DIABETES MELLITUS Flashcards
Hormones that increase blood glucose levels
Glucagon
Adrenaline
Cortisol
Growth hormone
Glucose transporters and functions
GLUT1- most cells eg muscle cells
GLUT 2 - beta cells, renal tubules, hepatocytes
GLUT 3 - CNS, placenta
GLUT 4 - Muscle, Adipose tissue
What is the effect of insulin on glucose metabolism in the fasting state
Modulates gluconeogenesis and glycogenolysis in the liver
What is the effect of insulin on glucose metabolism in the postprandial state
Insulin suppresses hepatic glucose production and promotes peripheral utilisation of glucose
Types of diabetes
Primary ( Type 1 and Type 2)
Secondary diabetes
Age difference between type 1 and 2 diabetes
Type 1 - younger <30
Type 2 - older > 30
Which type of diabetes is common in obese people
Type 2
Which type of diabetes presents with ketonuria
Type 1 diabetes
In which type of diabetes does the C-peptide persist
Type 2 diabetes
What is LADA
Latent Autoimmune Diabetes in Adults is form of type 1 diabetes that occurs in later life due to slower progression to insulin deficiency
Autoantibodies are present in which type of diabetes
Type 1 diabetes presents with islet autoantibodies
Give examples of islet antigens
Insulin autoantibodies
Glutamic acid decarboxylase
Protein tyrosine phosphatase (IA-2 / ICA 512)
Give the four main determinants of Type 2 diabetes
Age
Ethnicity
Family history
Obesity
Positive family history is seen in which type of diabetes
Type 2 diabetes
Metabolic syndrome is seen in which type of diabetes
Type 2 DM
…… DM has a gradual onset whilst….. DM has an abrupt onset
Type 2, Type 1
What are the functions of amylin
Suppresses post meal glucagon secretion
Regulates gastric emptying
Increases satiety
Regulates plasma glucose concentrations
What is biphasic insulin secretion
Insulin is secreted in two phases following a meal
And initial bolts release called the first phase insulin response which lasts for 5-10 minutes
the second phase of insulin response which lasts for 60-120 minutes
What is basal insulin secretion
The low rate of continuous insulin secretion by the pancreas to maintain normal FBG levels
What are the incretins and their sources
GLP-1 from L cells of the colon and ileum
GIP from K cells
What are the functions of the incretins
Stimulate insulin secretion
Suppress glucagon secretion
Slow gastric emptying
Increase satiety
What is acanthosis nigiricans
Blackish pigmentation at the nape of the neck and in the axillae in diabetics and obese patients
ADA Diagnostic criteria for Diabetes
FPG- >= 126mg/dl or 7.0mmol/L
2 hour Postload glucose / OGTT >= 200mg/dl 0r 11.1mmol/L
Random blood glucose >= 11.1mmol/L
HbA1c >= 6.5% (48mmol/L)
Dietary recommendations for diabetics
Low in sugar
High in starchy carbohydrates with low glycemic index
High in fibre
Low in fats( especially saturated)
What are the side effects of metformin
Anorexia
Diarrhea
Lactic acidosis
Epigastric discomfort
Side effects of pioglitazone
Weight gain
Fluid retention
Heart failure
Increases risk of bladder cancer
Mild anaemia
Osteoporosis resulting in peripheral bone fractures
What are the five available DPP-4 inhibitors
Aloglipton
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin
Main side effect of DPP4 inhibitors
Nausea is the main side effect
What is the renal threshold for glucose
10mmol/L
Example of SGLT2 inhibitors
Canapagliflozin
Dapagliflozin
Empagliflozin
Unwanted effects of SGLT2 inhibitors
Increase in genital candidiasis and UTIs
Osmotic diuresis which causes hypotension
Bladder cancer with dapagliflozin
Increase risk for bone fractures
Which anti diabetics cause weight reduction
Incretin analogues
SGLT2 inhibitors
Which antidiabetics cause weight gain
Sulfonylureas
Thiazolidinediones
Meglitinides
Insulin
Which antidiabetics have no effect of weight
DPP-4 inhibitors
Which vaccines are recommended for diabetics
Hepatitis B
Influenza
Pneumococcal vaccines
