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Year 1 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is Type 1 diabetes?

A

Autoimmune disease chracterised by the destruction of beta cells that leads to an insufficiency in insulin production and glucose levels increasing over a period of time.

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2
Q

What is Type 2 diabetes?

A

Acquired lifestyle disease driven by obesity which reduces the body cell’s sensitivity to insulin and leads to exhaustion of beta cells constantly producing insulin as glucose levels continally increase over a period of time, causing reduction in insulin.

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3
Q

What is metformin?

A

Biguanide for Type 2 diabetic patients. Activates AMPK enzyme to decreases blood glucose levels by inhibiting gluconeogenesis and increasing glucose uptake.

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4
Q

What is the key regulator of fat and glucose metabolism?

A

Hepatic 5-AMP portein kinase/ AMPK enzyme. It causes phosphorylation of key enzymes for glucose uptake and inhibits ATP consuming pathways such as gluconeogenesis. It acts on hepatocytes to switch from anabolism to catabolism.

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5
Q

What are the considerations for metformin?

A

It is excreted unchanged by the kidney, has a short T12= 2-4 hrs so requires multiple daily dosage. It decreases B12 absorption, and should be avoided with low GFR below 30.

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6
Q

How does metformin affect organelles?

A

It inhibits mitochondrial respiration which causes lactate accumulation during tissue hypoxaemia or renal impairment.

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7
Q

What is HbA1c?

A

Glycated Hb used to measure blood glucose levels in diabetic patients

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7
Q

What are the benefits of metformin?

A

Improves cardiovascular mortaility, weight neutral, no significant risk of hypoglycaemia as a standalone and reduces levels of glycated Hb.

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8
Q

What is sulfonylureas?

A

Insulin secretagogue which binds to beta cells to increase first and second phase insulin production in response to hyperglycemia

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9
Q

What are the benefits of sulfonylurea?

A

Reduces HbA1c, no risk of hypoglycaemia, neutral weight and improves cardiovascular mortality.

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10
Q

What is an insulin secretagogue?

A

Medication which binds to beta cells to stimulates the pancreas to increase insulin production

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11
Q

What are the adverse effects of sulfonylureas?

A

It is an insulin secretagogue which causes Hypersensitivity reaction in the first 6-8 weeks. Causes GI discomfort, weight gain, hypoglycaemia in excess .

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12
Q

What are the important considerations for sulfonylureas?

A

Insulin segratagoue with rapid oral absorption, short T12 and highly protein bound and metabolised by the liver.

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12
Q

What are the important considerations for sulfonylureas?

A

Insulin secretagogue that has Rapid oral absorption, short T12 and highly protein bound and metabolised by the liver.

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13
Q

What is thiazolidinediones?

A

Glitazone drug which is a PPAR gamma (Perixosome proliferator activated receptor) nuclear receptor agonist for transcription of insulin sensitising genes in the skeletal muscle and adipose tissue and vascular wall.

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14
Q

Where is PPAR y expressed?

A

Improves insulin sensitivity in the liver Skeletal muscle, vascular endothelium, adipose tissue, pancreatic Beta cells, macrophages and the CNS.

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15
Q

What are the benefits of thiazolidneidione?

A

It is a PPAR gamma agonist which reduces HbA1c and there is no hypoglycaemia risk.

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16
Q

What is pioglitazone?

A

Part of thiazolidenedione class which is a PPAR gamma agonist for insulin sensitising genes. It is metabolised in the liver so hypoglycaemic effect is gradual.

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17
Q

What are the side effects of glitazones?

A

Increases risk of bladder cancer, fluid retention, GI disturbance, headache, anaemia. There is weight gain due to fat cell differentiation and hypoglycaemia IF used with sulfonylureas

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18
Q

Why do diabetic medications cause weight gain?

A

To decrease blood glucose, it Increases glucose uptake and insulin release and the storage of glucose as fat. It may increases appetite or decrease metabolism but this effect is variable.

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19
Q

What are incretins?

A

Formed from the conversion of pro-glucagon in intestinal cells. In L cells, it forms GLP-1 and in K cells, it forms GIP.

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20
Q

What is the function of incretin?

A

Suppress the release of glucagon via GLP-1 and increase the release of insulin via GIP following a meal. It reduces motility which increases satiety.

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21
Q

What is the incretin hormones?

A

Glucagon-like Peptide and GLucose insulinotropic peptide.

22
Q

What metabolises incretins?

A

DPP-4 enzyme.

23
Q

What is postprandial?

A

Following a meal, there is increase in blood glucose. Incretin GLP-1 acts to reduce postprandial glucagon secretion which reduces hepatic glycogenolysis and regulates gastric emptying.

24
Q

What is the physiological effects of GLP-1?

A

It increases beta cell proliferation and apoptosis. Reducing gastric emptying to increase satiety and decrease food intake. Increases insulin and reduces hepatic glycogenolysis and reduces glucagon secretion.

25
Q

What is exenatide?

A

Incretin mimetic of GLP-1 which contains more amino acids. It has a short half life so it is taken twice daily via subcutaneous injection before morning and evening meal.

26
Q

What is the function of liraglutide?

A

It is a GLP-1 analogue with a chnage in C16 and C34 only with a long half life and slow absorption. It is bound to albumin and no renal clearance. Used with insulin sensitisers such as metformin, sulphonylurea and pioglitazone.

27
Q

What are the effects of GLP-1 analogues?

A

Reduces HbA1c and weight. However, may cause GI disturbance and pancreatitis.

28
Q

What is the duration of action for exenatide?

A

Extended released and detectable weeks tomonths after single dose.

29
Q

What are the DPP-4 inhibitors?

A

Medications which act on DPP-4 enzyme to reduce metabolism of incretins, specifically GLP-1.

30
Q

What are the gliptins?

A

DPP-4 nihibitors. Includes sitagliptin, vildagliptin, saxagliptin and linagliptin which increawses levels of incretins for greater insulin secretion and glucagon suppression.

31
Q

Which gliptin is excreted through bile?

A

Linagliptin

32
Q

Which gliptins rely on a GFR function above 50?

A

Sitagliptin.

33
Q

What are the effects of gliptins in the body?

A

DPP-4 inhibitior which reduces HbA1c, weight neutral and has oral administration.. It causes mild Gi symptoms, pancreatitis (because it increases proliferation of beta cells) exfoliative dermatitis and increases respiratory infections.

34
Q

What is familial renal glucosuria?

A

Genetic condition where kidneys cannot reabsorb glucose from urine so it is excreted in urine as glucosuria but otherwise normal blood glucose and asymptomatic. There is no long term complication and there is tubular dysfunction.

35
Q

Where does majority of renal handling of glucose occur?

A

In the S1 segment via SGTLT2 transporter.

36
Q

What is the SGLT-2 inhibitors?

A

Gliflozin suffix. They inhibit the SGLT-2 Transporter for Type 2 diabetics to decrease glucose reabsorption in the bloodstream and increase excretion in urine.

37
Q

What are the effects of SGLT-2 inhibitors?

A

Reduces glucose reabsorption to improve glycaemia without hypoglycaemia risk. Promotes weight loss, reduces cardiovascular risk by reducing hypertension. It increases genitourinary infection however.

38
Q

What is the indications for insulin?

A

Type 1 diabetes, surgery for diabetics, acute illness in diabetics, gestational diabetes.

39
Q

When is insulin indicated for Type 2 diabetics?

A

When there is inadequate control with oral hypoglycaemic agents. Usually, it is contraindicated with regular use of this.

40
Q

What are the species of insulin?

A

Human and Animal.

41
Q

What are the types of insulin?

A

Human insulin is derived from e.coli or yeast. Beef insulin increases allergic risk. Pork insulin is less antigenic and available as purified.

42
Q

What is Humulin?

A

Human insulin.

43
Q

What is the categories of insulin?

A

Short acting, intermediate acting, biphasic and analogues.

44
Q

What is the short acting insulin?

A

Humulin S: Soluble with an onset of 30 mins and peaks at 1-3 hours. Duration of action is up to 8 hours. Helps to control blood sugar immediately after a meal.

45
Q

What is intermediate acting insulin?

A

Humulin I- It is either a neutral portamine hagedorn/NPH formulation or isophane formulation of humulin. They both have onset of 1.5 hours and peak action of 4-12 hours and duration of action of 24hrs. It helps to control blood sugar levels throughout the day.

46
Q

What is pre-mixed insulin?

A

Combinatins of short and intermediate acting insulin. It has 30 min onset, 2-8hr peak and duration of action of 24 hrs. Helps to control blood sugars both immediately after a meal and maintain throughout the day.

47
Q

What is long-acting insulin analogues?

A

Delayed and prolonged absorption from injection site. Longer duration of action than NPH (intermediate insulin) but reduced peak. Provides blood sugar control throughout the day and night and typically used in combination.

48
Q

How can insulin be delivered?

A

Insulin devices or vials/syringes.

49
Q

What is the role of insulin devices?

A

Includes insulin pens, can be durable where the insulin cartridge is replaceable or disposable.

50
Q

What are the advantages of insulin devices?

A

Improves dose accuracy, convenient, easy user use for self-management, portable,

51
Q

What is basal insulin?

A

Provides steady release of insulin throuighout the day. AKA long acting insulin mimetic.

52
Q

What is the insulin pumps?

A

Continuous subcutaneous insulin infusion, battery operated, basal insulin is administered throughout the day, bolus insulin given before meal and needles/catheters have to be changed every 3 days.

53
Q

What is the side effects of insulin?

A

Hypoglycaemia, allergic reaction and injection site problems.

Year 1 (191 decks)

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