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Year 4: Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What cells in the pancreas secrete insulin

A

beta cells in islets of langerhans

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2
Q

What does insulin do

A

Lowers blood sugar by:

  • causing cells to absorb glucose to use as fuel
  • causing muscles + the liver to absorb glucose and store as glycogen
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3
Q

what cells in the pancreas secrete glucagon

A

alpha cells in islets of langerhans

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4
Q

what does glucagon do

A

Raises blood sugar by:

  • causing stored glycogen in liver to break down into glucose – glycogenolysis
  • causing liver to convert protein + fats into glucose – gluconeogenesis
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5
Q

how are ketones produced

A

liver converts fatty acids to ketones

- occurs when there is insufficient glucose and glycogen stores have been depleted

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6
Q

what is type 1 diabetes

A

autoimmune destruction of beta cells in the islets of langerhans leading to absolute insulin deficiency

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7
Q

triad of symptoms in T1DM

A

polyuria
polydipsia
weight loss

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8
Q

antibodies in T1DM

A

Anti-islet cell Ab

Anti-GAD antibody

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9
Q

what is type 2 diabetes

A

insulin resistance + impaired insulin production causing hyperglycaemia

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10
Q

modifiable risk factors for T2DM

A

Obesity
Sedentary lifestyle
High carbohydrate diet

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11
Q

HbA1c diagnostic of diabetes

A

> 48mmol/L (6.5%)

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12
Q

diagnosis of diabetes using

  • random blood glucose
  • fasting blood glucose
A

random - >11.1mmol/L
fasting - >7 mol/L
-Once is enough if symptomatic
-If asymptomatic these results must be seen on 2 occasions for a diagnosis of diabetes

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13
Q

what is pre-diabetes

A

indication that patient is heading towards diabetes but does not meet full diagnostic criteria
- should be educated on lifestyle modifications to decrease risk of progressing to diabetes

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14
Q

HbA1c range indicative of pre-diabetes

A

42-47 mmol/L

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15
Q

what test can pick up pre-diabetes

A

Oral Glucose tolerance test

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16
Q

what is an Oral glucose tolerance test

A

75g glucose given to a fasting patient, baseline glucose + glucose 2 hours after drink measured

17
Q

result showing impaired glucose tolerance on OGTT

A

plasma glucose 7.8-11 after 2 hours

- Body struggles to cope with processing a carbohydrate meal

18
Q

result showing diabetes on OGTT

A

glucose >11 after 2 hours

19
Q

what is a normal fasting glucose level

A

<6 mmol/L

20
Q

what is an impaired fasting glucose level

A

6.1 -6.9 mmol/L

21
Q

what is a fasting glucose level indicative of diabetes

A

> 7mmol/L

22
Q

what is MODY

A

development of T2DM in patients <25 years old

23
Q

inheritance of MODY

A

autosomal dominant

24
Q

most common genetic defect in MODY

A

defect HNF-1 alpha gene (MODY 3)

25
Q

treatment of MODY

A

responsive to sulfonylureas

26
Q

What is latent autoimmune diabetes of adulthood (LADA)

A

Type 1 diabetes presenting in later life

  • low c peptide
  • antibody positive
  • requires insulin
27
Q

treatment of pre-diabetes

A

lifestyle

  • weight loss
  • smoking cessation
  • low glycemic diet
28
Q

1st line tx T2DM

A

metformin

29
Q

2nd line tx T2DM

A

metformin + Sulfonylurea / pioglitazone / DPP4 inhibitor / SGLT-2 inhibitor

30
Q

3rd line tx T2DM

A
  1. metformin + 2 other diabetic drugs (triple therapy) OR

2. metformin + insulin

31
Q

in a patient on metformin, what HbA1c measurement requires addition of another drug

A

when HbA1c reaches 58mmol/L

32
Q

what can cause a higher than expected HbA1c

A

things that increase RBC life span:

  • splenectomy
  • Vit B12/folic acid deficiency
  • Iron deficiency anaemia
33
Q

what can cause a lower than expected HbA1c

A

things that lower RBC life span:

  • sickle cell anaemia
  • G6PD deficiency
  • hereditary spherocytosis
34
Q

what drug can cause impaired glucose regulation

A

steroids

Year 4: Endocrine (15 decks)

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