Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EXAM 2 > DIABETES > Flashcards

DIABETES Flashcards

1
Q

Insulin synthesis

A

Insulin is protein synthesized by ribosomes on the surface of the RER.

  • RER - The protein is folded and disulphide bonds are created.
  • Golgi body - Cleavage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Secondary diabetes

A

Diabetes that is caused due to an underlying disease. This includes…
* Liver disease
* Pancreatic disease
* Endocrine disease
* Drug-induced diabetes - Thiazide duiretics, Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Gestational diabetes

A

Diabetes that occurs during pregnancy (2nd or 3rd trimester) due to insulin resistance.

Managed: Diet, Insulin
Risk: Large bith weight baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Metabolic syndrome

A

A combination of medical conditions that together greatly increase the risk of CVD and Type II diabetes .These are…
* High blood presure
* High Blood glucose
* High cholesterol

  • Central abdominal obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diabetes symptoms

A

Also known as the 4Ts…
* Tired [FATIGUE]
* Thirst [POLYDIPSIA]
* Toilet [POLYURIA]
* Thinner [WEIGHT LOSS]

also blurred vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Diabetes ketoacidosis and its symptoms ?

A

A condition in which the body severely lacks insulin and sugar is no longer used for energy. Instead, fat is broken down and used as energy.
Symptoms:
* Excessive thirst
* Polyurea
* Nausea
* Vomiting
* Hyperventilation
* Ketone breath
* Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DKA pathophysiology

A
  • Blood glucose increase {HYPERGLYCEMIA} = osmotic diuresis; dehydration, hypotension
  • Ketone body increase ; metabolic acidosis -> hyperventilation
  • Hypokalemia
  • Muscle catabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Type I diagnosis

A
  • Symptoms: Random VPG > 11.1mmol/l + Fasting VPG >7 mmol/l
  • No symptoms: {Random VPG + Fasting VPG}x2

VPG = Venous plasma glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Type II diagnosis

A

HbA1c > 48 mmol/ml + symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Insulin treatment problems

A

Local treatment
* Bruising/scarring
* Allergic reaction (rare)
* Lipohypertrophy

Weight gain
Hyperglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hypoglycaemia symptoms

A
  • Confussion
  • Weakness
  • Mood changes (agressive)
  • Impaired speech
  • Unconciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How would you treat hypoglycaemia if the person can swallow

A

1.5-2 tubes of GlycoGel 40%
OR
Fresh juice
OR
Sweets

IM = Intramuscular

AIM: BG > 4mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you treat hypoglycaemia if a person can’t swallow

A

IM Glucagon 1mg
OR
IV Glucose (150ml of 10% over 15 minutes)

AIM: BG > 4mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Microvascular complications

A
  • Diabetic eye disease
  • Diabetic nephron disease
  • Diabetic nerve disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of diabetic eye disease ?

A
  • Diplopia (double vision)
  • Cataracts
  • Glaucoma (High fluid pressure in the eye)
  • Retinopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prevention/treatment of Retinopathy

A
  • Good blood glucose control
  • Good hypertension management
  • No smoking
  • Laser treatment (to seal of the leaking blood vessels)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are the microvascular complications so?

A

The nephron, nerves and eyes are especially vulnerable to due to difference in epithelial cells.

The cells DO NOT REQUIRE insulin for the diffusion of glucose through the cell membrane into the cell. Ergo, they are most vulnerable during hyperglycaemic conditions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Screening for nephropathy

A
  • Use of specialist dipstick
  • Detecting the presence and quantity of microalbuminauria
  • Calculate the ACR

ACR >3 mg/mmol requires treatment.

ACR = Albumin to creatine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of nephropathy (blood glucose)

A

Aim for HbA1c < 48mmol/mol
OR
<53mmol/mol if type 2 diabetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

TYPE 1 diabetes

Nephropathy treatment targets (BP)

A
  • ACR < 70mg/mmol: <140/90mmHg
  • ACR >70mg/mmol: <130/80mmHg
  • Over 80 years old: <150/90mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

TYPE 2

Nephropathy treatment targets (BP)

A
  • ACR is not considered
  • BP target: <140/90mmHg
  • Over 80 years old: <150/90mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

High BP-nephropathy treatment

A
  • Initially: ARB/ACEi
  • Second step: ARB/ACEi + CCB

ARB: Losartan, ACEi: Lisinopril, CCB: Amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the contra-indications of Pioglitazone ?

A
  • Ketoacidosis
  • Heart failure (history of or otherwise
  • Bladder cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

First-line treatment for type II diabetes with no CVD risk

A
  1. Metformin (Metformin MR if GI disturbance)
  2. SGLT-2 inhibitor (IF established CVD or risk)
  3. Add one of Pioglitazone, Sulfonylurea, DPP4-inhibitors to the metformin treatment for dual therapy.
  4. Triple therapy for Metformin, SGLT2 inhibitor and one of the other 3 classes of drugs.
  5. Replace all but SGLT-2 with inter insulin regime

3,4, or 5 can be used in place of metformin if contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are all insulin increasing drugs contraindicated by ?

A

Diabetic ketoacidosis

24
Q

How often should the HbA1c of a type II DM patient be measured ?

A

Every 6 months.

25
Q

What is lipohypertrophy and what are its complications ?

A

It is a lump of fatty tissue under your skin caused by the repetitive injections of insulin at the same area.
Complications include…
* Decreases insulin absorption
* Poor blood glucose control
* Pain

26
Q

What are the effects of somatostatin ?

A
  1. Inhibits insulin
  2. Supresses gastric absorption
27
Q

Give an example of RAPID insulin

A

Novorapid, Humanlog

28
Q

Give an example of SHORT acting insulin

A

Actarapid, Humulin S

29
Q

Give an example of LONG acting insulin

A

Lantus (glargine)

30
Q

Summarise the 3 insulin regimes

A

1) Basal-bolus (Type I): Long acting ON+ rapid/short with each meal
2) Twice daily (Type II): Intermediate+short Insulin taken OM + ON
3) Inter (stage 3 type II): Intermediate OR long ON

31
Q

What is metformin and how does it work?

A

A biguanide drug that essentially inhibits mitochondrion complex 1 which results in an increase in the AMP:ATP ratio thereby causing stimulation of AMPK.

32
Q

How does glucose uptake cause insulin secretion

A

1) Glucose enters cell via GLUT2
2) Glycolysis of glucose = ATP
3) ATP inhibits K+ channels
4) Depolarisation = activation of voltage-gated Ca2+ channel
5) Influx of Ca2+causes exocytosis of insulin-filled vesicles.

33
Q

Summarise MOA of sulfonylureas

A

High-affinity for binding to K-ATP channel. They…
* Bind to SUR1 subunits at K channel
* Block the transporter
* Depolarization of the membrane
* Activation of the voltage-gated Ca2+ channel = Insulin released by vesicle exocytosis

Can cause hypoglycaemia -insulin is secreted even in the absence of gluc

34
Q

What is a GLP-1 agonist and what do they do?

A

Glucagon-like peptide that binds to GPCRs therefore causing an increase in cAMP thereby stimulating various pathways; CHOP, Epac2, PI3K, EGFR. It…
* Increase insulin secretion (glucose-dependent pathway)

  • Stimulates proliferation of β-cells = Increase in insuling secretion
  • Decrease gastric emptying and stops absorption of glucose in stomach
  • Decreases glucagon secretion

They are rapidly cleaved by DPP4 enzymes (Half-life: 1-2 mins)

35
Q

What are DPP4 inhibitors and what do they do ?

A

They inhibit DPP4 enzymes resulting in longer half-lives of GLP-1. This…
* Supresses gastric emptying and absorption
* Increases insulin secretion - cAMP pathway

Examples: Alogliptin, Linagliptin, Sitagliptin

36
Q

Summarise PPAR agonist MOA

A

PPAR agonists…
1) Bind to PPAR (transcription factor)
2) Translocate to the nucleus
3) Form heterodimers with retinoid X receptor
4) The dimer binds to PPAR response element and activate the transcription of adjacent genes.
This increases transcription of genes involves in insulin signalling = Enhances effectiveness of insulin

37
Q

Give an example of an inrreversible inhibitor of DPP4

A
  • Saxogliptin
  • Vildagliptin
38
Q

What is Liraglutide ?

A

A modified GLP-1 with a lipophilic fatty acid chain at C16. This drug binds to the albumin proteins and effectively ‘hides’ from the DPP4. It has a half-life of 11-15 hrs therefore it is suitable for one daily administrations.

39
Q

What is Albiglutide ?

A

It is a GLP-1 agonist drug. It is two GLP-1 compounds conjugated together thereby increasing resistance to DPP4. The suitable administration for this drug is once weekly by subcutaneous injection.

40
Q

What does the activation of AMPK lead to ?

A

Increases…
* Glucose uptake by cells
* Fat oxidation
* Improves insulin sensetivity which increases insulin receptor function

Reduces…
* Lipid synthesis and carbohydrate absorption from the GIT.

  • ATP synthesis = Inhibition of glucagon
  • Transcription of genes for gluconeogenesis = Inhibition
41
Q

Give an example of DPP4 inhibitors and their starting dose

A
  • Linagliptin 5mg OD
  • Alogliptin 25mg OD
  • Sitagliptin 100mg OD
42
Q

What antidiabetic medication can cause hypoglycaemia ?

A
  • Sulfonylureas
  • GLP-1 agonists
  • DPP4 inhibitors
43
Q

Give examples of Sulfonylureas and their starting doses

A
  • Glicazide 40-80mg OD
  • Glimepiridine 1mg OD
  • Glipizide 2.5 mg OD
44
Q

Give examples of SGLT2 inhibitors

A
  • Dapagliflozin 10mg OD
  • Empagliflozin 10mg OD -> 25mg OD (if needed)
  • Canagliflozin 100mg OD -> 300mg OD (if needed)
45
Q

What are SGLT2 inhibitors and what do they do ?

A

They are selective SGLT2 (transporter) inhibitors. They block/inhibit the transporter from reabsorbing glucose.
* Decreases blood glucose
* Does not affect insulin
* Results in glucosuria

SGLT2 would otherwise reabsorb ~90% of filtered glucose (BAD)

46
Q

What is the first-line treatment for type 1 DM ?

A

BASAL-BOLUS
1) Basal:
* Offer twice daily long acting (Detemir)
* If twice not acceptable then offer OD detemir or glargine

2) Bolus:
* Offer rapid-acting analogues for BEFORE each meal.
DO NOT OFFER NON-BASAL-BOLUS REGIMES TO NEWLY DIAGNOSED TYPE 1 DM

Detemir = Levemir, Glargine = Lantus

47
Q

Describe the Twice-daily regime ?

A

Consists of the administration, of either Novomix 30 or Humulin M3, before breakfast and before dinner. These contain a mix of short acting and intermidiate acting insulins.

This regime is rarely used.

48
Q

What are the sick day rules for type 1 diabetics

A

Advice:
* DO NOT stop taking your insulin
* Test blood glucose more often (4x daily)
* Test for ketones using a kit
* Drink plenty of fluids
* REPLACE meals with carbohydrate containing drinks IF NECESSARY.

49
Q

Give examples of PPAR agonists and their starting dose

A

Pioglitazone 15-30mg OD -> 45mg OD (if needed)

15mg for elderly

50
Q

What are the target glucose level for diabetics

A

Before meals and waking: 4-7
90mins after meals: 5-9mmol/L

51
Q

What can treat the symptoms of hypoglycaemia

A

Beta-blockers: Propanolol, bisoprolol

52
Q

What is the lifestyle advice you would give to a type I diabetic ?

x /4

A

Diet
* Low salt, carbs, fat foods
* Atleast 5 portions of veg/fruit per day
* Monitor glucose intake

Alcohol
* Don’t drink more than 14 units a week
* Don’t drink alcohol on an empty stomach

Exercise
* Atleast 150 minutes of moderate intensity activity (walking/cycling) per week
* Advise them that their blood glucose levels.

Smoking
* Explain that smoking is a risk factor for cardiovascular disease

53
Q

What lifestyle advice would you give to a type II diabetic ?

A
  • Regular meals based on starchy, high fibre foods [eg bread, pasta, rice, cereals, potatoes]
  • Reduce intake of saturated fat
  • Five portions of fruit and veg
  • Low salt intake
  • Exercise 30mins per day for atleast 5 days of each week
  • No more than 14 units of alcohol per week
54
Q

What renoprotective medicine would you offer to a diabetic patient

A

Ramipril 1.25-2.5mg OD or Candersartan 8mg OD
(ACEi or ARB)

55
Q

What antihypertensive medicine can cause a dry cough and what steps would you take going forward

A

ACE inhibitors like Ramipril and lisinopril. Replace them with an ARB such as candersartan 8mg

56
Q

What are the recommendations for initial drug treatment for a type 2 diabetic

A

1) Start on Metformin 500mg OD with breakfast for 1 week
2) Change to BD with breakfast and evening meal for atleast 1 week
3) Change to TD with breakfast, lunch and dinner
4) Assess for CVD risk - If Qrisk > 10% then add an SGLT2 inhibitor - Dapagliflozin 10mg OD (with counselling)

57
Q

Why is the risk of hypoglycaemia
less with metformin

A

Because metformin works by decreasing the output of glucose from the liver and does not increase the secretion of insulin thereby inducing less of a hypoglycaemia risk.

58
Q

Give examples of GLP-1 agonists and their starting doses

A
  • Exenatide 5 mcg TD
  • Liraglutide 0.6mg OD -> 1.2 mg OD (after 1 week)
  • Semaglutide 0.25mg qw for 4 weeks -> 0.5mg qw for 4 weeks

qw = Once weekly

59
Q

What is the only recommended statin for CVD protection

A

Atorvastatin 20 mg ON

EXAM 2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions