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GI and metabolism > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the definition of diabetes?

A

Symptoms and random plasma glucose > 11 mmol/l

Fasting plasma glucose > 7 mmol/l

No symptoms - GTT (75g glucose) fasting > 7 or 2h value > 11 mmol/l

HbA1c (glycated Hb) is now used in diagnosis.

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2
Q

What are the presenting features of diabetes?

A

Polyuria and polydipsia (thirst) - osmotic diuresis and activation of hypothalamus.

Weight loss and fatigue - impaired glucose utilisation.

Pruritis vulvae and balanitis

Hunger - lack of insulin preventing hypothalamic glucose uptake

Blurred vision - altered acuity due to uptake of glucose into lens

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3
Q

What is the prevelance of TIDM?

A

0.3%

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4
Q

What are the three clinical features of newly diagnosed type 1 diabetes?

A

Weight loss, short history and moderate - large urinary ketones

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5
Q

What are the aims of treatment for type 1 diabetes?

A

Relief of symptoms, prevention of ketoacidosis, prevention of complications (micro and macrovascular).

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6
Q

What are the microvascular complications of diabetes?

A

Retinopathy, neuropathy and nephropathy (U&Es and urine test for microalbumin).

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7
Q

What percentage of people with diabates in the UK will develop diabetic nephropathy?

A

30%

x30 risk of mortality

Tendency to develop retinopathy and neuropathy too.

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8
Q

Describe insulin treatment for diabetes.

A
  1. Twice daily mixture of short/medium acting insulin
  2. Basal bolus (1-2 daily medium acting plus pre-meal quick-acting)
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9
Q

What causes hypoglycemia in type 1 diabetes?

A

Innapropriately high insulin levels.

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10
Q

What percentage of people with type 1 diabetes experience hypoglycaemia?

A

30%

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11
Q

What percentage of people with type 1 diabetes will have severe hyperglycaemia once per year?

A

10%

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12
Q

What percentage of type 1 patients will have a blood glucose of 3.5 mmol/L on any given night?

A

50%

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13
Q

Why is hyperglycaemia a medical emergency?

A

Cerebral tissue uses glucose for fuel. Interruption of supply produces instant changes.

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14
Q

What signs are produced by a plasma glucose of 2mmol/L?

A

Abnormal EEG and confusion

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15
Q

What signs are produced by a plasma glucose of 1 mmol/L?

A

Coma and seizures.

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16
Q

What signs are produced by a plasma glucose of < 1 mmol/L?

A

If prolonged - irreversible cerebral damage.

17
Q

What are the physiological protections counterregulatory hormones?

A

Adrenaline and glucagon - both increase hepatic glucose output.

18
Q

What are the autonomic signs and symtoms of hypoglycaemia?

A

Nausea, tremor, sweating, tachycardia, pallor and anxiety (adrenergic).

19
Q

What are the neuroglycopenic signs and symptoms of hyperglycaemia?

A

Confusion, drowsiness, lethargy, lack of concentration , slurred speech, aggression and coma.

20
Q

What are the risks associated with the avoidance of hypoglycaemia?

A

Increases the risk of diabetic complications.

21
Q

What proportion of patients can expect a reasonable life expectancy in diabetes?

A

2/3

22
Q

What are the consequences of insulin resistance in type 2 diabetes?

A

Decreased insulin-dependent glucose uptake into muscle and adipose tissue.

Combined with excessive glucose production by the liver, this leads to hyperglycaemia, which in turn causes a compensatory increase in insulin secretion.

As diabetes becomes more severe the insulin response becomes progressively impaired due to pancreatic exhaustion.

23
Q

What are the complications of type 2 diabetes?

A

Blindness, ESKD, CVD, CVA and amputations.

24
Q

By how much is one’s life expectancy shortened at diagnosis of type 2 diabetes?

A

10 years

25
Q

What are the standard initial treatments in type 2 diabetes?

A

Weight loss and exercise

26
Q

How do thiazolidinediones (e.g. rosiglitazone) work?

A

Decrease insulin resistance in adipose tissue, skeletal muscle and liver.
They may have a beneficial effect on b-cell function.
Direct insulin sensitizers that act as agonists for the nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARg). PPARg increases the transcription of certain insulin-sensitive genes, thereby improving insulin sensitivity.

27
Q

How do biguanides such as metformin work?

A

Primarily suppress hepatic glucose output. In addition, they enhance insulin sensitivity and stimulate insulin-mediated glucose disposal. They do not stimulate insulin secretion.

28
Q

How do the sulphonylureas and meglitinides work?

A

Both lower fasting blood glucose concentrations, primarily by stimulating insulin secretion from the pancreas.

29
Q

How do alpha-glucosidase inhibitors such as acarbose work?

A

Delay digestion and absorption of carbohydrates in the gastrointestinal tract. They inhibit the enzyme a-glucosidase, responsible for the metabolism of complex carbohydrates into absorbable monosaccharides.

30
Q

How do glucagon-like peptide 1 (GLP-1) analogues work?

A

Mimic GLP-1, a gastrointestinal hormone that increases insulin secretion from the pancreas and inhibits glucagon release.

31
Q

How do dipeptidyl peptidase 4 (DPP-4) inhibitors work?

A

Block the DPP-4 enzyme which would otherwise inactivate GLP-1.

32
Q

What is the triangle approach to diabetes management?

A
  1. Improve glucose levels
  2. Avoid hypoglycaemia
  3. Limit glucose variability

GI and metabolism (25 decks)

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