Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PM3B: Autumn > Diabetes Lecture 2: Type 2 Diabetes > Flashcards

Diabetes Lecture 2: Type 2 Diabetes Flashcards

1
Q

How is type 2 diabetes normally caused

A

Reduced insulin secretion and insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does insulin resistance mean

A

Normally biological effects are not observed at physiological insulin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is beta cell dysfunction and describe the phases it goes through

A

when type 2 diabetics secrete less insulin daily

Phase 1: less insulin initially

Phase 2: exaggerated insulin response- may cause hypoglycaemia 3-4 hours after meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of type 2 diabetes

A

Increased thirst and hunger

Increased urination

Fatigue

Blurred vision

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is HYPEROSMOLAR HYPERGLYCAEMIA STATE (HHS)

A

Medical emergency to do with

Hyperglycaemia
Dehydration and Uraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you screen for type 2 diabetes

A

Random blood glucose levels

Fasted blood glucose levels

HbA1C levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors for type 2 diabetes

A

Family history: Parents or sibling has it

Health problems: stroke, hypertension, coronary heart disease, peripheral artery disease

Ethnicity: afro carribean or african, south asian

Age: 40+ years

Waist measurement

BMI: greater than 25

Past: gestational diabetes

has known glucose intolerance or impaired fasting hyperglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the macrovascular complications that can occur in diabetic patients

A

Stroke

Heart attack

Angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the microvascular complications that can occur in diabetic patients

A

Diabetic retinopathy

Erectile dysfunction

Autonomic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the treatment goals of type 2 diabetes

A

Preserve life

Alleviate symptoms

Achieve good glycemic control- avoid long term complications

Avoid iatrogenic side effects- hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how do you manage type 2 diabetes: DEED

A

Dietary modification

Exercise

Education

Drug treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does the diabetic diet consist of in managing type 2 diabetes

A

Low fat- low saturated fat

Increase fibre and complex carbs

Weight loss- moderate caloric deficit diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does exercise consist of in managing type 2 diabetes

A

Exercise 30 minutes per day

Increases glycemic control, reduces CVD risk

Reduces blood pressure and improves lipid profile

Improves insulin sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does education consist of in managing type 2 diabetes

A

Patient aware that good glycemic control will avoid diabetic complications

Diabetic patients have increased mortality and morbidity

Risk of CVD or diabetic retinopathy

Erectile dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does drug treatment consist of in managing type 2 diabetes

A

Insulin secretagogues
Stimulates insulin release from pancreas, restores early phase insulin release
Example: Meglitinides and SULPHONYLUREAS

Insulin sensitisers
Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give examples of sulphonylureas

A

Short acting: Gliclazide or tolbutamide

Long acting: glibenclamide

17
Q

What is the mechanism of action of sulphonylureas and Meglitinides

A

Increase insulin release from pancreas by binding to sulphonylurea receptor

Closes the K+ ATP channel which causes a rise in intracellular calcium and insulin release

Reduces HbA1c levels by 1.5 to 2%

18
Q

What are the commonside effects of sulphonylureas

A

Weight gain

Hypoglycaemia

19
Q

Give an example of Meglitinides

A

Nateglinide- can only be used with metformin

Repaglinide- derivative of glibenclamide

20
Q

What is the mechanism of action of GLICLAZIDE

A

Promotes insulin secretion from pancreatic beta cells

Binds to the sulfonyl urea receptor (SUR1) which binds and blocks the ATP sensitive potassium channel

Decrease in potassium efflux leads to depolarisation of Beta cells, opens up voltage dependent calcium channels

Activation of CALMODULIN- releases insulin secretory granules

21
Q

What is an insulin sensitiser

A

Enhances the effect of endogenous circulating insulin, reduces insulin resistance and decrease hepatic glucose production

22
Q

What are the two examples of insulin sensitiser

A

BIGUANIDES

THIAZOLIDINEDIONES (glitazones)

23
Q

Explain the role of the Biguanide METFORMIN

A

Increases glucose uptake in skeletal muscle and adipocytes, suppress hepatic glucose generation (gluconeogenesis)

Reduces glucose absorption from the small intestine (high drug concentration)

Suppress appetite, achieves weight loss and has cardio protective effect

Reduces HbA1c levels by 1 to 2%

24
Q

What are the side effects of metformin

A

GI side effects, anorexia, nausea, pain in abdomen, diarrhoea

minimised with gradual increase to dose or modified release

25
Q

What is the mechanism of action of metformin

A

Inhibit pyruvate mechanism which increases lactic acid production

Reduces glucose production in liver and decrease glucose absorption

Involves activating AMP activated protein kinase in liver and skeletal muscle

26
Q

Give an example of Thiazolidinediones and risks associated with it

A

Pioglitazone

Risk in heart failure and bladder cancer patients

27
Q

What is the mechanism of action of thiazolidinediones

A

Bind to PPAR-gamrha (peroxisome proliferator activated receptor gamma)

Regulates: gene transcription, enhances glucose and fatty acid uptake, utilises adipocytes, reduce secretion of cytokines that inhibit insulin action

Reduce glucose output of liver

28
Q

What is an inhibitor of gastrointestinal glucose absorption

A

Acarbose

29
Q

What is an mechanism of action of acarbose

A

Alpha-glucosidase inhibitor that reduces glucose uptake in small intestine

Slows digestion and absorption of glucose after a meal

30
Q

Explain how therapies based on glucagon like peptide 1 (GLP-1) work

A

Glucagon release from alpha cell is regulated by pancreas secreting insulin

When stimulated, it has roles of slowing gastric emptying, slowing digestion and nutrient absorption, moderating blood glucose levels

31
Q

Give examples of Dipeptidylpeptidase 4 inhibitors

A

Saxagliptin

Sitagliptin

32
Q

Explain the mechanism of action of Dipeptidylpeptidase 4 inhibitors

A

Inhibits DPP-4 which decreases GLP-1 degradation which leads to increased insulin secretion and decrease glucagon secretion

33
Q

Give examples of GLP-1 mimetic analogues

A

EXENATIDE and liraglutide (delivered by subcutaneous injection)

34
Q

What is the mechanism of action for GLP-1 mimetic analogues

A

DPP4 resistant analogues that bind to and active GLP-1 receptor

Leads to increased insulin secretion, decrease of glucagon secretion, slow gastric emptying and promotes weight loss

35
Q

How do selective sodium glucose co-transporter 2 (SGLT-2) inhibitors work and give examples of them

A

Dapaglifozin

Independent insulin mediated glucose control pathways, SGLT-2 block the reabsorption of glucose in the kidneys and promote urinary excretion

36
Q

When is insulin used in type 2 diabetes

A

When impossible to control good glycemic control with oral hypoglycaemic drugs

Often given alongside metformin etc

37
Q

What is gestational diabetes

A

Diabetes that occurs during the first time in pregnancy

38
Q

How do you monitor for gestational diabetes

A

Routine tests for glycosuria

39
Q

How do you treat gestational diabetes

A

Lifestyle modification

Exercise

First line: insulin therapy or some oral hypoglycaemic drugs

PM3B: Autumn (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions