Diabetes Mellitus Flashcards

1
Q

Diabetes mellitus is (acute or chronic ?) hyperglycaemia secondary to __________________________________

A

chronic

relative or absolute insulin defficiency

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2
Q

Diabetes

} FBS >_____mg/dl (__mmol)on at least ___ occasions
} RBS ____mg/dl (___mmol) on at least ___ occassions
} Classical symptoms or evidence of complications plus a high blood sugar
} HBA1c >___ mmol/l

A

126mg/dl (7mmol) ; 2

200mg/dl (11.1mmol) ; 2

7 mmol/l

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3
Q

Patho physiology of type 2 DM

} ____________________

A

Insulin resistance

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4
Q

Pathophysiology of type 2 DM

Causes of insulin resistance
} Compensatory _____________
} Progressive ___________________
} Increased ________ of ______ cells and resulting _______________ cell mass
} Rising ________ and ________ levels
} Increased ________ in kidneys
} Rising tubular maximum for glucose
} Osmotic diuresis
} Finally, hypoinsulinaemia

A

hyperinsulinaemia

beta cell dysfunction

apoptosis; beta ; declining beta

glucagon and glucose

glucose reabsorption

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5
Q

Pathophysiology of type 1 DM

Rapid ____________ due to ___________ or due to ________

A

beta cell destruction; auto- immune disease

toxins

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6
Q

Pathophysiology of type 1 DM

Autoimmune dysfunction may be triggered by pathways such as cross reaction between _____________ and ____________, _____________ plays a role here

} Insulitis occurs due to islet cell ________________ and islet cell ___________.————- cells are spared

A

bovine serum albumin antibodies; Beta cell antigens; Molecular mimicry

cytoplasmic antibodies; surface antibodies

Alpha

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7
Q

Symptoms of diabetes
List 10

A

Polyuria
} Polydipsia
} Polyphagia
} Pruritus
} Poor wound healing
} Poor vision
} Poor erection
} Poor obstetric history } Weight loss
} Boils

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8
Q

Management of type 2 DM

________________
________________
________________

A

Diabetes education
Pharmacological
Surgical

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9
Q

Management of type 2 DM

Diabetes education – ———-,———, monitoring, setting goals for _______, ______, blood sugars, lipids, etc

} Pharmacological – _______ and _______
} Surgical – ________ and ________ transplants, _________ procedures

A

exercise, diet, monitoring, setting goals for weight, BP, blood sugars, lipids, etc

OHAs and injectables

islet and pancreas transplants, bariatric procedures

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10
Q

Injectable Anti-Diabetic Drugs

} ________
} ________
} ________
} ________

A

} Insulin
} Insulin analogues
} GLP – 1 receptor agonists
} Pramlintide

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11
Q

Oran Anti diabetic drugs and groups

List 7
} Dopamine agonists- Bromocriptine Mesylate

A

Sulfonylureas
} Biguanides
} Meglitinides
} Thiazolidinediones } DPP 4 inhibitors
} Alpha glucosidase inhibitors
} Sodium glucose transporter 2 inhibitors
} Bile acid sequestrants -Colesevalam
} Dopamine agonists- Bromocriptine Mesylate

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12
Q

Sulfonylureas

} One of the oldest groups of OHAs
} Given _____ times daily
} Very potent insulin __________
} Tendency for _________ and _________
} Unfavourable cardiovascular profile in first generation SUs

A

1-3

secretagogue

hypoglycaemia and weight gain

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13
Q

The most frequently used OHA

A

Metformin

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14
Q

First line drug in type DM is ??

A

Metformin

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15
Q

The drug most used in combination with other OHAs is??

A

Metformin

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16
Q

Metformin

Given _______ times daily

(Low or High?) risk of hypoglycaemia and weight gain

May cause _______________ in some patients

May cause _____________ in elderly with end organ failure (liver, cardiac, etc)

A

2-3

Low

megaloblastic anaemia ; lactic acidosis

17
Q

Thiazolidinediones

Examples : ________ and ________

Given ______ daily

A

Pioglitazone and rosiglitazone

once

18
Q

Thiazolidinediones

It ________________ , improves insulin ___________

(Low or High?) risk of hypoglycaemia in monotherapy

Main disadvantage is ___________, oedema and risk of CHF, bone fractures, bladder cancer

A

Preserves beta cells

sensitivity; Low

weight gain

19
Q

Alpha glucosidase inhibitors

Examples?

A

Acarbose Voglibose

20
Q

Alpha glucosidase inhibitors

Given with meals _____ times daily

_______ effect on Weight

(Low or High?) hypoglycaemia risk

Causes flatulence and C/I in IBD, IBS or other bowel dx
} Reduces cardiovascular morbidity
} Studied in the STOPNIDDM trial

A

2-3; No

Low

21
Q

SGLT2 inhibitor

Inhibit SGLT2 cotransporter
• ________g of glucose/day eliminated in the urine
• Insulin- ________________ process

A

50-80

independent

22
Q

SGLT2 inhibitors

New group of drugs

Causes reduction in hyperglycaemia, weight _________, _____________ reduction

Those now licensed are canaglifozin and dapaglifozin, empaglifozin, ertugliflozin

Others coming are sergiflozin, ipraglifozin

Main challenge is ________________ in women and ___________ in uncircumcised men

A

reduction; blood pressure

vaginal yeast infections

balanitis

23
Q

Targets of Anti-DM drugs

} FBS _____-_____mg (____ -____ mmol)
} HBA1c ____-_____%
} Lipids within range
} Tchol ___mmol
} LDL ___mmol (2.6)
} TG ___mmol
} HDL > 1in males (1.25 females)

A

} FBS 80-120mg (4.4-6.6mmol) } HBA1c 6.5-7%
} Lipids within range
} Tchol 5mmol
} LDL 3mmol (2.6)
} TG 2mmol
} HDL > 1in males (1.25 females)

24
Q

_________ is the most effective anti-diabetic agent

A

Insulin