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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
Q

What does the destruction of pancreatic beta cells cause?

A

Hyperglycaemia

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26
Q

Why does the destruction of pancreatic beta cells cause hyperglycaemia?

A

Absolute deficiency of insulin and amylin

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27
Q

What is amylin?

A

Glucoregulatory peptide hormone co-secreted with insulin

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28
Q

What does amylin do?

A

Lowers blood glucose by slowing down gastric emptying and supressing glucagon output from pancreatic beta cells

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29
Q

How does type 2 diabetes present?

A

Slow onset
Patients middle aged/elderly
Strong familial incidence

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30
Q

What causes a hyperglycaemic hyperosmolar nonketotic state?

A

Low insulin -> inc gluconeogenesis and glycolysis

  • > hyperglycaemia
  • > glycosuria and increased plasma osmolarity
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31
Q

What does an increased plasma osmolarity lead to?

A

Cerebral dehydration and impaired consciousness

32
Q

What does hyperglycaemia cause?

A

Glycosuria

33
Q

What does glycosuria cause?

A

Osmotic diuresis and loss of water and electrolytes

34
Q

What does loss of water and electrolytes cause?

A

Dehydration
Increased blood viscosity
Thrombosis

35
Q

How do you diagnose diabetes when there are no symptoms present?

A

Test blood sampled on two different days

36
Q

How do you diagnose diabetes when symptoms are present?

A 
Random plasma glucose >11.1mmol/L
Or 
Fasting plasma glucose >7mmol/L
Or
Oral glucose tolerance where plasma glucose >11.1mmol/L
37
Q

What are the symptoms that would cause you to test for diabetes?

A

Polyuria
Polydipsia
Weight loss (type 1 only)

38
Q

What does fasting mean when testing for diabetes?

A

No caloric intake for at least 8 hrs

39
Q

What is pre-diabetes?

A

Impaired glucose tolerance

40
Q

What is the threshold for impaired glucose tolerance?

A

Fasting plasma glucose >7mmol/L

Oral glucose tolerance of 7.8-11.1mmol/L

41
Q

What is the threshold for impaired fasting glycaemia?

A

Fasting plasma glucose 6.1-6.9mmol/L

Oral glucose tolerance value of <7.8mmol/L

42
Q

When do you do an oral glucose tolerance test?

A

In patients with:
impaired fasting glycaemia
Unexplained glycosuria
Clinical features of diabetes with normal plasma glucose values

43
Q

Why do you carry out an oral glucose tolerance test?

A

To check the bodys ability to metabolise glucose

44
Q

How do you do an oral glucose tolerance test?

A

75g oral glucose tolerance and blood tests at 0 and 120 mins after glucose

45
Q

How do you treat type two diabetes?

A

Diet and exercise -> oral monotherapy -> oral combination -> insulin with/without oral agents

46
Q

What drug is used in oral monotherapy for type 2 diabetes?

A

Metformin

47
Q

What drug is used in oral combination therapy for type 2 diabetes?

A

Sulphonylureas
gliptins
GLP-1 analogues

48
Q

What do thiazolidinediones do?

A

Reduced insulin resistance

49
Q

How do SGLT2 inhibitors work?

A

Prevent glucose reabsorption and increase excretion

50
Q

How do incretin targeting drugs work?

A

Help the body to increase glucose when needed

51
Q

Why do you monitor glycaemic control?

A

To prevent complications or avoid hypoglycaemia

52
Q

How do you monitor glycaemic control?

A

Capillary blood measurement
urine analysis
Blood HbA1c
Urinary albumin

53
Q

What does glucose in urine give an indication of?

A

Blood glucose concentration above renal threshold

54
Q

What is blood HbA1c?

A

Glycated Hb; covalent linkage of glucose to residue in Hb

55
Q

What are the long term complications of (badly managed) diabetes?

A

Micro and macro vascular disease

56
Q

What are the examples of microvascular disease?

A

Retinopathy, nephropathy, neuropathy

57
Q

What are some examples of macrovascular disease?

A

Atherosclerosis heart attack/ stroke

58
Q

What is hypoglycaemia defined as?

A

Plasma glucose <2.5 mmol/L

59
Q

What are the causes of hypoglycaemia?

A

Drugs

More common in type 2 diabetes (when taking insulin and inslin secretagogues)

60
Q

What is the treatment for hypoglycaemia?

A

Exogenous insulin and insulin secretagogues

61
Q

What are some examples of insulin secretagogues?

A

Glyburide
Glipizide
Glimepiride

62
Q

What can cause hypoglycaemia in patients without diabetes?

A 
Alcohol and pharma drugs (Beta blockers, ACE inhibitors, IGF-1 etc) 
Endocrine disease
Insulinoma
Inherited metabolic disorders
Sepsis
Chronic kidney disease
63
Q

What does ethanol inhibit?

A

Gluconeogenesis

64
Q

What happens if you have a several day long alcohol binge with limited food intake?

A

Hepatic depletion of glycogen

65
Q

What happens in sepsis?

A

Cytokine accelerated glucose utilisation and induced inhibition of gluconeogenesis in the setting of glycogen depletion

66
Q

Why does chronic kidney disease cause hypoglycaemia?

A

Involve impaired gluconeogenesis, reduced renal clearance of insulin and reduced renal glucose production

67
Q

What is another name for reactive hypoglycaemia?

A

Postprandial hypoglycaemia

68
Q

What is reactive hypoglycaemia?

A

Drops in blood sugar are usually recurrent and occur within four hours of eating

69
Q

What causes reactive hypoglycaemia?

A

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
Q

What are the categories for signs of hypoglycaemia?

A

Neurogenic

Neuroglycopaenic

71
Q

What are the neurogenic symptoms of hypoglycaemia triggered by?

A

Falling glucose levels

72
Q

What are the neurogenic symptoms of hypoglycaemia activated by?

A

Autonomic nervous system

73
Q

What are the neurogenic symptoms of hypoglycaemia mediated by?

A

Sympathoadrenal release of catecholamines and ACh

74
Q

What are the neurogenic symptoms of hypoglycaemia?

A 
Mood changes
Trembling
Paleness
Sweating
Dizziness
Blurred vision
Hunger
Headaches
Extreme tiredness
75
Q

What is neuroglycopaenia caused by?

A

Neuronal glucose deprivation

76
Q

What are the symptoms of neuroglycopaenia?

A 
Confusion
Difficulty speaking
Ataxia
Paresthesia
Seizures
Coma
Death

MBD/MI (Wothaya) (57 decks)

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