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CSI > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is prediabetes?

A

Have higher than normal glucose levels but haven’t developed type 2 diabetes Have high risk of developing type 2 diabetes

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2
Q

Are there any symptoms of type 2 diabetes?

A

NO, if you start getting symptoms then you’ve developed type 2 diabetes

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3
Q

What are the risk factors of type 2 diabetes

A

Age- over 40 if white and over 25 if black Genetics Ethnicity History of high BP Overweight Smoking Pregnancy- gestational Alcohol, sleep, sedentary lifestyle

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4
Q

How to prevent type 2 diabetes by reducing risk

A

Mediterranean diet, Nordic diet, cut down on carbs, avoid food with high glycaemic index Be active

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5
Q

Explain GI concept?

A

How quickly glucose is absorbed into the blood, i.e. how quickly it increases your blood glucose levels

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6
Q

Are all low GI food good?

A

No, chocolate has low GI as it contains fat; but will increases your weight

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7
Q

What affects GI?

A

Protein and fat in soma efood Process of cooking Fibre: whole grain and high fibre slow doesn’t absorption of carbs

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8
Q

What are examples of good low GI food to eat to reduce risk of developing type 2 diabetes?

A

Choose easy cook risk Whole meal roti Swap white bread for rye bread

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9
Q

What is the NHS diabetes prevention programme?

A

NHS England, diabetes UK and public health England join to find best behavioural intervention for those with high risk of developing Type 2 diabetes.

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10
Q

According to research what are the best 3 ways of preventing diabetes?

A

Reducing weight Increasing physical activity Improving diet

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11
Q

What are the complications associated with diabetes?

A

Heart, kidney, strokes, eye and foot problems Health inequalities due to diabetes

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12
Q

What are 3 core goals underpinning NHSDPP behavioural interventions

A

Achieving healthy weight Achievement of dietary recommendations Achievement of CMO physical activity recommendations

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13
Q

How will the NHS DPP programs be structured?

A

At least 13 sessions At least 16 hours face to face contact time spreading across 9 months Each session lasting 1-2 hours Goals will be set to make positive lifestyle changes

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14
Q

Who is eligible to go onto NHSDPP program>?

A

18 years or over Fasting plasma glucose level of 5.5-6.9mmol/mol HbA1c of 42-47mmol/mol This is called ‘non-diabetic hyperglycaemia’ Result must be within last 12 months

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15
Q

What are the 3 primary referal mechanism onto the NHS DPP program?

A

NHS Health check program- high risk after stage 1 of diabetic filter and confirmed blood test. Those identified with non-diabetic hyperglycaemia through opportunistic assessment in e clinical care Those who have been included in register as having high HbA1c/FPG or have it in the past.

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16
Q

What are the core defects of type 2 diabetes?

A

Insulin resistance in muscle and liver Impaired insulin secretion

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17
Q

How does insulin resistance in adipocyte exacerbate type 2

A

Causes increased lipolysis and increased plasma free fatty acids; can lead to insulin resistance and Beta cell decline

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18
Q

How does neurotransmitter imbalance in the brain exarcebate type 2

A

Low dopamine and high serotonin Reduced appetite suppressive effects; lead to weight gain

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19
Q

How does renal reabsorption affect type 2

A

Increased renal absorption of glucose through SGLT2 and increased threshold for glucose spillage lead to hyperglycaemia

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20
Q

Where can GLUT4 channel proteins be found? And what is it’s significance?

A

Adipose tissue, Skeletal muscle, cardiac muscle. It is insulin regulated/dependent

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21
Q

How is GLUT 1,2 &3 different from GLUT4?

A

They are insulin independent

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22
Q

What cells can you find GLUT 1 -3 and what transport does does it do?

A

GLUT-1- endothelium, erythrocytes; Basal GLUT2- kidney, small intestine pancreatic; low affinity GLUT3- neurones, placenta: high affinity

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23
Q

What type of transport does glucose transporters carry out? What is the EXCEPTION?

A

Facilitated diffusion EXCEPT SGLT1/2 transporter found in luminal epithelial cells in kidney and intestine

24
Q

What is the effect of insulin on the liver

A

Increased Glucose uptake and glycogenesis Reduced glycogenolysis and gluconeogenesis Reduced lipolysis

25
Q

What is the effect of insulin on fats?

A

Increased glucose uptake and lipogenesis Decreased lipolysis

26
Q

What is the effect of insulin on the muscle?

A

Increased glucose uptake and protein synthesis and glycogenolysis Decreased protein catabolism

27
Q

What is the overall outcome and pathophysiology of Type 2 diabetes

A

Overall outcome: INSUFFICIENT INSULIN and insulin RESISTANCE. Beta cell hypertrophs and there’s hyperinsulinaemia but as tipping point reaches due to insulin resistance; beta cell exhausted and can’t produce enough insulin.

28
Q

What are the effects of Type 2 diabetes in the blood?

A

Hyperglycaemia Increased Free fatty acid in plasma Increased amino acid in plasma

29
Q

What are the risk factors of type 2 diabetes?

A

Obesity Smoking/alcohol Diet- too much sugar Sedentary lifestyle Ethnicity- Afro Caribbean, Indian, Hispanic Genetics- complex trait

30
Q

How can obesity lead to type 2 diabetes

A

Too much visceral fat; release adipokines, lead to inflammation, toxic on beta cells and which lead to vicious cycle of increasing glucose concentration

31
Q

What are the symptoms of type 2 diabetes?

A

Polyphagia Polydipsia- increased thirst Glycosuria (renal glucose threshold is passed; it varies per person) Polyuria

32
Q

What is HbA1C; what is its significance?

A

Haemoglobin that has become glycosylated. Occurs NON- enzymatically. Formation of HbA1C is proportional; to plasma glucose levels hence can be used to diagnose an monitor diabetes

33
Q

What are the merits of using HbA1C in diagnosing or monitoring diabetes?

A

No need to use resources like sugary drink to test it Patient doesn’t need to fast first. Hb stays for 2-3 month in blood; consistency

34
Q

What are the disadvantages of using HbA1C?

A

Underlying disease like anaemia cause premature haemolysis- underestimated levels of glucose Patient with HIV/ kidney disease affects HbA1C HbA1C can also bind to fructose or galactose; not accurate

35
Q

What is the first line of medication give to those with Type 2 diabetes? Why?

A

Metformin Doesn’t cause weight gain Minimal risk of hypoglycaemia Well tolerated and administered orally Reduce CVD risks Enhance insulin sensitivity in LIVER

36
Q

What are the side effects of Metformin?

A

Diarrhoea; other GI effects.

37
Q

In Normal metabolism; what is the expected fasting glucose levels, post prandial level and random?

A

Fasting glucose- lower than 5.5mmol/l Post prandial- lower than 7.8mmol/l Random- lower than 11.1mmol/l

38
Q

In IMPAIRED FASTING GLUCOSE, what is the fasting glucose level, post prandial level and random level

A

Fasting glucose- between 5.5 to 6.9mmol/l Post prandial- lower than 7.8 mmol/l Random- lower than 11.1mmol/l

39
Q

In Imparied glucose TOLERANCE, what is the fasting glucose level, post prandial and random?

A

Fasting glucose- lower than 7mmol/l Post prandial- 7.8-11.1mmol/l Random- lower tan 11.1mmol/l

40
Q

In diabetes, what is fasting glucose, post prandial and random glucose levels

A

Fasting glucose- higher than 7mmol/l Post prandial- higher than/ equal to 11.1mmol/l Random- higher/equal to 11.1mmol/l

41
Q

In a patient who has impaired glucose REGULATION, what prediabetic or combination of prediabetic blood signs will the patient show?

A

Either has just impaired glucose tolerance or a combination of impaired glucose tolerance and impaired fasting glucose

42
Q

What is the pathophysiology of impaired fasting glucose?

A

HEPATIC insulin resistance- more glucose output from liver

43
Q

What is the pathophysiology of impaired glucose tolerance?

A

MUSCLE insulin resistance and impaired post prandial insulin release Poor glucose uptake

44
Q

When are behavioural insights most helpful?

A

When individual want to make positive behavioural change but struggle to do so.

45
Q

What are the three steps in achieving NHS DPP target and what framework does it use for each step.

A

Uptake, retention and behaviour change EAST framework E- easy A-attractive S- social T- timely

46
Q

What are the diabetes complications divided into?

A

Micro vascular- damage to small vessels Macro vascular- damage to larger blood vessels

47
Q

Give examples of micro vascular complications?

A

Retinopathy- leadings to blindness Nephropathy- damage to kidneys leading to renal failure Neuropathy- damage to nerds, lead to impotence and diabetic foot disorder- can lead to amputation due to infection

48
Q

What is the etiology of retinopathy and how can it be diagnosed?

A

Small vessel damage that supplies the BACK of the eyes- the retina. Can lead to blindness Diagnosis- via regular eye examinations

49
Q

What are symptoms AND treatment of retinopathy

A

Symptoms- blurred vision, other visual symptoms may be present. Treatment- good metabolic control delays progressions and. Timely intervention

50
Q

What is the etiology of NEPHROPATHY and how can it be diagnosed =?

A

Small vessel damage that supplies kidneys- lead to renal failure and death or dialysis and kidney transplant if lucky Diagnosis - can be diagnosed via urine test for proteins and blood test for kidney function

51
Q

What are the symptoms and treatment options for patients presenting with nephropathy?

A

Symptoms- NO symptoms EARLIER on but as it progresses, patient feels TIRED and anemic , develop electrolyte imbalances and not think clearly. Treatment- if diagnosed earlier- control high blood pressure and glucose levels. Restrict dietary protein and treatment that treats kidney.

52
Q

What is the etiology of NEUROPATHY and how can it be diagnosed?

A

Etiology- damage to nerve directly by hyperglycaemia or loss of flow of blood to Nerve via small vessels. Lead to sensory loss, impotence and damage to limbs Diagnosis - early diagnosis made by recognising symptoms and careful examinations by healthcare providers

53
Q

What are the symptoms and treatment options for neuropathy?

A

Symptoms Impotence, numbness or pain in extremities Develops foot infections, cant recognise cuts. Lead to amputation Treatment If diagnosed earlier and blood glucose levels controlled well- can be delayed

54
Q

What can execrable diabetic foot disease to those patients presenting with diabetes complications

A

Those with inadequate footwear Regular inspection an good care of feet prevent amputation (by 45-85%)

55
Q

What is the etiology of the CVD complications from T2DM and what are the treatment options?

A

Etiology Atherosclerosis due to hyperglycaemia; narrow arteries. Can lead to heart attack(ischeamia) or stroke. Can block arteries to extremities leading to pain and decreased healing of infections. Treatment Control risk factors of CVD and control blood glucose levels

56
Q

What are the symptoms of CVD and how can it be diagnosed?

A

Symptoms ranging from: Chest pain to leg pain to confusion and paralysis Diagnosis: early detection of risk factors like obesity and alcohol and smoking and high BP and cholesterol. Early detection of the complications and risk factor can slow down progression

CSI (17 decks)

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