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MET2 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Diabetes

A

Chronic metabolic disease characterised by elevated levels of blood glucose which leads over time to serious heart, blood vessel, eye, kidney, and nerve damage

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2
Q

Which type of diabetes is autoimmune

A

Type 1

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3
Q

What cell disruption causes type 1 diabetes

A

Disruption of pancreatic beta cells in islets of langerhans

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4
Q

What causes type 1 diabetes

A

Autoantibodies attack islets of langerhans

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5
Q

Insulitis

A

Inflammation of islets of langerhans

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6
Q

What causes type 2 diabetes

A

Abnormal insulin action and beta cell dysfunction

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7
Q

Type 2 diabetes risk factors

A

Family history
Ethnicity
Overweight
Diet
Inactivity
Older age
Hypertension
Impaired glucose tolerance
History of gestational diabetes
Poor nutrition in pregnancy

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8
Q

How does obesity cause insulin resistance

A

Accumulation of lipids and their metabolites
Incr circulating conc of FFAs
Chronic inflammation
Altered adipokine levels
Mitochondrial dysfunction
Oxidative stress
ER stress

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9
Q

How does hyperinsulinaemia lead to type 2 diabetes

A

Increases lipid synthesis and exacerbates insulin resistance

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10
Q

Do most genetic susceptibility genes for type 2 diabetes impair insulin secretion or impact insulin action

A

Impair insulin secretion

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11
Q

What environmental components can damage beta cells

A

Lipotoxicity
Glucotoxicity
Glucolipotoxicity
Hyperinsulinaemia

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12
Q

What is the most common type of monogenic diabetes

A

Maturity onset diabetes of the young MODY

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13
Q

What causes maturity onset diabetes of the young MODY

A

Impairment of insulin secretion/beta cell dysfunction due to mutation of single MODY gene

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14
Q

What pregnancy complications are associated with gestational diabetes

A

Hypertension
Large birth weight babies
Obstructed labour

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15
Q

Why are children of mothers with gestational diabetes predisposed to becoming overweight

A

Exposure to hyperglycaemia in the womb

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16
Q

What are possible mechanisms of gestational diabetes

A

Excessive proinsulin may induce beta cell stress
High hormone concentrations may affect beta cell function and peripheral insulin sensitivity

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17
Q

What type of diabetes has features of type 1 and type 2 diabetes

A

Latent autoimmune diabetes of adults LADA

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18
Q

How is diabetes diagnosed

A

Symptoms
Plasma glucose
Oral glucose tolerance test
HbA1c

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19
Q

What plasma glucose results indicate diabetes

A

Random - >11.1mmol/L
Fasting - >7mmol/L

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20
Q

What test is recommended for gestational diabetes diagnosis

A

Oral glucose tolerance test

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21
Q

What plasma glucose levels indicate gestational diabetes

A

Fasting - >5.6mmol/L
2 hrs - >7.8mmol/L

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22
Q

What is HbA1c

A

Hb with glucose attached

23
Q

What does HbA1c test show

A

Average plasma glucose over previous 8-12 wks

24
Q

What HbA1c indicated diabetes

A

48mmol/L - 6.5%

25
Q

What is indicated by a HbA1c level of 42-47 mmol/L

A

Prediabetes

26
Q

How is type 1 diabetes treated

A

Insulin and analogues

27
Q

What drugs are used in type 2 diabetes

A

Biguanides
Sulfonylureas
Thiazolidinediones
GLP1R agonists and DPP-4 inhibitors
SGLT2 inhibitors
Meglitinides
Alpha glucosidase inhibitors
Bile acid sequestrants

28
Q

What drug type is metformin

A

Biguanide

29
Q

How do biguanides help diabetes

A

Inhibit Gluconeogenesis
Enhance insulin sensitivity

30
Q

How do thiazolidinediones help diabetes

A

Increase insulin sensitivity by promoting adipogenesis

31
Q

What is the main issue with thiazolidinediones in type 2 diabetes treatment

A

Cause weight gain

32
Q

How do solfonylureas and prandial glucose regulators help type 2 diabetes

A

Stimulate insulin secretion

33
Q

Why are DPP-4 inhibitors given with GLP-1 receptor agonists

A

DDP4 cleaves GLP-1

34
Q

How do SGLT2 inhibitors help diabetes

A

Reduce glucose reabsorption and increase urinary glucose secretion

35
Q

How is DKA treated

A

Fluids
Electrolytes esp K+
Insulin

36
Q

What causes Kussmaul’s respiration in DKA

A

incr breathing to counteract metabolic acidosis

37
Q

What can reduced insulin and excess glucagon cause in diabetics

A

DKA

38
Q

Chronic complications of diabetes

A

Hyperglycaemia
Atherosclerosis
CV events
Nephropathy
Neuropathy
Retinopathy
Amputation
Dislipidaemia

39
Q

Diabetic retinopathy mechanisms

A

Dilation of retina veins
Microaneurisms of retina veins
Internal haemorrhaging and oedema in retina
Formation of fragile new blood vessels which bleed, reduce vision, and cause separation and detachment of areas of the retina
Decr retinal blood flow
Diabetic macular oedema
Apoptosis of retinal pericytes

40
Q

What is diabetic nephropathy

A

Disease of the kidney involving damage to the blood vessels in the glomerulus

41
Q

Characteristics of diabetic nephropathy

A

Proteinuria
Glomerular hypertrophy
Decr GFR
Renal fibrosis

42
Q

Types of diabetic neuropathy

A

Peripheral
Autonomic
Proximal
Focal

43
Q

What type of diabetic neuropathy causes pain or feeling loss in the hands arm feet and legs

A

Peripheral

44
Q

What type of diabetic neuropathy causes changes in digestion, bowel and bladder problems, erectile dysfunction, and heart problems

A

Autonomic

45
Q

What type of diabetic neuropathy causes pain in the thighs and hips and weakness in legs

A

Proximal

46
Q

What type of diabetes can affect any nerve in the body causing pain or weakness

A

Focal

47
Q

What are complications of diabetic neuropathy in the feet

A

Foot ulcers
Infection
Limb amputation

48
Q

Why does diabetes increase risk of athersclerosis

A

Hyperglycaemia
Dislipidaemia
AGE modification of oxidised LDL and their receptor
Glycation of apolipoprotein, LDL, or LDL receptor

49
Q

How do hyperglycaemia and Dislipidaemia cause atherosclerosis

A

Causes Endothelial cell dysfunction which increases adhesion of monocytes and platelets

50
Q

How doe sAGE modification of oxidised LDLs and their receptor cause atherosclerosis

A

Incr LDL uptake into atherosclerotic plaques
Pro inflammatory cytokines production

51
Q

How does glycation of apolipoprotein, LDL, and LDL receptors cause atherosclerosis

A

Impairs cholesterol effluent from atherosclerotic plaques and cholesterol clearance

52
Q

What are vascular complications of diabetes

A

Compromised nutrient and oxygen supply to tissues
Stroke
Heart disease
Peripheral artery disease

53
Q

Why is COVID morbidity higher in diabetics

A

Impaired immune response
Expression and activity of ACE
Inflammation
Atherothrombotic state

MET2 (25 decks)

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