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Endocrinology > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What is the action of insulin?

A

Decrease hepatic glucose output
Decrease proteolysis
Decrease lipolysis
Decrease ketogenesis

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2
Q

What are the clinical implications involving insulin?

A

Type 1 diabetes mellitus
Hypoglycaemia
Insulin Resistance
Type 2 diabetes mellitus

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3
Q

In which cells is GLUT-4 common in?

A

Myocytes (muscle)

Adipocytes (fat)

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4
Q

What are the main features of GLUT-4?

A

Highly insulin-responsive
Lies in vesicles
Recruited and enhanced by insulin
7-fold increase glucose uptake

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5
Q

Where does gluconeogenesis take place?

A

The liver

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6
Q

What effect does insulin have on the liver in the few state?

A

Amino acids taken up by the liver
Increased protein synthesis
Decreased gluconeogenesis

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7
Q

What are the main fuels stores of the body?

A

Carbohydrate
Protein
Fat

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8
Q

How long does it take for these stores to be depleted?

A

Carbohydrate- 16 hours
Protein- 15 days
Fat- 30/40 days

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9
Q

What is the function lipoprotein lipase?

A

(LPL) enzyme breaks down triglycerides that would otherwise be unable to leave the circulation

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10
Q

What is the action of insulin on adipocytes in the fed state?

A

Increases glucose uptake int the fat cell
Converts the glycerol and NEFA’s into triglycerides
Encourages lipogenesis
Inhibits glycolysis

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11
Q

How can insulin act quickly on the liver?

A

Secreted into the hepatic portal system

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12
Q

What is the action of insulin on adipocytes in the fasting state?

A

Hepatic gluconeogenesis responsible for 25% of hepatic glucose output after a 10 hour fast

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13
Q

Why is the brain unique?

A

Unable to utilise fatty acids as a fuel

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14
Q

What does ketone body production result from?

A

Low levels of insulin

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15
Q

When is ketone body formation abnormal?

A

When there are high levels of glucose

Normal in fasting state

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16
Q

What is hepatic glycogenolysis?

A

Generation of glucose from stored glycogen in the liver

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17
Q

What is the action of insulin on muscle in the fed state?

A

Uptake of glucose bu muscle cells

Used for respiration to release energy

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18
Q

What is the action of insulin on muscle in the fasting state?

A

No action

Counter regulatory hormones prevent excess uptake

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19
Q

Summarise what occurs in the fasted state?

A

Low insulin-to-glucagon ratio
[Glucose] 3.0-5.5mmol/l
Increased [NEFA]
Decreased [amino acid] when prolonged

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20
Q

What actions occur in the fasted state?

A 
Increased
 Proteolysis
 Lipolysis
HGO from glycogen and gluconeogenesis
Muscle to use lipid
Brain to use glucose, later ketones
 Ketogenesis when prolonged
21
Q

Summarise what occurs in the fed state?

A

Stored insulin released then 2nd phase

High [insulin] to [glucagon] ratio

22
Q

What actions occur in the fed state?

A 
Stop HGO
↑ Glycogen                         
↓ gluconeogenesis
↑ protein synthesis
↓ proteolysis 
↑ Lipogenesis
23
Q

How is diabetes diagnosed?

A

Fasting glucose >7.0mmol/L

Random glucose >11.1mmol/L

24
Q

What tests are used to diagnose diabetes?

A

Oral glucose tolerance test

HbA1c (>48mmol/mol)

25
Q

How is the oral glucose test carried out?

A

Fasting glucose
75g glucose load
2-hour glucose

26
Q

What is required for diagnosis?

A

2 positive tests

1 postive test and osmotic symptoms

27
Q

Describe the pathophysiology in type 1 diabetes

A 
Autoimmune condition
Absolute insulin deficiency
Diabetic ketoacidosis (serious acute complication)
28
Q

How does T1DM present?

A

Weight loss
Hyperglycaemia
Glycosuria with osmotic symptoms (polyuria, nocturia, polydipsia)
Ketones in blood and urine

29
Q

What are the useful diagnostic tests for T1DM?

A

Antibodies: GAD, IA2
C-peptide
Presence of ketones

30
Q

What is insulin induced hypoglycaemia?

A

Too much insulin is administered
Reduced glucose output from liver
Glucose is taken up by muscles

31
Q

What is the counter-regulatory response to hypoglycaemia?

A 
Increased
Glucagon 
 Catecholamines
 Cortisol
 Growth hormone
Not sufficient to fully deal with a hypo episode
32
Q

What does an increase in these hormones result in?

A

Increased Hepatic glucose output
with glycogenolysis and gluconeogenesis
Increased Lipolysis

33
Q

What is impaired awareness of hypoglycaemia?

A

Reduced ability to recognise symptoms of hypoglycaemia
Due to loss of counterregulatory response
Recurrent hypoglycaemia

34
Q

What are the autonomic signs of hypoglycaemia?

A

Sweating
Pallor
Palpitations
Shaking

35
Q

What are the neuroglycopenic signs of hypoglycaemia?

A 
Slurred speech
Poor vision
Confusion
Seizures
Loss of consciousness
36
Q

What is severe hypoglycaemia?

A

Defined as an episode where a person needs third party assistance to treat

37
Q

How does alcohol increase the likelihood of a hypo?

A

Negative effects on the liver

Reduced HGO

38
Q

Describe the pathophysiology in type II diabetes

A

Insulin resistance resides in liver, muscle and adipose tissue

39
Q

What are the two pathways that can lead to resistance?

A

MAPK Pathway

PI3K-Akt pathway

40
Q

What results from insulin resistance?

A

High [TG]
Low [HDL]

Insulin resistance
Adipocytokines
Inflammatory state
Energy expenditure

Hypertension
BP >135/80 mmHg

Waist circumference
Men >102 cm
Women >88 cm

Fasting glucose
>6.0 mmol/L

41
Q

How does Type 2 diabetes present?

A 
Hyperglycaemia
Overweight
Dyslipidaemia
Less osmotic symptoms
With complications
Insulin resistance
Later insulin deficiency
42
Q

What are the risk factor for type 2 diabetes?

A 
Age		
PCOS
High BMI		
Family Hx	
Ethnicity
Inactivity
43
Q

What are the diet recommendations for diabetes?

A 
Healthy eating or diet
Total calories control
Reduce calories as fat 
Reduce calories as refined carbohydrate
Increase calories as complex carbohydrate
Increase soluble fibre
Decrease sodium
44
Q

What is the management pathway for type 1?

A

Exogenous insulin (basal-bolus regime)
Self-monitoring of glucose
Structured education
Technology

45
Q

What is the management pathway for type 2?

A

Diet
Oral medication
Structured education
May need insulin later

46
Q

What are the long-term complications of diabetes?

A

Retinopathy
Neuropathy
Nephropathy
Cardiovascular

47
Q

Why can’t insulin be given as a tablet?

A

Peptide hormones broken down by digestive system

48
Q

Who is in the diabetes team?

A

Dietician
Diabetes specialist nurse
Psychologist
Consultant

Endocrinology (9 decks)

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