Diabetes Flashcards
1
Q
Glucose?
A
- Glucose is leading energy source for humans
- stored for rapid release
- utilised in times of stress so that serum conc is maintained at level that provides constant supply of glucose to neurons-SNS
- danger of high and low cycling
- minute-to-minute control is function of endocrine pancreas gland
- HbA1c test provides 3-month average of glucose levles
2
Q
Talk to me about Insulin please
A
- Hormone
- Normally produced and released from pancreatic beta cells-endocrine part
- Islets of Langerhans
- alpha cells release glucagon in response to low glucose
- beta cells release insulin in response to high glucose
- work together to maintain serum glucose level within normal limits of 3.5-8mmol/L
- Islets of Langerhans
- Stimulates adipose and muscle cells to uptake glucose
- Binds to specific insulin receptor sites on cell membranes, stimulating transport of glucose into cells
- by facilitated diffusion
- Binds to specific insulin receptor sites on cell membranes, stimulating transport of glucose into cells
- Also stimulates synthesis of glycogen (glucose stored for immediate releasure during times of stress/low glucose)
- glucagon breaks down glycogen-glucose (liver)
- Insulin release reduced as blood glucose levels fall
3
Q
Hyperglycaemia
A
- Fasting blood sugar >11mmol/l
- glycosuria (sugar in urine)-infection
- cells cannot use glucose present-fatigue
- hungry/thirsty
- ketoacidosis-metabolism shifts to use of fat and ketone waste cannot be removed effectively-fruity breath-DANGER
- muscle breakdown-need amino acids-protein in urine
- slowed wound healing-all above
- thickening of basement membrane in blood vessels, decreased blood flow
- heart attacks/strokes
- retinopathy (eyes)
- neuropathies (feet and legs)
- nephropathy (renal)
4
Q
Hypoglycaemia
A
- Blood sugar <3mmol/l
- starvation or too much insulin
- body reacts immediately because cells need glucose to survive-esp. neurons
- parasympathetic stimulation
- increased GI activity-increase digestion and absorption
- SNS then responds by increasing Blood glucose levels
- glucagon, breakdown of fat/glycogen
- Signs: nervousness, anxiety, sweating, pale, cool, headache, shakiness
- extreme-loss of consciousness and coma
5
Q
Talk to me about Diabetes Mellitus (Honey Urine) Type I and treatment options?
A
- Don’t produce Insulin
- Usually only onset-childhood
- don’t know how or why, just suddenly happens? genetic link? viral destruction?
- <10%
- (although now thoughts that there may be several more sub-types of diabetes)
- Currently treatment aimed at tightly regulating blood sugar levels through use of Insulin
- transplantation-successful but experimental
6
Q
What are the side effects of insulin replacements?
A
- Fat hypertrophy at injection site
- transient oedema
- local reaction at injection site
- Other options? external/implantable insulin pump, inhaled insulin, insulin patch
7
Q
When are Insulin replacements used?
A
- Diebetes mellitus, type I
- sometimes in type II if not controlled by diet/pills, ketoacidosis or frequent hypoglaecimias
- OK in pregnancy and breastfeeding
- NOT if MAOIs-decrease glucose levels
- Allergies to animal insulin-although now most are human analogues-made in laboratories using recombinant DNA technology and E. Coli
Contraindications (and side effects) include;
- hypoglycaemia
- ketoacidosis
8
Q
Outline Humalog
A
Rapid-acting
- starts working within 15mins (peak = 1 hour)
- used in adults + children over 3 years old
9
Q
Outline Humulin 1
A
Intermediate-acting
- Peak activity between 1-8 hours
- Human isophane insulin
10
Q
Glargine
A
Long-acting
- baseline over 24 hours
- Human insulin analogue
11
Q
Novomix 30
A
mixed
- biphasic insulin
- Short acting - contains 30% soluble insulin aspart
- intermediate acting - contains 70% insulin aspart crystalised with protamine
12
Q
Talk to me about Diabetes Mellitus (Honey Urine) Type II and treatment options?
A
- Mature adults (increasing in teenagers/young adult)
- slow and progressive onset
- Can be related to life-style factors
- slow and progressive onset
- Cells don’t produce enough Insulin OR Insulin resistance OR person may not have enough receptor sites to support body size-obesity
- >90% of cases
- Initial treatment
- diet-control amount and timing, and weight loss decrease Rs needed
- exercise-increases movement of glucose into cells by activation of SNS and increase in K+
- When no longer work, oral angents and possibly eventually insuline
13
Q
What happens with Insulin Resistance?
A
- receptors do not recognise insulin
- glucose stays in the blood
- pancreas keeps releasing Insulin as seems that not effective
- blood becomes heavy with Insulin-increased BP
- can’t use enegry-tired, sluggish, hungry
14
Q
What are the contraindications of Oral Agents?
A
- Keotacidosis for all
- Bladder? for Pioglitazone
- Allergies
- Pregnancy
15
Q
Gliclazide
A
- Sulphonylurea-first oral agents-often baseline, others added/combined
- Augmenting insulin secretions
- acts on beta cells (so activity needs to be present)
- closes K+ channels causing membrane depolarisation
- Ca2+ enters the cell, signalling exocytosis of insulin
