Diabetes Flashcards
sulphonylureas
inhibit the potassium ATP pump on beta cells > +insulin secretion
may cause weight gain
e.g. glibenclamide, glicazide
metformin
biguanide
increase the uptake of glucose by skeletal muscle
acts on the liver to inhibit glucneogenesis
25% develop GI side effects
pioglitazone
TF for genes involved in triglyceride storage. Stops deposition of lipids in non-adipose tissue, helping to reduce insulin resistance and the development of ALD.
works over a period of months
Side effects: increased long bone fractures, water retention and bladder cancer
DPP-IV inhibitors
DPP-IV normally degrades GLP-1 so inhibiting it allows GLP-1 to act for longer.
Well tolerated - weight neutral, oral tablet and provide a fairly stable glucose level
e.g. sitagliptin
GLP-1 agonists
GLP-1 normally secreted upon ingestion of food, causing:
beta: enhanced glucose-dependent secretion of insulin
alpha - decreased secretion of glucagon
liver - decreased hepatic glucose output
brain - promotes satiety and reduced appetite
stomach - slows gastric emptying
Drugs works very well and lead to weight loss as well.
Issue as they must be injected
e.g. exenatide
SGLT-2 inhibitors
Channel in the PCT that normally reabsorbs up to 90% of the glucose in the tubule.
have additional benefit of osmotic diuresis which can be beneficial in the context of hypertension.
can have issue where kidneys and pancreas cross-talk leading to release of glucagon, increasing chances of DKA developing
e.g. empaglifozin
what is whipple’s triad
Symptoms known or likely to be caused by hypoglycemia especially after fasting or heavy exercise (Autonomic or neuroglycopaenic symptoms)
A low plasma glucose measured at the time of the symptoms
Relief of symptoms when the glucose is raised to normal
name a rapidly acting insulin analogue
norvorapid
name a long-acting insulin analogue used as a basal insulin
lantus
how is hypoglycaemia defined in a diabetic on insulin therapy
<4.0 mmol/l of glucose
at what blood glucose level can you begin to see autonomic symptoms and what causes this
3.9 mmol/l - 3mmol/l (most occur at 3)
Caused by the release of the counter-regulatory hormones glucagon and adrenaline
at what blood glucose level will cognitive function begin to be disrupted
2.5-2.8 mmol/l.
at what blood glucose level will people begin to have seizures
<2 mmol/l of glucose
what are the diagnostic criteria for DKA
metabolic acidosis: Venous bicarbonate < 18mmol, H+ > 45 mEq/L, pH < 7.3
plasma glucose: >13.9 mmol/l
Urinary/plasma ketones: ≥2+ urinary / >3mmol/L
list the clinical features of DKA
- Osmotic Symptoms - Polydipsia and polyuria
- Weight Loss
- Breathlessness – Kussmaul respiration
- Abdominal pains, especially in children
- Leg cramps
- Nausea and vomiting
- Confusion
how do you treat DKA
insulin, potassium, fluids
what is the major electrolyte deficiency in DKA
potassium
what is the major electrolyte deficiency in HHs
sodium
what is Autoimmune Polyendocrine Syndrome Type 2
triad of addison’s, autoimmune thyroiditis and type 1 DM
name some associations of Autoimmune Polyendocrine Syndrome Type 2 and who is more likely to develop the syndrome
pernicious anaemia, coeliac disease, alopecia, primary hypogonadism, myasthenia gravis and Stiff man syndrome
Women are more likely to have and it normally presents in aduthood.
what are the main causes of DKA except for a new presentation of type 1 DM
pregnancy, non-compliance, inappropriate alterations in insulin, MI, infection
if a patient with diabetes requires an anti-hypertensive what drugs could they be placed on
ACE inhibitor, calcium channel blocker or a thiazide diuretic
what are the risk factors for gestational diabetes
- BMI >30 kg/m2
- Previous macrosomic baby weighing 4.5 kg or more
- Previous GDM
- Family history of diabetes (first degree relative)
- Minority ethnic origin with high prevalence of diabetes (South Asian, black Caribbean, Middle Eastern).
