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Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What effect does insulin have on blood biochemistry?

A
  • Decreased glucose and potassium and it is taken up by cells
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2
Q

What is the WHO criteria for a diagnosis of diabetes?

A
  • Fasting glucose of >7mmol/l
  • Random glucose of > 11mmol/l

One if symptomatic, 2 if aysmptomatic

  • HbA1c 48mmol/l or 6.5%. (type 2)
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3
Q

What are the symptoms of undiagnosed T1DM?

A
  • Weight loss
  • Polyuria
  • Polydipsia
  • Fatigue
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4
Q

What is the criteria of DKA?

A
  • Hyperglycaemia (>11mmol/l)
  • Hyperketonaemia or ketononuria
  • Metabolic acidosis
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5
Q

What are the common biochemical markers of T1DM?

A
  • Low C-Peptide

- High Diabetes associated antibodies

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6
Q

What is the pathogenesis of T1DM?

A

Genetic predisposition to autoimmunity. Often precipitated by viral illness. Association with environmental factors (cows milk)>

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7
Q

What are the common biochemical markers of T2DM?

A
  • High C-Peptide

- Negative antibodies

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8
Q

What is the pathophysiology of MODY?

A

Dominant mutation in a single gene - usually HNF-1a.

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9
Q

What is the most common management of MODY?

A

Sulphonylurea and glicazide

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10
Q

What is the most common insulin regimen for T1Dm?

A
  • Once a day basal, e.g. Levemir

- Bolus before meals, e.g. Novorapid

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11
Q

What molecule is expressed by pancreatic beta cells in order to detect glucose levels and regulate insulin secretion?

A

Glucokinase

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12
Q

Describe the epidemiology of T2DM

A
  • Age (>50)
  • Overweight
  • Family history
  • Ethnicity (SE asian)
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13
Q

What is the pathophysiology of T2DM?

A

Insulin resistance due to genetic pre disposition and obesity leads to hyperinsulinaemia. Aging/continued obesity results in beta cells being unable to compensate, leading to hyperglycaemia.

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14
Q

What is the usual pharmacological treatment of T2DM?

A

1st line - Metformin. If poorly tolerated, Sulphonyurea.
2nd line - Add one of: Sulphonyurea, SGLT-2 inhibitor, DPP-4 inhibitor, pioglitazone
3rd line - Add another or start injectable insulin or GLP-1 agonist

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15
Q

Describe the pharmacology of metformin (mechanism, CV benefit, hypo risk, side effects, contraindications)

A

Inhibits hepatic gluconeogenesis and increases peripheral insulin sensitivity and therefore glucose uptake and utilisation.

  • High CV benefit
  • Low hypoglycaemia risk
  • Weight loss
  • Possible gastrointestinal side effects
  • Contraindicated in chronic heart failure and CKD
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16
Q

Describe the pharmacology of sulphonyureas (mechanism, CV benefit, hypo risk, side effects, contraindications)

A

Close potassium channels on beta cells, causing depolarisation and increased insulin secretion.

  • No CV benefit
  • High hypoglycaemia risk
  • Weight gain
17
Q

Describe the pharmacology of SGLT-2 inhibitors (mechanism, CV benefit, hypo risk, side effects, contraindications)

-flozins

A

Inhibits the SGLT-2 in the proximal convoluted tubule in the kidney, decreasing renal reabsorption of glucose

  • CV benefit
  • Low hypoglycaemia risk
  • Weight loss
  • Genitourinary side effects
18
Q

Describe the pharmacology of DPP-4 inhibitors (mechanism, CV benefit, hypo risk, side effects, contraindications)

  • gliptins
A

Inhibits DPP-4 which reduces the destruction of incretins. Incretins increase insulin secretion and decrease glucagon secretion.

  • No CV benefit
  • Not hypo risk
  • Weight neutral
  • Well tolerated
19
Q

Describe the pharmacology of Pioglitazones (mechanism, CV benefit, hypo risk, side effects, contraindications).

A

Increases sensitivity to fat, liver and muscle cells to insulin

  • Weight gain
  • Low hypo risk
  • Side effects of oedema and fracture risk
  • Contraindicated in heart failure
20
Q

Describe the pharmacology of GLP-1 agonists (mechanism, CV benefit, hypo risk, side effects, contraindications)

A

Injectable, mimics incretins to increase insulin secretion, decrease glucagon secretion and decrease appetite.

  • CV benefit
  • Weight loss
  • Low hypo risk
  • Gastrointestinal side effects
21
Q

Describe the pharmacology of insulin (mechanism, CV benefit, hypo risk, side effects, contraindications)

A

Increased glucose uptake by skeletal muscle. Decreased lipolysis. Increased hepatic glycogenesis and reduced gluconeogenesis.

  • No CV benefit
  • Hypo risk
  • ## Weight gain
22
Q

What should be considered when prescribing for a diabetic with renal failure?

A
  • Metformin should be stopped with eGFR <30

- SGLT-2 inhibitors less effective in CKD

23
Q

What is hypoglycaemia in diabetic patients?

A

<4mmol/l

24
Q

What is hypoglycaemia in a non-diabetic patient?

A

<2.5mmol/l with symptoms

25
Q

What are the signs and symptoms of hypoglycaemia?

A

Sweating, tremor, hunger, palpitations.

Confusion, drowsiness, vision impairment, coma.

26
Q

What is Whipples triad?

A
  1. Symptoms of hyperglycaemia
  2. Definite low plasma glucose
  3. Relief of symptoms after administering glucose
27
Q

What is Whipples triad?

A
  1. Symptoms of hyperglycaemia
  2. Definite low plasma glucose
  3. Relief of symptoms after administering glucose
28
Q

What investigations would be carried out on a non-diabetic patient with suspected post-prandial (eating) hypoglycaemia.

A

Oral glucose tolerance test can be misleading. Give mixed meal after overnight fast and measure venous plasma glucose over 5 hours.

29
Q

What investigations would be carried out on a non-diabetic patient with suspected fasting hypoglycaemia.

A

72 hour fast to invoke the homeostatic response which stops the blood glucose from falling (glucagon, adrenaline, cortisol).

30
Q

What biochemical markers would be investigated in a non-diabetic patient with hyperglycaemia?

A

Glucose, insulin, C-peptide, ketone bodies, insulin antibodies

31
Q

What biochemical markers would suggest endogenous hyperinsulinaemic hypoglycaemia?

A
  • Low blood glucose
  • High insulin
  • High C-peptide
32
Q

What investigations would be carried out to determine the cause of endogenous hyperinsulinaemic hypoglycaemia?

A
  1. Imaging of pancreas

2. Arterial calcium stimulation

33
Q

What hormone increases appetite in obese people?

A

Grhelin

34
Q

What hormone decreases appetite in obese people?

A

Leptin

Endocrine (9 decks)

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