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MBD/MI (Wothaya) > Diabetes And Hypoglycaemia > Flashcards

Diabetes And Hypoglycaemia Flashcards

1
Q

What are blood glucose levels maintained by?

A

Dietary carbohydrate
Glycogenolysis
Gluconeogenesis

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2
Q

What happens in the body in a fed state?

A

Glucose increases -> insulin release
Decrease in glycogenolysis and increase of liver nutrient uptake
Increase in peripheral uptake and decrease in peripheral catabolism

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3
Q

What happens in the body in a fasting state?

A

Decrease in insulin secretion -> increase in gluconeogenesis

Peripheral glucose uptake decreases and increased lipolysis and proteolysis

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4
Q

What is the function of insulin?

A

Promotes storage and growth

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5
Q

What is the function of glucagon?

A

Mobilises fuel

Maintains blood glucose in fasting

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6
Q

What is the function of epinephrine?

A

Mobilises fuel in acute stress

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7
Q

What is the function of cortisol?

A

Long term change

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8
Q

What is the function of growth hormone?

A

Inhibits insulin action

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9
Q

What are the major metabolic pathways involving insulin?

A

Glucose storage in muscle and liver

Protein and fatty acid synthesis

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10
Q

What are the major metabolic pathways involving glucagon?

A

Activates gluconeogenesis, glycogenolysis and fatty acid release

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11
Q

What are the major metabolic pathways involving epinephrine?

A

Stimulates glycogenolysis and fatty acid release

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12
Q

What are the major metabolic pathways involving cortisol?

A

Amino acid mobilisation and gluconeogenesis

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13
Q

What are the major metabolic pathways involving growth hormone?

A

Stimulates lipolysis

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14
Q

What is diabetes mellitus characterised by?

A

Chronic hypoglycaemia, glycosuria and associated abnormalities of lipid and protein metabolism

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15
Q

What are the classifications of diabetes mellitus?

A

Type 1
Type 2
Secondary
Gestational

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16
Q

What happens in type 1 diabetes?

A

Deficiency in insulin secretion

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17
Q

What happens in type 2 diabetes?

A

Normal insulin secretion but there is target organ insulin resistance

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18
Q

What causes secondary diabetes?

A

Chronic pancreatitis
Pancreatic surgery
Antagonist secretion

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19
Q

What differentiates gestational diabetes?

A

It occurs for the first time in pregnancy

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20
Q

When does type 1 diabetes first present?

A

Children and young adults but can present at any time

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21
Q

What may symptom appearance be preceded by?

A

Pre-diabetic period of several months

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22
Q

What is the most common cause of type 1 diabetes?

A

Autoimmune destruction of beta cells

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23
Q

What is the pathogenesis of type 1 diabetes?

A

Autoantigens presented to T lymphocytes initiate an autoimmune response
Circulating autoantibodies to various cell antigens against glutamic acid decarboxylase

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24
Q

What is the most commonly detected antibody associated with type 1 diabetes?

A

Islet cell antibody

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25
What does the destruction of pancreatic beta cells cause?
Hyperglycaemia
26
Why does the destruction of pancreatic beta cells cause hyperglycaemia?
Absolute deficiency of insulin and amylin
27
What is amylin?
Glucoregulatory peptide hormone co-secreted with insulin
28
What does amylin do?
Lowers blood glucose by slowing down gastric emptying and supressing glucagon output from pancreatic beta cells
29
How does type 2 diabetes present?
Slow onset Patients middle aged/elderly Strong familial incidence
30
What causes a hyperglycaemic hyperosmolar nonketotic state?
Low insulin -> inc gluconeogenesis and glycolysis - > hyperglycaemia - > glycosuria and increased plasma osmolarity
31
What does an increased plasma osmolarity lead to?
Cerebral dehydration and impaired consciousness
32
What does hyperglycaemia cause?
Glycosuria
33
What does glycosuria cause?
Osmotic diuresis and loss of water and electrolytes
34
What does loss of water and electrolytes cause?
Dehydration Increased blood viscosity Thrombosis
35
How do you diagnose diabetes when there are no symptoms present?
Test blood sampled on two different days
36
How do you diagnose diabetes when symptoms are present?
``` Random plasma glucose >11.1mmol/L Or Fasting plasma glucose >7mmol/L Or Oral glucose tolerance where plasma glucose >11.1mmol/L ```
37
What are the symptoms that would cause you to test for diabetes?
Polyuria Polydipsia Weight loss (type 1 only)
38
What does fasting mean when testing for diabetes?
No caloric intake for at least 8 hrs
39
What is pre-diabetes?
Impaired glucose tolerance
40
What is the threshold for impaired glucose tolerance?
Fasting plasma glucose >7mmol/L | Oral glucose tolerance of 7.8-11.1mmol/L
41
What is the threshold for impaired fasting glycaemia?
Fasting plasma glucose 6.1-6.9mmol/L | Oral glucose tolerance value of <7.8mmol/L
42
When do you do an oral glucose tolerance test?
In patients with: impaired fasting glycaemia Unexplained glycosuria Clinical features of diabetes with normal plasma glucose values
43
Why do you carry out an oral glucose tolerance test?
To check the bodys ability to metabolise glucose
44
How do you do an oral glucose tolerance test?
75g oral glucose tolerance and blood tests at 0 and 120 mins after glucose
45
How do you treat type two diabetes?
Diet and exercise -> oral monotherapy -> oral combination -> insulin with/without oral agents
46
What drug is used in oral monotherapy for type 2 diabetes?
Metformin
47
What drug is used in oral combination therapy for type 2 diabetes?
Sulphonylureas gliptins GLP-1 analogues
48
What do thiazolidinediones do?
Reduced insulin resistance
49
How do SGLT2 inhibitors work?
Prevent glucose reabsorption and increase excretion
50
How do incretin targeting drugs work?
Help the body to increase glucose when needed
51
Why do you monitor glycaemic control?
To prevent complications or avoid hypoglycaemia
52
How do you monitor glycaemic control?
Capillary blood measurement urine analysis Blood HbA1c Urinary albumin
53
What does glucose in urine give an indication of?
Blood glucose concentration above renal threshold
54
What is blood HbA1c?
Glycated Hb; covalent linkage of glucose to residue in Hb
55
What are the long term complications of (badly managed) diabetes?
Micro and macro vascular disease
56
What are the examples of microvascular disease?
Retinopathy, nephropathy, neuropathy
57
What are some examples of macrovascular disease?
Atherosclerosis heart attack/ stroke
58
What is hypoglycaemia defined as?
Plasma glucose <2.5 mmol/L
59
What are the causes of hypoglycaemia?
Drugs | More common in type 2 diabetes (when taking insulin and inslin secretagogues)
60
What is the treatment for hypoglycaemia?
Exogenous insulin and insulin secretagogues
61
What are some examples of insulin secretagogues?
Glyburide Glipizide Glimepiride
62
What can cause hypoglycaemia in patients without diabetes?
``` Alcohol and pharma drugs (Beta blockers, ACE inhibitors, IGF-1 etc) Endocrine disease Insulinoma Inherited metabolic disorders Sepsis Chronic kidney disease ```
63
What does ethanol inhibit?
Gluconeogenesis
64
What happens if you have a several day long alcohol binge with limited food intake?
Hepatic depletion of glycogen
65
What happens in sepsis?
Cytokine accelerated glucose utilisation and induced inhibition of gluconeogenesis in the setting of glycogen depletion
66
Why does chronic kidney disease cause hypoglycaemia?
Involve impaired gluconeogenesis, reduced renal clearance of insulin and reduced renal glucose production
67
What is another name for reactive hypoglycaemia?
Postprandial hypoglycaemia
68
What is reactive hypoglycaemia?
Drops in blood sugar are usually recurrent and occur within four hours of eating
69
What causes reactive hypoglycaemia?
Possibly a benign tumour in the pancreas overproducing insulin Too much glucose used up by the tumour itself Deficiencies in the counter-regulatory hormones
70
What are the categories for signs of hypoglycaemia?
Neurogenic | Neuroglycopaenic
71
What are the neurogenic symptoms of hypoglycaemia triggered by?
Falling glucose levels
72
What are the neurogenic symptoms of hypoglycaemia activated by?
Autonomic nervous system
73
What are the neurogenic symptoms of hypoglycaemia mediated by?
Sympathoadrenal release of catecholamines and ACh
74
What are the neurogenic symptoms of hypoglycaemia?
``` Mood changes Trembling Paleness Sweating Dizziness Blurred vision Hunger Headaches Extreme tiredness ```
75
What is neuroglycopaenia caused by?
Neuronal glucose deprivation
76
What are the symptoms of neuroglycopaenia?
``` Confusion Difficulty speaking Ataxia Paresthesia Seizures Coma Death ```

MBD/MI (Wothaya) (57 decks)

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