Diabetes Flashcards
What cells are glucagon secreted from?
Alpha - islet of langerhan
What cells produce insulin
Beta cells - islet of langerhan
Summarise glucagons effect and pathway on the body
1) G alpha S pathway - cAMP
2) Glycogen released
3) glucogenolysis increased
4) Increased blood glucose
5) Increase in gluconeogenesis
How does insulin promote glucose uptake?
1) GLUT 2 into cells
2)Glucose phosphorylation to ATP
3) ATP inhibits K+ channels
4) Depolarisation = activation Ca2+
5) Stimulates insulin vesicle release
How does insulin get released by parasympathetic activation?
1) G alpha S pathway - cAMP
2) pka phosphorylates Ca2+ channels
3) stimulates release of insulin vesicles
What does insulin inhibit?
1) Glycogenolysis - breakdown of glycogen
) Gluconeogenesis - making glucose
What cells secrete somatostatin?
Delta - islet of langerhans
What are the effects of somatostatin?
1) Inhibits insulin
2) Supresses gastric absoprtion
What are the 4 main causes for reduction in insulin release?
1) Decrease in beta cells
2) Decreased cell glucose uptake
3) Glucose exceeds renal threshold
4) Insulin resistance
What is the structure of insulin?
21 alpha chain peptide
30 beta chain peptide
linked with disulfide bonds
Give example of RAPID insulin
Novorapid, Humalog
Give example of SHORT insulin
Actarapid, humulin S
Give example of INTERMEDIATE insulin
Humulin I, Insulatard
Give example of LONG insulin
Lantus
List the different equipment used for insulin
1) Vial and syrine
2) Reuseable pen
3) Disposable pen
4) innolet
5) insulin pump
What is lipohypertrophy
When you inject into the same area.
What are the implications of lipohypertrophy?
1) Decreases insulin absorption
2) Poor glucose control
3) Pain
Summarise the 3 insulin regimes:
1) Basal-Bolus - Long acting insulin at night, rapid/short acting insulin with meals
2) Twice daily - Insulin taken morning and night
3) Inter - intermediate acting insulin 1/2 times daily
Summarise MOA of metformin
1) Metformin inhibits mitrochondria chain complex 1
2) Decrease ATP, Increase AMP
3) AMPK activated
4) AMPK = decrease transcription for gluconeogenesis, Increase fat oxidation, Increase GLP-1
Summarise MOA of sulfonylureas
1) Targets K+ Channels in beta cells
2) Inhibits channels
3) K+ cant leave - depolarisation
4) Ca2+ activate
5) Insulin released by vesicle exocytosis
Summarise MOA of GLP-1 agonists
1) Targets Glucagon-like peptide receptor
2) Increase insulin secretion
3) Decreased gastric emptying and stops absorption of glucose in stomach
Summarise MOA of DPP-4 inhibitors
1) Decreases breakdown of GLP-1 so that there is more incretin
2) Supresses gastric emptying and absorption
3) Increases insulin secretion - cAMP pathway
Summarise MOA of PPAR gamma agonists
1) Enhances effectiveness of insulin
2) PPAR + RXR = receptor complex
Summarise MOA of SGLT2 inhibitors
1) Inhibits SGL transporter in proximal tubule
2) Sodium and Glucose cant pass through from tubule into blood
3) Decreases glucose reabsorption in blood
4) Glucose excreted in urine
Give examples of sulfonylureas
Gliclazide
‘ZIDES’
Give examples of SGLT2
Dapagliflozin
‘FLOZINS’
Give example of DPP-4 inhibitor
Sitagliptin
‘GLIPTINS’
Give example of PPAR agonist
Pioglitazone
Give example of GLP-1 agonist
Ozempic semiglutide
How would you treat hypoglycaemia if a person can swallow
Glucose tablets, fresh juice, sweets, 40% glucose gel
How would you treat hypoglycaemia if a person can’t swallow
Intramuscular glucagon
999 IV glucose
Symptoms of DKA
ketone breath, nausea an vomiting, reduced consciousness, dehydration , hyperventilation
Symptoms of Hypo
Confusion, impaired speech, mood changes, unconciousness
Symptoms of T2 HHNKS
nausea and vomiting, dehydration, weakness and reduced consciousness
What are the target glucose levels for non diabetics
3.4-5.8mmol/l
What are target glucose level for diabetics
Before meals and waking - 4-7
90 mins after meals - 5-9
What type of medication can cover up the symptoms of hypoglycaemia
Beta blockers - reduce sympathetic symptoms
What blood glucose testing methods arent deemed appropriate for diagnosis
finger prick
urine stick
What should the value of a HbA1c test be and what does this show
<48 mmol/l
shows average blood glucose levels over the past 8-12 weeks
What are the 3 tests used for diabetes diagnosis and their results
1) Random plasma glucose = >11.1
2) Fasting plasma glucose = >7.0
3) Glucose tolerance test = >11.1
When can HbA1c be used to diagnose
When value >48 + symptoms
Summarise NICE guidelines for type 2 diabetes
1) METFORMIN
2) Sulfonylurea or pioglitazone or DPP-4 inhibitor
3) Up to triple therapy treatment
4) Insulin therapy
5) swapped to GLP-1 agonist if insulin isnt tolerated and BMI low enough (<35)
SGLT2 added if any cardiovascular risk of heart problems
What is first line therapy for when metformin isnt tolerated
Sulfonylurea or SGLT2
