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Diabetes and its treatment Flashcards

1
Q

What do alpha cells make?

A

glucagon

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2
Q

What do beta cells make?

A

insulin

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3
Q

What do delta cells make?

A

somatostatin

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4
Q

What contributes to glucose in the blood?

A

Food and Liver

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5
Q

What takes up glucose from the blood?

A

Muscle and kidney (and liver)

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6
Q

When does blood glucose peak throughout the day? (which would then normally be followed by insulin release)

A

Post prandial (roughly 8am, 1pm and 7 pm)

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7
Q

What is diabetes?

A

Metabolic disorder characterised by chronic hyperglycemia resulting from defects in inslin sceretion, insulin action or both

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8
Q

What would result in lack of insulin?

A

Reduced production

Insulin cant get to the cell to work

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9
Q

What happens when there is no insulin released?

A

The liver releases more glucose

The muscle cannot take much so the kidneys uptake the glucose

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10
Q

How is diabetes diagnosed?

A

High blood glucose and symptoms, Hb test (but this doestn detect young people with rapid onset as it looks at the previous 3 months)

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11
Q

What vessels are affected by retinopathy and arterial disease?

A

Retinopathy - microvessels

Arterial disease - macrovessels

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12
Q

What is HbA1c?

A

glycated haemoglobin. It is a measurement of diabetes management over 2 - 3 months.

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13
Q

What affects HbA1c?

A

renal failure - changes the cells ability to bind glucose

thalassaemia - abnormal Hb which binds to glucose more strongly

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14
Q

When can HbA1c be inaccurate?

A

Abnormally high caused by persistent HbF (thalassaemia)

Low caused by haemolysis or increased red cell turnover (blood loss)

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15
Q

What is the blood glucose level of a diabetic when fasting and 2 hrs after meal?

A

fasting >7mmol/L

post 2 hrs >11.1mmol/L

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16
Q

What is IGF ? (almost diabetes)

A

Impaired glucose fasting. (Pre-type 1 diabetes)
Unknown cause
50% risk of diabetes
Treat with healthy diet, yearly glucose checks

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17
Q

What is IGT? (almost diabetes)

A

Impaired glucose tolerance (Pre-type 2 diabetes)
Cause is insulin resistance
50% risk of diabetes
Increased risk of heart disease
Treat with diabetic diest, yearly glucose checks and treat cardiac risk factors
Prevent progression with exercise and weight loss

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18
Q

Other than type 1 and 2, what is the other form of diabetes?

A

Gestational

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19
Q

Name 3 classifications of diabetes?

A

INSULIN DEFICIENCY - auto-immue destruction of pancreas
INSULIN RESISTANCE - unknown cause related to obesity, receptor abnormalities, excessive hormone
GESTATIONAL

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20
Q

Describe type 1 diabetes mellitus?

A 
Less cells in the pancreas, cant make insulin
Incidence 1/10,000
Often younger with weight loss
M>F
Cause is genetic and environmental
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21
Q

How does type 1 diabetes mellitus present?

A 
Polyuria
Thirst
weight loss
dehrydration (wee 5-8L/day)
ketoacidosis
coma
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22
Q

What are the 2 new delivery systems for insulin?

A

INSULIN PUMP - continuous insulin given, less hypos, less insulin, but high cost
INHALED INSULIN - small trials, only 1/10 dose absorbed, long term safety unkown

23
Q

Describe an islet cell transplant?

A

Islets taken from donor pancreas
Isolate islets of langerhans
infusion of islets which go to the portal vein

24
Q

Describe a pancreas transplant?

A

Donor donates pancreas and duodenum

25
What happens if pt needs a short operation?
Half the normal morning dose First on the list Monitor symptoms Cover antibiotics
26
What happens if pt needs a long operation?
Needs to be in hospital First on the list Iv, glucose and K+ cover with antibiotics
27
Describe type 2 diabetes?
Insulin resistance so glucose does not go into cell Incidence 1/1000 Often older with weight gain M=F Cause is genetic and environment (more genetic though)
28
What is the link between birth weight and insulin resistance?
Increased birth weight = increased risk resistance decreased body weight = increased insulin sensitivity Increased BMI = increased rate type 2 diabetes
29
How does type 2 diabetes present?
Non symptomatic Metabolic - thirst, polyuria Non metabolic - comlications: blurred vision, CVA, peripheral neuropathy, angina, MI, UTI, foot ulcers
30
How do we treat type 2 diabetes? (in order of stage)
IF THIN - diet, exercise, sulphonylureas, metformin, insulin | IF FAT - diet, exercise, weight loss, metformin, sulphylureas, insulin
31
What action do sulphonylureas have?
Increased insulin release from pancreas
32
What are the side effects of sulphonylureas? | egs tolbutamide, glibenclamide, glicazide
hypoglycaemia, weight gain, nausea, anorexia, vomiting, alcoholic, skin rash
33
What is the action of metformin?
Suppresses glucose production by the liver
34
What are the side effects of metformin?
nausea, vomiting, diarrhoea, VitB12 malabsorption, lactic acidosis
35
What is the action of thiazolidinediones?
Increased insulin sensitivity. Increase muscle and decreases secretion from the liver
36
What are the side effects of thiazolidinediones? | eg rosilitizone
Hypoglycaemia, liver damage, fluid retention, weight gain
37
What drugs decrease absorption?
``` Alpha glucosidase inhibitors (acarbase) - flatulence, no hypo, slow glucose absorption Lipase inhibitors (orlistat) - weight loss, decreased cholesterol, flatulence, no hypo, omhobots pancreatic and gastric lipase ```
38
What is GLP -1?
Glucagon like peptide 1 | Diabetics dont produce as much GLP -1
39
When is GLP - 1 secreted?
On the ingestion of food
40
What are the effects of GLP - 1?
BETA CELLS - enhances glucose dependant insulin secretion in pancreas ALPHA CELLS - suppressed postprandial glucagon secretion LIVER - reduced hepatic glucose output STOMACH - slows the rate of gastric emptying BRAIN - promotes satisfaction and decreases apetite
41
What are the 2 incretin based therapies?
1. DPP - 4 inhibitors - protect native GLP -1 from inactivation by DPP-4 (eg sitagliptin, vildagliptin, alogliptin) 2. GLP - 1 receptor agonists - mimic native GLP - 1 (eg exenatide, liroglutide, lixisematide)
42
What is exenatide?
A GLP - 1 receptor agonist. It is resistant to DPP-IV degradation. Given subcutaneously Decreases HbA1c Augments glucose stimulating insulin secretion, slows gastric emptying, suppresses innapropriately increased glucagon
43
Which two organs play large roles in managing diabetes?
Gut and kidney
44
Describe the normal glucose handling of the kidney?
80% glucose is reabsorbed by SGLT2 10% glucose reabsorbed by SGLT1 Minimal glucose excreted in urine
45
What is the action of dapagliflozin?
stops reabsorption by SGLT2 in the renal proximal tubule so more glucose secreted in urine Secondary benefit of weight loss
46
What 2 classes of treatment can be used for diabetes?
Insulin dependent mechanisms - glucose utilisation | Insulin independent mechanisms - glucose excretion
47
What are the insulin dependent mechanisms? (glucose utilisation)
Insulin sensitisers - thiazolidinediones, metformin Insulin releasers - sulphonylureas, meglitinides Insulin replacement - insulin
48
What are the insulin independant mechanisms? (glucose excretion)
SLGT-2 inhibition - dapagliflozin | GLP - 1 and DDPIV - increase insulin release
49
What is gestational diabetes?
Mother has increased glucose which crosses the placenta so the baby produces insulin and this controls its own glucose. But insulin is a growth factor so the baby gets other complications and increased risk of still birth.
50
When is gestational diabetes prone?
2nd and 3rd trimester
51
What is the treatment for gestational diabetes?
85% diet | 15% diet and insulin
52
What are the complications associated with gestational diabetes?
Still births, large baby, death for mother
53
What is the chance that a mother who experiences gestational diabetes will have diabetes in the future?
50% diabetic in next 5 yrs | 15% diabetic in next pregnancy

Human Disease (54 decks)

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