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Human Disease > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is normal blood glucose level?

A

Fasting = 4-6 mmol/L

After meal = less than 7.8 mmol/L

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2
Q

What is the normal response to high blood glucose levels?

A

Insulin is released by beta cells of the pancreas so that fats take in glucose from the blood

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3
Q

What is the normal response to low blood glucose levels?

A

Glucagon is released by alpha cells of the pancreas so that the liver releases glucose cells into the blood

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4
Q

What is the difference between type 1 and type 2 diabetes?

A

Type 1 = no insulin is released

Type 2 = cells dont respond to insulin

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5
Q

What are the symptoms of type 1 diabetes?

A 
Frequent urination
excessive thirst
extreme hunger
dramatic weight loss
Irritability
Fatigue
Nausea
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6
Q

What are the symptoms of type 2 diabetes?

A 
Increased thirst
Night time urination
Blurry vision
Unusual fatigue
Dark skin around the neck or armpits
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7
Q

What characteristics do you need to diagnose diabetes?

A

Diabetes symptoms +
random plasma glucose over 11mmol/L or fasting over 7
OR
no diabetes symptoms but positive results in the two tests
OR
HbA1c over 48mmol/mol

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8
Q

What does the treatment for diabetes aim to achieve?

A

Keep patient feeling well
Prevent hypoglycaemia
Delay the onset of micro and macrovascular problems

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9
Q

What is the main determinant of microvascular problems?

A

Tight glycaemic control

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10
Q

What is the main determinant of macrovascular problems?

A

Hypercholesterol
Smoking
Obesity

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11
Q

What are the 5 main complications from diabetes?

A 
Poor healing - AMPUTATION
HEART DISEASE
KIDNEY FAILURE
STROKE
Damaged blood vessel in the retina - BLINDNESS
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12
Q

What is the treatment for type 1 diabetes?

A

Insulin (pump or pen device)

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13
Q

What is the treatment for type 2 diabetes?

A 
ORAL FORM
Metformin
Sulphonylureas
Glitazones
DPP4 inhibitor
SGLT2 inhibitor
INJECTABLE FORM
GLP-1 agonist
Insulin via pen devices
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14
Q

What is the difference between different types of insulin?

A

Rate of absorption
Peak onset of action
Duration of action

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15
Q

Where can insulin be injected?

A

Bum
Upper outer thigh
Upper outer arm
Abdomen

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16
Q

What is insulin pump therapy?

A

Pump attached to stomach and injects insulin automatically

Insulin must be kept in the fridge, unless being used - then room temperature OK

17
Q

What is the duration of action of insulin?

A

Rapid acting = 1-4 hours
Short acting = 1-7 hours
Intermediate acting = 1 -10 hours
Long acting = 1-24 hours

18
Q

What is metformin?

A

Treatment for type 2 diabetes
1st line for obese type 2
Dose max 2g per day with or after meals

+VES
Prevents any cardiovascular complications with diabetes
Doesnt cause hypoglycaemia
Aids weight loss

-VES
 Gastrointestional changes – diarrhoea, vomiting,
loss of appetite
Lactic acidosis
B12 deficiency
19
Q

What are sulphonylureas?

A

Eg GLICLAZIDE - stimulates pancreatic beta cells to produce insulin
Dose 160 mg twice a day taken before meals
Weight gain
Hypoglycaemia

20
Q

What are glitazones?

A 
Eg Pioglitazones
Improve insulin resistance
Dose max 45g once daily at any time
Fluid retention
Haematuria 
Increased risk of bone fracture
Weight gain
Hepatotoxicity
21
Q

What are the effects of incretin hormones (GLP)?

A

Stimulates release of insulin in the presence of glucose
Reduce apatite
Reduces hepatic gluconeogenesis
Delays gastric emptying

22
Q

What inactivates GLP?

A

DPP4

23
Q

What are SGLT2 inhibitors?

A 
Eg Dapaglifozin
Taken orally, 5 or 10mg
Increase frequency of UTI
Increase frequency of thrush
Modest diuretic effect ( due to osmotic diuresis from urinary glucose excretion)
24
Q

What is the action of SGLT2

A

SGLT2 are responsible for 90% of glucose reabsorption in the kidney

25
Q

What is hypoglycaemia?

A

Refers to any episode of low blood glucose

26
Q

What are the symptoms of hypoglycaemia?

A

1) Autonomic – due to activation of autonomic nervous systems ( sweating, tremor, anxiety, palpitation, etc)
2) Neuroglycopaenic – due to reduced glucose delivery to the brain ( poor concentration, odd behaviour, dizziness, blurr vision etc )
3) Coma / death

27
Q

What is the treatment for hypoglycaemia?

A

Glucose tablet or drink, jelly babies if mild

Im glucagon or Intravenous glucose if severe

28
Q

What are the consequences of hypoglycaemia?

A

1) Quality of life
2) Fear of further hypoglycaemia – poor control of diabetes
3) Falls – leading to fracture
4) Cardiovascular – prolongation of QT interval, leading to arrthymia and death
5) Repeated hypoglycaemia
- Probably cognitive impairment
- Hypoglycaemia unawareness
6) Driving consequences

29
Q

What is the law surrounding hypoglycaemics driving?

A
  • Must have awareness of hypoglycaemia
  • Not more than one hypoglycaemia needing third party assistance in last 12 months
  • Appropriate blood glucose monitoring
30
Q

What is diabetic ketacidosis?

A

Acute insulin deficiency causing

1) less glucose uptake - hyperglycaemia - polyuria, thrist
2) Lipolysis leading to the formation of fatty acids - ketone formation - ketoacidosis - nausea and respiratory compensation

31
Q

Who is prone to diabetic ketoacidosis?

A

Type 1 diabetics

32
Q

How do we diagnose diabetic ketoacidosis?

A

Capillary blood glucose > 11 mmol/l
Capillary ketones > 3mmol/l
Venous pH

33
Q

What is the treatment for diabetic ketoacidosis?

A

1) Fluid resuscitation is main priority – to correct dehydration and hypotension
( a typical patient of 70kg would have lost about 7 liters of fluids at
presentation )
2) Insulin infusion – to shut down production of
ketone and improve acidosis
3) Screen and treat for any underlying infection
4) DVT prophylaxis
Aim for resolution of DKA within 6-12 hours

Human Disease (54 decks)

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