diabetes Flashcards
endocrine functions of the pancreas arise from the hormones produced in the islets of langerhands. what are the 4 cell types and what do they produce?
Alpha cells - glucagon
Beta cells - insulin
delta - somatostatin
PP: pancreatic polypeptide
Stimulated by growth hormone and serves to increase growth but also to regulate the secretion of insulin and glucagon?
somatostatin
♣ Functions as the regulator of both the endocrine and exocrine functions of the pancreas.
pancreatic polypeptide
what is cleaved from insulin on release ?
c peptide
does the c peptide serve a function ?
no
the antagonist of insulin and acts to increase blood sugar in response to a decrease in levels
glucagon
in response to a low blood sugar, what cells release glucagon in the pancreas?
alpha cells
what effect does glucagon have on the liver?
it causes the liver to break down glycogen to glucose
normal range of blood sugar from fasting?
4.4-6.1
what are the tests used to diagnose diabetes?
fasting glucose
2 hour glucose tolerance test
Hba1c
3 antibodies identified in type 1 diabetes?
anti GAD
anti IA2
anti znT8
pathophysiology of T1DM?
autoimmune destruction of beta cells in the islets of langerhans
when does type 1 usually present?
in children or teenagers
presentation of type 1?
fatigue weight loss polydypsia and polyuria DKA abdominal pain vomiting signs of systemic shock
what does LADA stand for?
late onset of diabetes of adulthood
when does LADA usually present ?
25-40
sole treatment of T1DM?
insulin therapy
what should target HbA1c be in type 1?
48-59
sick day advice for type 1?
even if sick, don’t stop taking insulin
try to eat and drink as much as possible
increase blood glucose monitoring to a minimum of 4 times per day
seek medical advice if ketones found on dip
what is basal bolus regimen?
take long acting insulin before bed and short acting insulin before each meal
what insulin regimen is best for patients with regular diet and lifestyle?
biphasic injections (x2 injections of mixed insulin)
short acting?
Humulin, Humalog, novorapid
Long acting insulins?
Lantus and Lenevenir
mixed solution ?
novomix
what is lypohypertrophy?
fatty lumps from continually using same injection sites
what is thought to contribute to the insulin resistance in T2DM?
obesity and high sugar intake
pathophysiology of T2DM?
a static level of insulin resistance but a progressive failure of insulin secretion. Eventually production becomes non existent
what is the diagnostic criteria for T2DM?
if symptomatic - one raised fasting or OGTT result
asymptomatic - two raised fasting or OGTT results
first line management of type 2?
diet
2nd line tx of type 2
metformin (insulin sensitizer)
when is insulin therapy commenced in type 2?
when all other drug therapy has been exhauseted
all type 2 diabetic patients above 40 should be commenced on?
statin - no matter what the lipid profile
monogenic autosomal dominant form of diabetes which can present in neonates, teenagers or young adults?
MODY (maturity onset diabetes of the young)
which drugs are good at treating MODY
sulfonylureas
management of MODY?
addressing cardiovascular risk factors in order to lower overall risk
