Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetes > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What’s the difference between type a T1 and type b T1

A

Type a: autoimmune

Type b: idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What genetic factors predispose for T1DM

A

HLa DR3 and DR4. DR2 is protective. IDDM2 and 12 also contributes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the steps in the lack of insulin action

A

Hyperglycemia -> glycosuria -> osmotic diuresis -> poluria ->polydipsia -> dehydration -> weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the consequences of lipolysis

A

Ketogenesis -> ketosis -> nausea -> acidosis -> compensate with hyperventilation (serious insulin deficiency). Respiratory compensation for metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the macrovascular complications of diabetes

A

Angina, claudication, TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the microvascular complications of diabetes

A

Retinopathy (as glucose concentration shifts, eye ball and lens will shrink and expand
Neuropathy
Autonomic (abnormal sweating, gastroparesis, diarrhea, postural dizziness, erectile dysfunction, incontinence), radiculopathy
Compression (pain, tingling, weakness in carpal tunnel)
Mononeuritis (more susceptible to damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the clinical features for T1DM

A

Insulin deficient, ketosis prone, HLA markers, autoimmune, onset peak in adolescence, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the clinical features for T2DM

A

Insulin resistant and deficient, not ketosis prone, polygenic, S Asians, Increases with ageing, associated with obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the venous plasma glucose levels for diabetes

A

Over 7 fasting and over 11.1 at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the venous plasma glucose levels for impaired glucose tolerance

A

Less than 7 fasting, (above 7.8 but below 11.1) at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the venous plasma glucose levels for impaired fasting glucose

A

Above 6.1 but less than 7 at fasting, less than 7.8 at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the diagnostic criteria for diabetes

A

Symptoms and random plasma glucose over 11.1
Asymptomatic and HbA1c over 48 on 2 occasions, fasting plasma glucose over 7 mmol and/or 2 hour post 75g glucose load over 11.1 on 2 separate occasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What’s the normal percentage of glucose in urine

A

0.1%, cannot be used to diagnose diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When should HbA1c not be used

A

Blood glucose levels have risen rapidly
Symptomatic children and young people
Symptoms suggesting T1DM
Short duration diabetes symtpoms
Patients are high risk of diabetes who are acutely ill
Taking medication that may cause rapid glucose rise e.g. corticosteroids, anti psychotics
Acute pancreatic damage/pancreatic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How much does glucose concentration fall in plasma and why

A

0.5 mmol over 3 hours due to glycolysis in RBC. Whole blood glucose is 10-15% lower than in plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is capillary glucose testing conducted

A

Prick finger with lancet, obtain blood sample, apply to reagent strip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the long term blood glucose control methods

A

Glycated haemoglobin - non enzymatic addition of glucose to amino groups of Hb
Serum fructosamine - glycated albumin. Reference range 200-285

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the interferences with HbA1c measurement

A

Hb variants (HbF can elevate)
Altered red cell survival (haemolytic anaemia)
Chemically modified Hb (carbamylation in uremia can elevate, acetylation with aspirin can elevated)
Reduced glycation process - vitamin C can lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the steps of ketone metabolism

A

Acetyl CoA form fatty acyl-CoA -> 3-hydroxybutyrate and acetoacetate and saturates in DKA. Acetoacetate and 3-hydroxybutyrate ratio should be similar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does ketone blood test measure

A

b-hydroxybutyrate
Normal concentration less than 0.6
Over 1.5 clinically significant
Over 3mmol part of triad for DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does ACR measure

A 
Urine microalbumin (urine albumin and creatinine ratio), helps identify kidney disease that can occur as a complication of diabetes
Persistent microalbuminuria has 20x increased risk of diabetic renal disease
22
Q

What are the measurements for microalbuminuria

A

ACR over 2.5mg/mmol (men)

ACR over 3.5 mg/mmol (women)

23
Q

What are other causes of increased albumin excretion

A

UTI, non diabetic renal disease, menstrual contamination, vaginal discharge, uncontrolled hypertension, heart failure, inter-current illness and strenuous exercise

24
Q

What drugs can be used to treat T1DM

A

Insulin

25
Q

What drugs can be used to treat T2DM

A

Biguanides, sulphonylureas, thiazolidinediones, meglitinides, incretins, DPP4 inhibitors, alpha-Glucosidase inhibitors, SGLT2 inhibitors, amylin analogues, insulin

26
Q

What’s an example of a biguanide?

A

Metformin

27
Q

How does biguanide work?

A

Act through AMPK, increase AMP levels, mTOR (mammalian target for rampamyacin), inhibition of glycerophosphate dehydrogenase -> decrease hepatic gluconeogenesis

28
Q

What do biguanides not have an effect on

A

Insulin, glucagon, GH, cortisol, somatostatin

29
Q

How does biguanide work

A

Decrease blood glucose concentration by:
decreased hepatic glucose production
potentiate insulin action on muscle and adipose tissue
stimulation of glycolysis in tissues, stimulates glucose uptake
decrease carbohydrate absorption
stimulate lactate production
decreases LDL and VLDL
inhibit expression of genes involved in gluconeogensis

30
Q

What drugs for T2DM cause hypoglycaemia

A

Sulphonylureas, thiazolidenediones, and insulin

31
Q

What are the side effects of biguanides

A

Diarrhoea, nausea and metallic taste, rare lactate acidosis, decreases intestinal absorption of folate and vitamin B12

32
Q

What sulphonyureas area used

A

Glibencalmide, Glipizide

33
Q

What are acute effects of sulphonyureas

A

Increase insulin release, increase plasma insulin concentration, decrease hepatic clearance of insulin

34
Q

What are chronic effects of sulphonyureas

A

No acute increase in insulin release but decreased plasma glucose concentration still remains
Chronic hyperglycaemia decreases insulin release
Down regulation of sulphonylurea receptor

35
Q

What are the side effects of sulphonylureas

A

Neuroglycopenia (lack of glucose supply to brain)
Confusion and coma - take oral glucose
If severe give IV glucose, glucagon, adrenaline

36
Q

What meglitinides are used

A

Repaglinide, nateglinide

37
Q

How do meglitinides work

A

Take before meals

Close K+ATP channels on beta-cells, share 2 binding sites with sulphonylureas but have their own distinct binding site

38
Q

What thiazolidenediones are used and what are their respective side effects

A

Trolitazone - live toxicity
Rosiglitazone - CV problems
Pioglitazone - risk bladder cancer
All cause weight gain due to increased differentiation of adipocytes, fluid retention by stimulating amiloride Na+ absorption

39
Q

What is thiazolidenediones mechanism of action

A

Activates insulin response genes that control carbohydrate metabolism
Needs insulin to be effective
Reduces insulin resistance in peripheral tissues
Reduces glucose production by liver
Increases glucose uptake in muscle and adipose tissue potentiates actions of insulin
Increase adipocyte number and lipogensis

40
Q

How do SGLT inhibitors work

A

SGLT2 is found in early proximal tubule, responsible for most absorption of glucose. Inhibitors increase diuresis. SGLT2 inhibitors inhibit glucose re-uptake in kidney

41
Q

What are examples of SGLT2 inhibitors

A

Dapagliflozin, canaglifozin, empagliflozin -> combined with metformin

42
Q

What alpha-glucosidase inhibitors are used

A

Acarbose and miglitol

43
Q

How do alpha-glucosidase inhibitors work

A

Inhibits intestinal brush border alpha-glucosidase
Inhibits carbohydrate breakdown and reduce postprandial increase in blood glucose levels
Effective in T1DM and T2DM

44
Q

What are incretins

A

Group of metabolic hormones that stimulate a decrease in blood glucose levels
GLP-1 and GLP-2 act on pancreatic beta cells to increase insulin release - found in distal ileum
GIP: glucose dependent insulinotrophic peptide or gastric inhibitory peptide K cells in duodenum

45
Q

How do incretins work

A 
Given as injection as peptides are not orally active
Stimulates insulin release
Suppresses glucagon secretion
Reduces appetite and body weight
Slows gastric emptying 
Stimulated beta cell number
46
Q

How do DPP4 inhibitors work

A

Blocks DPP4, which breaks down natural incretins

47
Q

How do amylin analgoues work

A

Amylin is a main component of pancreatic amyloid related to calcitonin
Decreases gastric emptying
Inhibits glucagon release from alpha cells
Promotes satiety
Related to beta amyloid and can form aggregates

48
Q

What obesity treatments are used

A

Orlistat (lipase inhibitor) - causes steatohorrhea
Ghrelin antagonists
Ghrelin vaccine
NPY agonists

49
Q

What are the differences between injected insulin and endogenous insulin

A

Loss of C peptide
Loss of portal:peripheral gradient
Weight gain
Not controlled endogenously

50
Q

What are rapid acting insulins

A

Lispro and aspart

Starts to work within half na hour and peak at 1-2 hours

51
Q

What are long acting insulins

A

Determir (twice a day)
Glargine (once a day)
Degludec

Diabetes (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions