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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
what is the presentation of T1DM?
Rapid Onset (often few weeks) weight loss + osmotic symptoms + low energy abdominal pain often slim Present as diabetes ketoacidosis
26
what is the management if T1DM?
Always need insulin at the start of diagnosis there is no role of oral agent (as body unable to produce any insulin)
27
what is the presentation of T2DM?
- 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
what is the prevalence type 2 diabetes in england 2017?
3,116,399
29
what are the three strands of management of T2DM?
1. Lifestyle 2. Oral Therapy 3. Insulin
30
what lifestyle changes can a patient do to manage T2DM?
Exercise | change in diet + weight loss (bariatric surgery)
31
what oral therapies can a patient make to manage T2DM?
- Metformin (first line) - DDP4 Inhibitor, SGLT-2 Inhibitor, GLP-1 agonist, Sulponylureas - up to three agents
32
what is gestational diabetes?
it is diabetes in pregnancy. A new diabetes not present prior to pregnancy. the hyperglycaemia is first detected in pregnancy.
33
what is the fasting glucose levels for those with gestational diabetes?
>5.6 mmol/litre or 2 hours plasma glucose level of 7.8mmol/litre
34
what test do you do to diagnose gestational diabetes?
oral glucose tolerance test if previously had gestational diabetes then could ask to use self monitoring using capillary blood glucose
35
when do we test for gestational diabetes in pregnancy
Done during booking scan (around 12 weeks) | if normal repeat at 24 to 28 weeks
36
what are the risk factors for gestational diabetes?
``` BMI > 30 previous macrocosmic baby previous gestational diabetes FH of diabetes Ethnic minority ```
37
what are the short term affects of gestational diabetes?
Macrosomia pre-eclampsia stillbirth neonatal morbidity
38
what are the long term affects of gestational diabetes?
Obesity (child) development of T2DM in mother
39
what is the management plan for those with gestational diabetes?
- change diet if mild - limited oral therapy options, metformin or glibenclamide - majority require insulin (during pregnancy)
40
what are the different types of genetic deafness?
Mature onset diabetes of the young maternal inherited diabetes and deafness Wolfram syndrome
41
what is mature onset diabetes of the young
Is a clinically heterogenous disorder characterised by noninsulin-dependent diabetes diagnoses at a young age with autosomal dominant transmission and lack of autoantibodies
42
what is disease of exocrine?1
this is secondary diabetes, essentially any condition that damages pancreatic organ
43
what are some diseases of the exocrine?
``` Pancreatitis - gallstones - alcohol Pancreatectomy - for cancer - trauma Cystic fibrosis Haemochromotosis ```
44
what are some drug induced diabetes?
``` Steroid - usually high dose and prolonged Atypical anti-psychotics Immunotherapy - Nivolumab used in melanoma treatment Protease inhibitor - used in HIV treatments ```
45
what is a counter regulatory hormone
a hormone that usually oposes action of insulin, secreted as a result of stress response
46
what are some counter regulatory hormones?
Glucagon Epinephrine/norepinephrine glucocorticoid Growth Hormone
47
what are some stimuli for insulin release
- glucose - fatty acid and ketones - Vagal nerve stimulation - gut hormones - Drugs (diabetes medication) - Prostaglandins
48
what are the stimuli for inhibition of insulin release?
- sympathetic stimulation - alpha adrenergic agents - beta blockers - dopamine - serotonin - somatostatin
49
what is Glucagon?
Polypeptide (29 aa)
50
where is glucagon degraded?
rapidly degraded in the tissues (esp. liver and kidney)
51
what are some stimuli for glucagon release?
- amino acids - beta adrenergic stimulation - fasting, hypoglvaemia - exercise - cortisol
52
what are some stimuli for inhibition of glucagon release
- glucose - somatostatin - free fatty acids - ketones - insulin
53
what are the actions of Glucagon?
- 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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