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Nick's MD1 > Diabetes mellitus > Flashcards

Diabetes mellitus Flashcards

1
Q

What are Kimmelstiel-Wilson lesions?

A

Nodular glomerulosclerosis

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1
Q

What is the most common cause of amputation in Australia?

A

Diabetic peripheral neuropathy

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1
Q

What are the 3 ways of monitoring diabetes control?

A

BSL. Hb1Ac. Fructosamine.

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1
Q

If a diabetic patient has HbA1c of 7%, but high BSLs, what should you consider?

A

Bleeding

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1
Q

Which cells make up 80% of the islets of Langerhans?

A

Beta cells

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1
Q

List three reasons for why is there increased atherosclerosis in DM

A

1 Increased hepatic production of atherogenic lipoproteins 2 Suppression of lipid uptake in peripheral tissues 3 Abnormal endothelial function with pro-coagulant effects

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1
Q

Which conditions are a contraindication for alpha-glucosidase inhibitors?

A

Cirrhosis or IBD

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2
Q

What is insulin glulisine?

A

Short acting insulin

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2
Q

Which enzyme converts pro-insulin => insulin?

A

Prohormone convertase 1

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2
Q

What are the side effects of sulphonylureas?

A

Weight gain and hypoglycaemia

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2
Q

What is the molecular target of metformin?

A

AMP kinase

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3
Q

Is more insulin released after IV or oral administration of glucose?

A

Oral

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5
Q

How do sulphonamides work at an organ level when treating diabetes?

A

Increase insulin release from the beta cells of the pancreas

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6
Q

Which cells have receptors for AGEs?

A

Macrophages, endothelial, vascular smooth muscle, T cells

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7
Q

What is exenatide?

A

A GLP-1R agonist

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8
Q

Which hormone is released with a fall in BSL?

A

Glucagon

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9
Q

What is the molecular action of sulphonylureas?

A

Inhibit ATP-dependent K+ channels

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9
Q

What class of drug is metformin?

A

Biguanide

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10
Q

What class of drug are the -liptins

A

DPP-IV inhibitors (prevents breakdown of GLP-1 to treat diabetes)

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11
Q

What does ‘diabetes’ mean?

A

Production of abundant urine

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12
Q

Which conditions are a contraindication for metformin?

A

Renal impairment

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12
Q

What is the tissue level effect of alpha-glucosidase inhibitors?

A

Reduce digestion and absorption of CHOs from small intestine

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13
Q

What type of cells kill beta islet cells in T1DM

A

Cytotoxic T cells

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13
Q

What are the main side effects of alpha-glucosidase inhibitors?

A

Flatulence, abdominal discomfort, loose stools

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14
Q

What is insulin lispro?

A

Short acting insulin

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15
Q

What is HbA1c?

A

Glycosylated haemoglobin - a marker for diabetes control

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16
Q

Which three tissue are particularly vulnerable to complications in diabetes mellitus?

A

Kidneys, retina, nerves

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18
Q

Name 2 main effects of GLP-1

A

Delays gastric emptying Stimulates pro-insulin syntheis

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19
Q

How doe DPP-4 drugs treat diabetes on a tissue level?

A

Inhibit breakdown of incretins, thus increasing insulin:glucagon ratios

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20
Q

How does diabetes cause peripheral neuropathy?

A

Ischaemic damage AGEs damage axons and schwann cells

20
Q

What are the 4 main actions of metformin at a tissue level?

A

GAIL Gluconeogenesis in liver is inhibited Absorption of carbohydrates is reduced Insulin-mediated glucose uptake is enhanced LDL and TAG levels are decreased

21
Q

What is the cascade for insulin release from beta cells?

A

Glucose enters through GLUT-2 Glycolysis and TCA cycle yields ATP ATP displaces ADP from K+ ATP channel K+ influx depolarises cell Depolarisation opens voltage gated Ca2+ channel Ca2+ enters cell and causes vesicles to exocytose insulin

23
Q

Which country has the highest prevalence of Type 1 diabetes?

A

Finland

23
Q

What type of drug is exenatide?

A

Glucagon-like peptide-1 agonist

25
Q

How long does the second phase of insulin release last for?

A

As long as the stimulus is present

26
Q

What do fructosamine levels tell you in a diabetic patient?

A

How good BSL control has been over the past 6 to 8 weeks

27
Q

Why is there polyuria in DM?

A

Hyperglycaemia => glucosurea => osmotic diuresis => polyurea

28
Q

Which is the most potent incretin?

A

GLP-1

30
Q

What are the 2 classical symptoms of Type 1 diabetes?

A

Polyuria and polydipsia

30
Q

Name 3 effects of amylin

A

Delays gastric emptying Inhibits glucagon secretion Reduces food intake

32
Q

What do theta cells of the pancreas secrete?

A

Pancreatic polypeptide

33
Q

What is detemir insulin?

A

A long acting form of insulin

35
Q

What are the two long acting forms of insulin?

A

Glargine and determir

36
Q

What are the three short acting forms of insulin?

A

Glulisine, lispro, aspart

37
Q

How do you treat an unconscious diabetic patient with hypoglycaemia?

A

IV glucose or glucagon

39
Q

Which cells secrete GIP ()glucose-dependent insuinotropic polypeptide)?

A

K cells of duodenum

41
Q

How is exenatide administered?

A

S.C.

43
Q

What is the most common cause of blindness in Australia?

A

Diabetic retinopathy

45
Q

What do HbA1c levels tell you in a diabetic patient?

A

How good BSL control has been over the past 3 months

46
Q

Name 5 ways that AGEs may lead to atherosclerosis?

A

Stimulate macrophages to release pro-inflammatory cytokines Stimulate vascular smooth muscles to proliferate Generate ROS in endothelial cells Cause endothelial cells to become pro-coagulant AGEs can cross-link with collagen, trapping LDL

48
Q

What effect does insulin have on potassium?

A

Lowers plasma K+ but transferring it intracellularly

50
Q

Which phase of insulin release is most impaired in T2DM?

A

Initial spike

52
Q

How long does the first phase of insulin release last for?

A

2-5 mins

53
Q

What is the magic number for HbA1c?

A

7%

54
Q

What are the main side effects of metformin?

A

GI upset and lactic acidosis

55
Q

What is the eponymous name for nodular glomerulosclerosis?

A

Kimmelstiel-Wilson lesions

57
Q

What degrades GLP-1?

A

DPP-IV Di-peptidyl peptidase-IV

58
Q

What is the most common cause of kidney failure in Australia?

A

Diabetic nephropathy

59
Q

What is the main macrovascular complication of DM?

A

Atherosclerosis

60
Q

What does glucagon do?

A

Causes liver to release glucose via GNG or glycogenolysis

61
Q

Why does orally administered glucose cause a greater increase in insulin levels?

A

It activates incretins (Glucagon-like peptide 1 and glucose-induced insulinotropic polypeptide)

62
Q

What is insulin aspart?

A

Short acting insulin

63
Q

What are 3 candidates for diabetes-mediated pathology?

A

Advanced glycation end products Activation of Protein Kinase C Polyol pathways

64
Q

What is the glycosylated form of haemoglobin?

A

HbA1c

65
Q

What are three typical pathological effects of diabetes in the kidneys?

A

Kimmelsteil-Wilson nodules Thickening of glomerular basement membrane Hyaline arteriolosclerosis

66
Q

Which cells secrete GLP-1?

A

L cells of small intestine

67
Q

What does dipeptidyl-peptidase do?

A

Breaks down incretins

68
Q

What is glargine insulin?

A

A long acting form of insulin

69
Q

What BSL levels indicate hypoglycaemia?

A

< 4 mmol/L

70
Q

What is the advantage of detemir insulin?

A

It has a FA added, meaning it has a longer half life and can cross BBB

71
Q

What effect does insulin have on fat metabolism?

A

Decreases lipolysis

72
Q

What is the most common precipitating event for diabetic ketoacidosis?

A

Infection

73
Q

What is released with insulin?

A

C-peptide and amylin

74
Q

How do sulphonylureas work at an organ level when treating diabetes?

A

Increase insulin release from the beta cells of the pancreas

Nick's MD1 (28 decks)

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