose uptake of glucose for storage as glycogen in the liver. What are the insulin:glucagon ratios in the fed and fasted states?

A
  • fed state = high insulin:low glucagon
  • fasting state = low insulin:high glucagon)
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6
Q

What is the cut of definition of hypoglycaemia?

A
  • <3.5 mmol/L
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7
Q

Hypoglycaemia is a blood glucose <3.5mmol/L. Adrenalin and glucagon are released in an attempt to increase plasma glucose, but this can cause side effects including what?

A
  • sweating, tremor, nervousness, palpitations, hunger
  • low glucose to the brain causes neuroglycopenic symptoms include confusion, drowsiness, slurred speech, poor coordination, irritability (anger), seizures
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8
Q

Insulinoma can cause hypoglycaemia. What is Insulinoma?

  • Hypoadrenalism (through the reduction of glucocorticoids)
  • Alcohol
  • Severe liver failure
  • Insulin or sulphonylureas (e.g. metformin)
A
  • tumour in the pancreas
  • neuroendocrine tumour increasing insulin secretion
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9
Q

Hypoadrenalism can cause hypoglycaemia. What is Hypoadrenalism?

A
  • adrenal gland dysfunction
  • glucocorticoids promote gluconeogensis
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10
Q

Alcohol can cause hypoglycaemia, how?

A
  • alcohol causes an increase in insulin secretion
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11
Q

Severe liver failure can cause hypoglycaemia, how?

A
  • liver cannot produce glucose
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12
Q

Insulin or sulphonylureas (e.g. metformin) can cause hypoglycaemia, how?

A
  • too much of the drug can increase insulin secretion
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13
Q

What are some simple appraches to combat hypoglycaemia?

A
  • eat/drink sugar
  • hypostop (high sugary gel)
  • intravenous dextrose 20% 75mls
  • intramuscular glucagon 1mg if IV not available
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14
Q

Diabetes mellitus is a problem controlling blood sugar levels due to the dysregulation of insulin and glucagon. What do insulin and glucagon do to blood glucose levels?

A
  • insulin = reduce blood glucose
  • glucagon = increase blood glucose
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15
Q

What % of all diabetes is due to type 1 diabetes, which is due to a lack of insulin and when does this generally present in patients who have it?

A
  • 10%
  • early age
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16
Q

What type of hypersensitivity is type 1 diabetes?

A
  • type 4 hypersensitivity response
  • bodies own T-cells attacks the beta cells of the pancreas
  • no beta cells means no insulin = hyperglycaemia
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17
Q

in type 1 diabetes we can detect autoantibodies. Human leukocyte antigens can be detected in the body, which ones are common?

A
  • HLA DR3 and DR4 on Chr 6
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18
Q

Patients with type 1 diabetes have a lack of insulin causing glucose to remain in blood and unable to get into muscle and adipose tissue, starving these tissue of energy. This can cause Glycosuria and Polyuria, what are these?

A
  • glycosuria = glucose in the urine
  • polyuria = increased urine due to osmotic fluid shifts
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19
Q

Patients with type 1 diabetes have a lack of insulin causing glucose to remain in blood and unable to get into muscle and adipose tissue, starving these tissue of energy. This can cause Polydipsia, what are this?

A
  • polydipsia (thirst)
  • due to fluid loss and dehydration (polyuria)
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20
Q

Patients with type 1 diabetes have a lack of insulin causing glucose to remain in blood and unable to get into muscle and adipose tissue, starving these tissue of energy. This can cause weight loss, why?

A
  • due to lipolysis and the breaking down of protein
  • adipose tissue and muscle try to produce their own energy
21
Q

Patients with type 1 diabetes have a lack of insulin causing glucose to remain in blood and unable to get into muscle and adipose tissue, starving these tissue of energy. This can cause polyphagia (hunger), why?

A
  • as they lose weight they want to eat more
22
Q

Where is type 1 diabetes most prevelent?

A
  • USA, UK and Scandanavia
23
Q

In type 1 diabetes patients are always at risk of Diabetic Ketoacidosis (DKA). What is DKA?

A
  • high levels of ketones which can be life-threatening
24
Q

What causes Diabetic Ketoacidosis (DKA)?

A
  • no insulin = no glucose for adipose tissue
  • adipose tissue turns on lipolysis increasing fatty acids
  • fatty acids are turned into ketones in the liver
25
Q

Ketones can be used by the body as an energy source in times of starvation. So why is Diabetic Ketoacidosis (DKA) dangerous?

A
  • ketones acetic acid and beta hydroxybutyric acid in the liver
  • can be used as energy, but ultimately are acids causing metabolic acidosis
26
Q

Ketones can be used by the body as an energy source in times of starvation. Diabetic Ketoacidosis (DKA) can be dangerous when levels of ketones acetic acid and beta hydroxybutyric acid are too high causing metabolic acidosis. We can change our breathing as a compensatory mechanism called Kussmaul’s breathing, what is this?

A
  • deep laboured breathing
  • aim is to remove CO2 and increase pH
27
Q

Ketones can be used by the body as an energy source in times of starvation. Diabetic Ketoacidosis (DKA) can be dangerous when levels of ketones acetic acid and beta hydroxybutyric acid are too high causing metabolic acidosis. We can change our breathing as a compensatory mechanism called Kussmaul’s breathing, which is deep laboured breathing in an attempt to remove CO2 and raise pH. DKA can also cause hyperkalaemia, how?

A
  • H+/K+ pump takes H+ from the blood into cells to reduce pH of blood
  • Na+/K+ pump is stimulated by insulin. No insulin = no K+ entering the cell and more in plasma
28
Q

How can we treat Diabetic Ketoacidosis (DKA)?

A
  • insuin
  • IV Fluids with replacement of K+ (this is due to a significant drop with insulin administration)
29
Q

Of all the people in the world with diabetes, what % have type 2 diabetes?

A
  • 90%
30
Q

What is type 2 diabetes and what are the basic things that can cause it?

A
  • insulin resistance
  • obesity, inactivity and/or hypertension
31
Q

What symptoms can someone with Diabetic Ketoacidosis (DKA) present with?

A
  • nausea, vomiting, fruity sweet breath (acetone), confusion (cerebral oedema due to fluid shifts
32
Q

What are the 3 most common symptoms patients with T2D present with?

A
  • polyuria = increase urine output
  • polydipsia = extreme thirst
  • polyphagia = extreme hunger
33
Q

Do patient with T2D experience Diabetic Ketoacidosis (DKA)?

A
  • no
34
Q

Hyperosmolar Hyperglycaemic State (HHS) can occur in patients with T2D, what is this and what can this do to cells?

A
  • increased plasma osmolarity from dehydration and glucose concentration
  • glucose attract H2O causing cells to become dry and shrivel
  • can cause mild acidosis
35
Q

What are the 4 main ways we can diagnosis diabetes?

A

1 - random blood sugar

2 - raised fasting glucose (fasted for 8 hours)

3 - oral glucose tolerance test (2 hours after a glucose load)

4 - HBA1C – proportion of Hb in RBC which has glucose attached to it - BEST MEASURES

36
Q

What is 4 - HBA1C?

A
  • average blood glucose from last 2-3 months
37
Q

What 2 major organs/tissue are caused by long term microvascular changes that can occur in diabetes due to hyperglycaemia?

A
  • retinopathy (damaged retina)
  • nephropathy (kidney dysfunction)
38
Q

What is the main cause of strokes and heart attacks in diabetic patients?

A
  • atherosclerosis
39
Q

Neuropathy can occur in diabetes, what is this?

A
  • damage or dysfunction of one or more nerves
  • results in numbness, tingling, muscle weakness and pain in the affected area
40
Q

Patients with diabetes heal poorly as a result of damage to blood vessels and neuropathy. What are they at an increased risk of developing?

A
  • leg ulcers
41
Q

What are the 3 main parts of a diabetic management plan?

A

1 - good glucose control through insulin in the case of Type 1 DM and the use of monotherapy or combination therapy in Type 2 DM

2 - HBA1C and daily blood sugar monitoring

3 - diet and exercise

42
Q

There are a number of different insulin management plans. Rapid Acting insulins include Novorapid (Analogue). How long can this last for?

A
  • increases insulin in the body quickly
  • doesnt last long
  • around 5 hours
43
Q

There are a number of different insulin management plans. Short Acting insulins include Actrapid (Soluble). How long can this last for?

A
  • comes on a little slower than rapid activing
  • but tend to last longer
  • last up to 8 hours
44
Q

There are a number of different insulin management plans. Long Acting insulins include Insulatard (Isophane). How long can this last for?

A
  • comes on slowly
  • but tends to last the day
  • last up to 24 hours
45
Q

There are a number of different insulin management plans. Long Acting insulins include soluble + LA or analogue + LA e.g Humulin M3. How long can this last for?

A
  • comes on medium pace
  • but tends to last the day
  • last up to 24 hours
46
Q

In patients with type 1 and type 2 diabetes, which is thin and fat?

A
  • type 1 = thinner
  • type 2 = overweight/obese
47
Q

In patients with type 1 and type 2 diabetes, do they both present with long term symptoms?

A
  • type 1 = no long term symptoms
  • type 2 = long history of symptoms
48
Q

In patients with type 1 and type 2 diabetes, what age do they normally present?

A
  • type 1 = < 30 years old
  • type 2 = > 30 years old

Year 1 NME (61 decks)

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