Diabetes Flashcards
what countries have a high prevelance of type 1 diabetes?
north america
australia
scandinavia
UK
what is the basic pathophysiology of type 1 diabetes?
inability to produce insulin-autoimmune against beta cells.
destruction of beta cells, effecting production and secretion of insulin.
when is the peak age of onset for type 1 diabetes?
9-14
what genes are implicated in type 1 diabetes?
HLA-DRQ
what are the possible ‘destruction markers’ used in suspected type 1 diabetes?
GAD antibodies
islet cell antibodies
peptides
describe normal insulin secretion?
over 24 hours a day especially at meal times
50% of requirement as ‘background requirement’ and the rest at meal time
what is the gold standard treatment for patients with type 1 diabetes?
4 injections a day
what are the benefits of good glucose control?
eye, kidney, nerve damage risk reduction
describe multiple injection therapy in type 1 diabetes?
flexible, dose depends on what patient eats
what are the increase risks assoicated with type 1 diabetes?
stroke
heart disease
eye, kidney, nerve damage
what is an insulin pump?
Pulse insulin which can be set up in appropriate rhythm for patient
what is flash glucose monitoring?
Small sensor automatically measures and stores glucose readings during day and night
give examples of transient diabetes mellitus?
gestational diabetes, drug induced, pancreatic toxicity
every other cause of diabetes is chronic
describe diabetes mellitus?
Chronic, metabolic, defective glucose homeostasis (hyperglycaemia)
what is the role of insulin?
facilitate uptake of glucose by cells. Insulin resistance (a lot of insulin but cells are not responsive to it)
Insulin stimulates the receptor which signals to glucose channel to let glucose into the cell
what investigations can be used to aid the diagnosis of diabetes?
- urine dipstick
- HbA1c
- oral glucose tolerance test
- fasting glucose
- plasma glucose
describe the role of urine dipstick in diagnosing diabetes?
old method, now used as guidance not diagnostic. People have didn’t renal thresholds eg in pregnancy it is lower.
- what is HbA1c?
- when can HbA1c not be used?
- what HbA1c levels are indicative of diabetes?
- Glycated hemoglobin is a form of hemoglobin that is chemically linked to a sugar.
- Cannot be used in haemoglobinopathies, anaemia, renal failure (chronic anaemia of disease), children, pregnancy
- Borderline 41-47 / Diabetes -48
describe the role of oral glucose testing in diagnosing diabetes?
measure of PPG (postprandrial plasma glucose) levels and is better guide to beta cell dysfunction than FPG (fasting plasma glucose)
Normal = <7.8
Diabetes = >11.1
Impaired glucose tolerance = 7.8-11.1
what plasma glucose levels suggest diabetes?
<6.1mmol/l = normal
> 7mmol = diabetes
what is the consequence of untreated type 1 diabetes?
without insulin
DKA
death
what is the main treatment for type 1 diabetes?
insulin
what are the aims of treatment for type 2 diabetes?
Doesn’t need insulin to survive Lifestyle changes- cannot bring beta cells back but can minimize resistance to insulin Lower renal threshold Reduce insulin resistance Improve beta cell secretion of insulin
what are the consequences if glucose isn’t absorbed?
If glucose isn’t absorbed ends up in gut with bacteria and helps growth of bacteria and co2 accumulation and patient will be bloated.
what are the sites of action for medication in type 2 diabetes
- insulin secretion
- GI
- glucagon secretion
- appetite control
- neurotransmitter dysfunction
- glucose reabsorption
- glucose uptake and utilisation
- lipotoxicity
- hepatic glucose output
what diabetes medication act on insulin secretion?
sulfonyureas
meglitinides
incretins
increase secretion
what diabetes medication act on glucagon secretion?
incretins
amylin
decrease secretion
what diabetes medication are appetite controllers?
incretins
amylin
what diabetes medication act by neurotransmitter dysfunction?
bromocriptine
what diabetes medicatoin act on glucose reabsorption
SGLT2 inhiitors
decrease reabsorption
what diabetes medication act to increase glucose uptake and utilisation?
thiazolidindiones
metformin
what diabetes medication cause lipotoxicity?
thiazolidinediones
what diabetes medications decrease hepatic glucose output?
metformin
thiazolidinediones
what diabetes medication act on GI tract
incretins
alpha glucosidase inhibitors
amylin
bile acid sequestrant