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INTERNAL MEDICINE > DIABETES MELLITUS > Flashcards

DIABETES MELLITUS Flashcards

1
Q

Hormones that increase blood glucose levels

A

Glucagon
Adrenaline
Cortisol
Growth hormone

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2
Q

Glucose transporters and functions

A

GLUT1- most cells eg muscle cells
GLUT 2 - beta cells, renal tubules, hepatocytes
GLUT 3 - CNS, placenta
GLUT 4 - Muscle, Adipose tissue

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3
Q

What is the effect of insulin on glucose metabolism in the fasting state

A

Modulates gluconeogenesis and glycogenolysis in the liver

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4
Q

What is the effect of insulin on glucose metabolism in the postprandial state

A

Insulin suppresses hepatic glucose production and promotes peripheral utilisation of glucose

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5
Q

Types of diabetes

A

Primary ( Type 1 and Type 2)
Secondary diabetes

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6
Q

Age difference between type 1 and 2 diabetes

A

Type 1 - younger <30
Type 2 - older > 30

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7
Q

Which type of diabetes is common in obese people

A

Type 2

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8
Q

Which type of diabetes presents with ketonuria

A

Type 1 diabetes

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9
Q

In which type of diabetes does the C-peptide persist

A

Type 2 diabetes

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10
Q

What is LADA

A

Latent Autoimmune Diabetes in Adults is form of type 1 diabetes that occurs in later life due to slower progression to insulin deficiency

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11
Q

Autoantibodies are present in which type of diabetes

A

Type 1 diabetes presents with islet autoantibodies

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12
Q

Give examples of islet antigens

A

Insulin autoantibodies
Glutamic acid decarboxylase
Protein tyrosine phosphatase (IA-2 / ICA 512)

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13
Q

Give the four main determinants of Type 2 diabetes

A

Age
Ethnicity
Family history
Obesity

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14
Q

Positive family history is seen in which type of diabetes

A

Type 2 diabetes

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15
Q

Metabolic syndrome is seen in which type of diabetes

A

Type 2 DM

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16
Q

…… DM has a gradual onset whilst….. DM has an abrupt onset

A

Type 2, Type 1

17
Q

What are the functions of amylin

A

Suppresses post meal glucagon secretion
Regulates gastric emptying
Increases satiety
Regulates plasma glucose concentrations

18
Q

What is biphasic insulin secretion

A

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

19
Q

What is basal insulin secretion

A

The low rate of continuous insulin secretion by the pancreas to maintain normal FBG levels

20
Q

What are the incretins and their sources

A

GLP-1 from L cells of the colon and ileum

GIP from K cells

21
Q

What are the functions of the incretins

A

Stimulate insulin secretion
Suppress glucagon secretion
Slow gastric emptying
Increase satiety

22
Q

What is acanthosis nigiricans

A

Blackish pigmentation at the nape of the neck and in the axillae in diabetics and obese patients

23
Q

ADA Diagnostic criteria for Diabetes

A

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)

24
Q

Dietary recommendations for diabetics

A

Low in sugar
High in starchy carbohydrates with low glycemic index
High in fibre
Low in fats( especially saturated)

25
Q

What are the side effects of metformin

A

Anorexia
Diarrhea
Lactic acidosis
Epigastric discomfort

26
Q

Side effects of pioglitazone

A

Weight gain
Fluid retention
Heart failure
Increases risk of bladder cancer
Mild anaemia
Osteoporosis resulting in peripheral bone fractures

27
Q

What are the five available DPP-4 inhibitors

A

Aloglipton
Linagliptin
Saxagliptin
Sitagliptin
Vildagliptin

28
Q

Main side effect of DPP4 inhibitors

A

Nausea is the main side effect

29
Q

What is the renal threshold for glucose

A

10mmol/L

30
Q

Example of SGLT2 inhibitors

A

Canapagliflozin
Dapagliflozin
Empagliflozin

31
Q

Unwanted effects of SGLT2 inhibitors

A

Increase in genital candidiasis and UTIs
Osmotic diuresis which causes hypotension
Bladder cancer with dapagliflozin
Increase risk for bone fractures

32
Q

Which anti diabetics cause weight reduction

A

Incretin analogues
SGLT2 inhibitors

33
Q

Which antidiabetics cause weight gain

A

Sulfonylureas
Thiazolidinediones
Meglitinides
Insulin

34
Q

Which antidiabetics have no effect of weight

A

DPP-4 inhibitors

35
Q

Which vaccines are recommended for diabetics

A

Hepatitis B
Influenza
Pneumococcal vaccines

INTERNAL MEDICINE (6 decks)

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