Diabetes Flashcards
Features of metabolic syndrome?
Increased BP Increased waist circumference Increased TGs Increased fasting glucose Reduced HDL
Catabolic hormones that are involved in diabetic ketoacidosis?
Glucagon
Catecholamines
Cortisol
GH
What type of diabetics get DKA?
Type 1 only
Process of ketoacidosis development in T1DM?
1) Glucagon = Increased PEPCK = more gluconeogenesis = less oxaloacetate
2) Therefore acetyl CoA accumulates
3) In T1DM, no insulin = hormone sensitive lipase activation = lipolysis = ketogenesis
Main complications of diabetes?
- Retinopathy
- CVD (2-3x risk of CHD or stroke)
- Nephropathy (leading cause of kidney transplants)
- Erectile dysfunction (~50% of men with long term diabetes)
- Foot problems
What is charcot arthropathy?
Bone & joint destruction from minimal trauma, common in diabetics
In what situations should metformin not be used?
Patients with AKI
Acutely unwell/dehydrated patients (lactic acidosis risk)
Mode of action of the sulphonylureas? example of one?
Stimulate the pancreas to release insulin, gliclazide.
Example of a GLP-1 agonist?
Exanatide
Mode of action of GLP-1 agonists
Stimulate the release of insulin from the pancreas and delay gastric emptying.
When should you not use GLP-1 Agonists?
suspended in patients with N&V, due to delay in gastric emptying
Problems with Sulphonylureas?
Risk of hypos. cannot be used in renal impairment.
Mode of action of SGLT2 antagonists?
Cause raised glucose excretion in kidneys.
Cautions with using SGLT2 inhibitors?
- Increased UTI risk
- Used with caution with diuretics
- Suspended in dehydration
- Patients on an SGLT2 will always have positive urine dipsticks
What is the target for pre-meal glucose in diabetics?
4-12mmol/L
What is the target for bedtime glucose in diabetic inpatients?
8-10mmol/L
Minimum target for elderly/ill diabetics?
6mmol/L
Symptoms of hyperglycaemia?
- Thirst
- Polyuria
- Blurred vision
- Nausea
- Fatigue
- Headaches
- Drowsiness
(imagine being drunk)
Blood glucose level to be considered a hyper- or a hypoglycaemia?
> 12mmol/L hyper
Symptoms of hypoglycaemia?
- Sweating
- Palpitations
- Shaking
- Hunger
- Confusion
- Drowsiness
- Speech difficulty
- Headache
- Nausea
What other conditions are usually present in metabolic syndrome?
Obesity
NAFLD
Vascular and clotting abnormalities
Three areas of the body that insulin causes the uptake of glucose?
Muscle, fat, liver
How does glucagon and insulin effect hepatic release of glucose?
Glucagon causes the release of PEPCK, which stimulates hepatic glucose release
Insulin directly inhibits hepatic glucose output.
How does pancreatic islet destruction lead to hyperglycaemia in T2DM?
Alpha cells hypertrophy and release more glucagon.
Beta cell number decreases, less insulin is released.
