Diabetes Flashcards
What does mellitus mean
sweet- high sugar content (hyperglycaemia)
what is insipidus
excessive thirst and urination - rare
what is diabetes?
inappropriate glucose homeostasis, hyperglycaemia, insulin insufficiency to meet regulation.
what type of diabetes is absolute insulin deficiency?
type 1
Type 2 is what type of insulin deficinecy
relative
what is the failure of insulin synthesis, release or activity known as?
MODY
HbA1c would score what if diabetic
> 48m/m
fasting glucose score would be what if diabetic
> 7m/mol
what would the random glucose score be in someone with diabetes
> 11.1m/mol
what is the score for 2hr glucose OGTT
> 11.1
what antibodies are usually present in type 1 diabetes
Anti GAD and anti- islet cell antibodies
what is insulinitis
lymphocyte infiltration
When does type 1 usually present
childhood/ peri puberty
what onset is type 1
acute +severe WEIGHT LOSS
does type 1 require insulin?
HELL YEAH
when does type 2 present
middle aged/ obese
how do you manage type 2 diabetes?
diet and tablets
what are complications of type 2 diabtes
neuropathy, retinopathy
whom does monogenic diabetes most commonly affect?
children
what would the antibodies be in monogenic diabetes
negative- GAD and C peptide positive
what does HbA1c show?
glucose control measure over 2-3 months
what microvascular complications can occur?
retinopathy, neuropathy, nephropathy
What macrovascular complications
heart disease and stroke
risk factors for type 2
previous MI and stroke, pregnancy, obesity, age, medications- antipsychotics
what is the classic presentation of type 1 diabetes?
polyuria, WL, polydipsia
Are cystic fibrosis patients likely to develop diabetes?
yes- >25%
What is prominent in bardet beadle syndrome
polydactyly, hypogonadal, visual/hearing impairment, DIABETES
In LADA are antibodies positive or negative?
positive (where MODY is negative)
What autoimmune conditions are associated with diabetes
coeliac, thyroid, anemia, IgA deficiency, Addisons
what are key elements of type 2 diabetes
insulin resistance and b cell dysfunction
describe the concept of insulin resistance
the receptor is not as responsive to insulin molecule and therefore less glucose enters cell, resulting in a build up of glucose in the blood
what factors cause insulin resistance
BUILD UP OF FAT, INFLAMMATORY, reduction In glycogen synthesis due to reduced glucose transport
truew or flase, at time of diabetes presentation, b cell function is already approx. half depleted
truuueee
which body shape is worse for diabetes, apple or pear
apple
what factors make up the metabolic syndrome
high BP, high triglycerides, low HDL, insulin resistance
what kind of lifestlyr advice can you give
WL, exercise, smoking cessation and improve diet
name a biguanide
metformin
what type of anti hyperglycaemic agents is glicazide/ glipizide
sulphylureas
What is pioglitazone
a thiazolidiones
what is the usual starting dose of metformin
500mg OD
What do the class biguanides do?
insulin sensitizers
does metformin cause hypos?
nooo
true or false, metformin can cause micro and macrovascular problems
FlALSE FALSE FALSE
IS METFORMIN SAFE IN PREGNANCY?
yes
are GI side effects common in metformin?
Yes-25%
Should you be weary with MI/strokes in patients taking metformin?
yeah
what should you do if eGFR is less than 30ml/min?
stop metformin
what do sulphonylureas do?
secrete insulin by acting of potassium channel
does sulphonylureas prevent micro and macrovascualar problems?
No- prevents microvascualr complications but NOT macrovascular
what is one of the biggest risks of sulphonylureas?
hypo attacks in older people
when should you totally avoid sulphonylureas?
in severe renal or hep[atic disease
thiazolinedione does ewhat?
transcripts genes that are insulin sensitive
What happens to your weight in TZDs?
you put weight on!
Patients with heart failure should not get TZDs
true- risk of fluid retention
does TZDs prevent against macrovascular complications?
Yes
True or flase- there si not a risk of hip fracture when taking plioglitazone
false!- 20% risk
what is the incretin pathway?
where glucose is absorbed better orally than iv
what are 2 incretins?
GIP form K cells and GLP-1 from L cells
what do GLP1 receptor agonists do?
suppress glucagon, promote insulin secretion, decrease gastric emptying, reduce apetite WL
why are DPP4 good?
becase they keep weight newutral and supress glucagon
what normally happens to sugar oin the body
sugar is completely reabsorbed
what doo SGLT2 inhibitors do?
decrease uptake of sugar
what are downsides to SGLT2 inhibitors
increase thrush, increase UTI?
when is insulin used?
basically as a last resort
How should you treat hypertension in patients that have diabetes?
NO ASPIRIN, statins, fibrates,
