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CP > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is diabetes?

A

a group of disorders characterised by hyperglycaemia and is caused by lack of insulin or reduced action of insulin.

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2
Q

what are the different cells present in the pancreatic islet?

A 
Alpha cells
beta cells 
delta cells
and 
F Cells
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3
Q

what do alpha cells in the prancreas produce

A

alpha cells produce glucagon and make up 25% of the islets

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4
Q

what do beta cells in the pancreas produce?

A

beta cells produce insulin and makes up 75% of islet cells

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5
Q

what do Delta cells in the pancreas produce?

A

Delta cells produces somatostatin and make up 5% of islet cells

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6
Q

what do F cells in the pancreas produce?

A

pancreatic polypeptide

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7
Q

how does proinsulin convert into insulin

A
  1. proinsulin is cleavage by pro hormone convertase 3 which creates split (32-33) proinsulin
  2. Carboxypeptidase converts this into Des (31,32) proinsulin
  3. this is then converted into insulin
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8
Q

how is proinsulin converted into c peptide?

A
  1. Prohormone convertase 2 splits the proinsulin to split (65,66) proinsulin
  2. Carboxypeptidase converts it into Des (64,65) proinsulin
  3. this leads to C peptide
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9
Q

what is the structure of insulin?

A

two chains

  • alpha chain
  • beta chain

a soluble protein

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10
Q

what is the action of insulin general?

A
  • metabolic
  • has paracrine effects
  • vascular
  • fibrinolysis
  • growth and cancer
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11
Q

what is the diagnosis criteria for Diabetes?

A

Fasting glucose > 7mmol/litre

random glucose > 11.1 mmol/litre

two hours reading post OGTT > 11.1mmol/litre

HbA1c >48 mmol/mol

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12
Q

what is the Oral Glucose Tolerance Test (OGTT) for diabetes

A

if the fasting glucose is equal to or above 7mmol/litre

ingest 75g anhydrous glucose if after 2 hours a glucose reading is equal to or over 11.1 mmol/litre

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13
Q

what should the impaired fasting glucose levels should be?

A

between 6.1 -6.9

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14
Q

what should the impaired glucose tolerance levels be between?

A

glucose >7.8 and <11.1

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15
Q

what is the HbA1c criteria?

A

reflects average plasma glucose over the previous 8-12 weeks

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16
Q

what is the average plasma glucose for those with pre-diabetes?

A

> 41 and <48mmol

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17
Q

what is the average plasma glucose for those with diabetes?

A

> 48 mmol/mol (above or equal to)

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18
Q

what is type 1 diabetes?

A

Autoimmune destruction of insulin producing beta cells in the islet of langerhans

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19
Q

what is the pathophysiology of T1DM

A
  • Autoimmunity
  • exposed/trigger to environmental factors
  • Genetics of T1DM
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20
Q

what are the risk factors for T1DM

A
  • Family History
  • genetic susceptibility
  • Perinatal factors
  • low birth weight
  • viral infections
  • Ditet - cows milk
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21
Q

what is stage 1 of type 1 diabetes?

A

Trigger of beta cell immunity but no symptoms of diabetes

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22
Q

what is stage 2 of type 1 diabetes?

A

Loss of beta cell secretory function + development of antibodies + slight glucose elevation (but no symptoms)

23
Q

what is stage 3 of type 1 diabetes?

A

Loss of beta cell capacity + symptoms

24
Q

What are the auto Antibodies (as a result of humeral autoimmunity) in T1DM?

A
  • Insulin autoantibodies
  • `Glutamic acid decarboxylase autoantibodies
  • Islet antigen-2 autoantibodies IA-2
  • ZnT8 transporter autoantibodies
25
Q

what is the presentation of T1DM?

A

Rapid Onset (often few weeks)

weight loss + osmotic symptoms + low energy

abdominal pain

often slim

Present as diabetes ketoacidosis

26
Q

what is the management if T1DM?

A

Always need insulin at the start of diagnosis

there is no role of oral agent (as body unable to produce any insulin)

27
Q

what is the presentation of T2DM?

A
  • Often overweight
  • symptoms present over few months
  • minimal weight loss
  • can present with complications such as vision loss or foot ulcers or fungal infection
  • can also present in state of Hyperosmolar Hyperglycaemia State (HHS) or HONK
28
Q

what is the prevalence type 2 diabetes in england 2017?

A

3,116,399

29
Q

what are the three strands of management of T2DM?

A
  1. Lifestyle
  2. Oral Therapy
  3. Insulin
30
Q

what lifestyle changes can a patient do to manage T2DM?

A

Exercise

change in diet + weight loss (bariatric surgery)

31
Q

what oral therapies can a patient make to manage T2DM?

A
  • Metformin (first line)
  • DDP4 Inhibitor, SGLT-2 Inhibitor, GLP-1 agonist, Sulponylureas
  • up to three agents
32
Q

what is gestational diabetes?

A

it is diabetes in pregnancy. A new diabetes not present prior to pregnancy. the hyperglycaemia is first detected in pregnancy.

33
Q

what is the fasting glucose levels for those with gestational diabetes?

A

> 5.6 mmol/litre or 2 hours plasma glucose level of 7.8mmol/litre

34
Q

what test do you do to diagnose gestational diabetes?

A

oral glucose tolerance test

if previously had gestational diabetes then could ask to use self monitoring using capillary blood glucose

35
Q

when do we test for gestational diabetes in pregnancy

A

Done during booking scan (around 12 weeks)

if normal repeat at 24 to 28 weeks

36
Q

what are the risk factors for gestational diabetes?

A 
BMI > 30
previous macrocosmic baby 
previous gestational diabetes 
FH of diabetes 
Ethnic minority
37
Q

what are the short term affects of gestational diabetes?

A

Macrosomia

pre-eclampsia

stillbirth

neonatal morbidity

38
Q

what are the long term affects of gestational diabetes?

A

Obesity (child)

development of T2DM in mother

39
Q

what is the management plan for those with gestational diabetes?

A
  • change diet if mild
  • limited oral therapy options, metformin or glibenclamide
  • majority require insulin (during pregnancy)
40
Q

what are the different types of genetic deafness?

A

Mature onset diabetes of the young

maternal inherited diabetes and deafness

Wolfram syndrome

41
Q

what is mature onset diabetes of the young

A

Is a clinically heterogenous disorder characterised by noninsulin-dependent diabetes diagnoses at a young age with autosomal dominant transmission and lack of autoantibodies

42
Q

what is disease of exocrine?1

A

this is secondary diabetes, essentially any condition that damages pancreatic organ

43
Q

what are some diseases of the exocrine?

A 
Pancreatitis
- gallstones
- alcohol 
Pancreatectomy 
- for cancer 
- trauma
Cystic fibrosis 
Haemochromotosis
44
Q

what are some drug induced diabetes?

A 
Steroid
- usually high dose and prolonged
Atypical anti-psychotics
Immunotherapy
- Nivolumab used in melanoma treatment
Protease inhibitor
- used in HIV treatments
45
Q

what is a counter regulatory hormone

A

a hormone that usually oposes action of insulin, secreted as a result of stress response

46
Q

what are some counter regulatory hormones?

A

Glucagon
Epinephrine/norepinephrine
glucocorticoid
Growth Hormone

47
Q

what are some stimuli for insulin release

A
  • glucose
  • fatty acid and ketones
  • Vagal nerve stimulation
  • gut hormones
  • Drugs (diabetes medication)
  • Prostaglandins
48
Q

what are the stimuli for inhibition of insulin release?

A
  • sympathetic stimulation
  • alpha adrenergic agents
  • beta blockers
  • dopamine
  • serotonin
  • somatostatin
49
Q

what is Glucagon?

A

Polypeptide (29 aa)

50
Q

where is glucagon degraded?

A

rapidly degraded in the tissues (esp. liver and kidney)

51
Q

what are some stimuli for glucagon release?

A
  • amino acids
  • beta adrenergic stimulation
  • fasting, hypoglvaemia
  • exercise
  • cortisol
52
Q

what are some stimuli for inhibition of glucagon release

A
  • glucose
  • somatostatin
  • free fatty acids
  • ketones
  • insulin
53
Q

what are the actions of Glucagon?

A
  • increase secretion of insulin and growth hormone
  • reduces intestinal motility and gastric acid secretion
  • increases glucose levels
    • glycogenesis
    • gluconeogenesis
    • lipolysis

CP (14 decks)

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