Diabetes Flashcards
What is diabetes?
Lifelong condition that causes a person blood sugar level to become too high. There are two different types
type 1 - the pancreas doesnt produce any insulin
type 2 - pancreas doesnt produce enough insulin or the body doesnt respond to insulin.
the hormone insulin is produced in the pancreas and it controls the amount of glucose in the blood and allows the body to use the glucose for energy.
What are the risk factors for type 2 diabetes?
Age
family history
overweight
What are some possible triggers for Type 1 diabetes?
Viruses
Dietary Factors
Emotional/Physical stress
Environmental toxins
What is the process behind Type 1 Diabetes?
Destruction of the beta cells in the pancreas
Where is insulin produced?
Beta cells of the isles of langerhans in the pancreas
What is the treatment for type 1 diabetes?
Insulin - subcutaneous or an insulin pump
Short acting given after meals or in acute hyperglycaemia
Intermediate/Long acting - basal insulin/overnight control
e.g. Actrapid, Novorapid (short acting), Insulin Glargane
Describe how type 2 diabetes is treated
Lifestyle Management first - suggested to lose weight, cut down sugar and increase exercise
If HbA1c increases further:
Biguanides e.g. Metformin - first line
If metformin not tolerated or contraindicated
- sulphonylurea e.g. tolbutaminde (also better if patient is not overweight)
- Pioglitazone or Rosiglitazone (Thiazolineinediones)
How does metformin work?
MOA not entirely understood but increases insulin receptor sensitivity
inhibits hepatic gluconeogenesis
Reduces hyperglycaemia but does NOT induce hypoglycaemia
What is the mechanism of action of Thiazolineinediones ?
PPAR-γ agonist - agonistically binds to hormone nuclear receptor site
Reduction in gluconeogenesis and an increased glucose uptake into muscles
What is the mechanism of action of Sulphonylureas?
Antagonise beta cell K+/ATP activity causing depolarisation causing increased intracellular calcium due to opening of voltage gated calcium channels. This causes insulin vesicle fusion with the membrane.
What are some ADRs of sulphonylureas?
Hypoglycaemia
Weight Gain
GI disturbances
What are some complications of Diabetes?
Macrovascular disease –> stroke, coronary artery disease, IHD
Microvascular disease –> Retinopathy
Peripheral Neuropathy –> sock and glove distribution
Diabetic foot
Infection - serious infections such as necrotising otitis media and rhinocerebral mucormycosis
Diabetic Ketoacidosis
How is diabetes monitored?
Via a HbA1c
Glucose in the blood will react with the terminal valine of the Hb molecules to produce glycoslated Hb
Shows how effective glucose control has been over the last 3 months because RBCs stay in the blood stream for 180 days (approx)
What are the main types of anti-obesity drugs?
Orlistat - gastric and pancreatic lipase inhibitor
causes soft fatty stools, flatulence, faecal discharge
What is the normal blood glucose level?
normally maintained at 5mmol/l
Range 3.5mmol/l - 8mmol/l
