Diabetes Mellitus Flashcards
Diabetes mellitus is (acute or chronic ?) hyperglycaemia secondary to __________________________________
chronic
relative or absolute insulin defficiency
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
126mg/dl (7mmol) ; 2
200mg/dl (11.1mmol) ; 2
7 mmol/l
Patho physiology of type 2 DM
} ____________________
Insulin resistance
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
hyperinsulinaemia
beta cell dysfunction
apoptosis; beta ; declining beta
glucagon and glucose
glucose reabsorption
Pathophysiology of type 1 DM
Rapid ____________ due to ___________ or due to ________
beta cell destruction; auto- immune disease
toxins
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
bovine serum albumin antibodies; Beta cell antigens; Molecular mimicry
cytoplasmic antibodies; surface antibodies
Alpha
Symptoms of diabetes
List 10
Polyuria
} Polydipsia
} Polyphagia
} Pruritus
} Poor wound healing
} Poor vision
} Poor erection
} Poor obstetric history } Weight loss
} Boils
Management of type 2 DM
________________
________________
________________
Diabetes education
Pharmacological
Surgical
Management of type 2 DM
Diabetes education – ———-,———, monitoring, setting goals for _______, ______, blood sugars, lipids, etc
} Pharmacological – _______ and _______
} Surgical – ________ and ________ transplants, _________ procedures
exercise, diet, monitoring, setting goals for weight, BP, blood sugars, lipids, etc
OHAs and injectables
islet and pancreas transplants, bariatric procedures
Injectable Anti-Diabetic Drugs
} ________
} ________
} ________
} ________
} Insulin
} Insulin analogues
} GLP – 1 receptor agonists
} Pramlintide
Oran Anti diabetic drugs and groups
List 7
} Dopamine agonists- Bromocriptine Mesylate
Sulfonylureas
} Biguanides
} Meglitinides
} Thiazolidinediones } DPP 4 inhibitors
} Alpha glucosidase inhibitors
} Sodium glucose transporter 2 inhibitors
} Bile acid sequestrants -Colesevalam
} Dopamine agonists- Bromocriptine Mesylate
Sulfonylureas
} One of the oldest groups of OHAs
} Given _____ times daily
} Very potent insulin __________
} Tendency for _________ and _________
} Unfavourable cardiovascular profile in first generation SUs
1-3
secretagogue
hypoglycaemia and weight gain
The most frequently used OHA
Metformin
First line drug in type DM is ??
Metformin
The drug most used in combination with other OHAs is??
Metformin
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)
2-3
Low
megaloblastic anaemia ; lactic acidosis
Thiazolidinediones
Examples : ________ and ________
Given ______ daily
Pioglitazone and rosiglitazone
once
Thiazolidinediones
It ________________ , improves insulin ___________
(Low or High?) risk of hypoglycaemia in monotherapy
Main disadvantage is ___________, oedema and risk of CHF, bone fractures, bladder cancer
Preserves beta cells
sensitivity; Low
weight gain
Alpha glucosidase inhibitors
Examples?
Acarbose Voglibose
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
2-3; No
Low
SGLT2 inhibitor
Inhibit SGLT2 cotransporter
• ________g of glucose/day eliminated in the urine
• Insulin- ________________ process
50-80
independent
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
reduction; blood pressure
vaginal yeast infections
balanitis
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)
} 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)
_________ is the most effective anti-diabetic agent
Insulin
