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Year 3 - primary care + medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Where is insulin produced?

A

In the beta cells, in the Islets of Langerhans in the pancreas

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2
Q

What is the normal range for blood glucose?

A

4.4 and 6.1 mmol/l

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3
Q

How does insulin reduce blood sugar?

A

Causes the cells to absorb more glucose which can be used as energy
Causes muscles and the liver cells to absorb glucose and convert it into glycogen to be stored

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4
Q

What is the role of glucagon?

A

It works to increase blood glucose by causes glycogenolysis (glycogen to glucose) and gluconeogenesis (production of glucose in the liver from proteins and fats)

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5
Q

Where is glucagon produced?

A

The alpha cells in the islets of Langerhans in the pancreas

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6
Q

What is type 1 diabetes?

A

Where the pancreas cannot produce insulin. This causes hyperglycaemia as glucose cannot be moved into cells from the blood.

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7
Q

What is type 2 diabetes?

A

When a resistance to insulin is built up over time. The beta cells also become damaged so produce less insulin. This causes blood glucose levels to rise and hence hyperglycaemia.

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8
Q

What are some risk factors for type 2 diabetes?

A 
Old age
Ethnicity (black, Chinese, south asian)
Family history
Obesity
Sedentary lifestyle
Hyperlipidaemia (high lipid diet)
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9
Q

How does type 2 diabetes commonly present?

A 
Fatigue
Polydipsia
Polyuria
Unintentional weight loss
Infections 
(glucosuria)
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10
Q

How is type 2 diabetes diagnosed?

A

Oral glucose tolerance testing (OGTT) - measure plasma glucose 2 hours after giving a 75g glucose drink >11.1mmol/L
Can also do random glucose levels > 11.1mmol/L
Fasting glucose >7mmol/L
HbA1c > 48mmol/mol

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11
Q

What is the diagnostic criteria for pre diabetes?

A

HbA1c - 42 - 47mmol/mol
Fasting glucose 6.1 - 6.9mmol/L
OGTT - 7.8 - 11mmol/L

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12
Q

What lifestyle changes can be made to help type 2 diabetes?

A

Diet modifications - low sugar foods. Eat vegetables and oily fish.
Exercise
Weight loss
Stop smoking

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13
Q

What is regularly monitored for in type 2 diabetics?

A

Diabetic retinopathy
Kidney disease
Diabetic foot

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14
Q

What are the medication options for type 2 diabetics?

A

first line - metformin
second line - add sulfonylurea, pioglitazone, DPP4 inhibitors or SGLT2 inhibitors
third line - triple threapy
then may need insulin adding

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15
Q

How does metformin work?

A

Increases insulin sensitivity and decreases hepatic gluconeogenesis

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16
Q

What are the side effects of metformin?

A

Diarrhoea
Abdominal pain
Lactic acidosis
Decreased appetite

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17
Q

How does pioglitazone work?

A

Increases insulin sensitivity and decreases hepatic gluconeogenesis
(takes 6-8 weeks to work due to the way it altters gene transcription)

18
Q

What are the side effects of pioglitazone?

A 
Weight gain
Fluid retention / oedema
Anaemia
Heart failure
Extended use may increase risk of bladder cancer
19
Q

How does gliclazide (sulfonylurea) work?

A

Stimulates B cells in the pancreas to produce and secrete insulin

20
Q

What are the side effects on gliclazide (sulfonylurea)?

A

Weight gain
Hypoglycaemia
Increased risk of CVD and MI if used as monotherapy

21
Q

What are incretins?

A

Hormones produced by the GI tract in response to meals. These act to decrease glucose levels by increasing insulin secretions and inhibiting glucagon production

22
Q

How does sitagliptin work?

A

It is a DPP-4 inhibitor therefore increases the release of incretins which work to increase insulin release.

23
Q

What are the side effects of sitagliptin (DPP-4 inhibitors)?

A

GI upset
Symptoms of URTI (upper resp tract infections)
Pancreatitis

24
Q

What does DPP-4 stand for?

A

Dipeptidyl-peptidase-4

25
Q

How does exenatide work?

A

GLP-1 (glucagon like peptide) receptor agonist -increases insulin secretion and supresses glucagon secretion.

26
Q

How is exenatide administered?

A

Subcutaneous injection

27
Q

What are the side effects of exenatide?

A

GI upset
Weight loss
Dizziness

28
Q

How does dapagliflozin work?

A

SGLT-2 inhibitor. This causes more excretion of glucose into the urine from the blood.

29
Q

What are the side effects of gliflozins?

A

Glucosuria
UTIs
Weight loss

30
Q

What are the different types of insulin?

A 
Rapid acting 
Short acting
Intermediate acting
Long acting
Combined
31
Q

What is DKA?

A

Diabetic ketoacidosis - lack of glucose in the cells causes ketone production. These then build up in the blood.

32
Q

Why does diabetes cause polyuria and polydipsia?

A

Excess glucose overwhelms the kidneys, meaning glucose enters the urine. Glucose is osmotically active so draws water with it causing polyuria. This leads to dehydration which causes the thirst (polydipsia)

33
Q

How does DKA present on investigation?

A 
Hyperglycaemia
Dehydration
Ketosis
Metabolic acidosis
Potassium imbalance
34
Q

What are the symptoms of DKA?

A 
Polyuria
Polydipsia
Nausea and vomiting
Acetone smell on breath
dehydration leading to hypotension
Altered conciousnes
35
Q

How is a case of DKA managed?

A

Fluid resuscitation
Insulin infusion
Monitor potassium and ketones and correct if necessary.

36
Q

What happens if injections are always in the same site?

A

lipodystrophy - subcutaneous fat hardens meaning insulin isn’t absorbed properly

37
Q

What are the symptoms of hypoglycaemia?

A 
Tremor
Sweating
Irritability
Dizziness
Pallor
Decreased conciousness
38
Q

What are the macrovascular complications of diabetes?

A

Coronary artery disease = MI
Stroke
Hypertension
Peripheral ischaemia = poor healing = diabetic foot and ulcers

39
Q

What are the microvascular complications of diabetes?

A

Peripheral neuropathy
Retinopathy
Kidney disease (glomerulosclerosis)

40
Q

How is diabetes monitored?

A

HbA1c - every 3-6 months

Capillary blood glucose

41
Q

How is type 1 diabetes managed?

A

Insulin regime involving multiple injections subcutaneously
Monitor dietary intake of carbohydrates
Monitor blood glucose levels

Year 3 - primary care + medicine (20 decks)

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