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3D week 1 - diabetes > diabetes Mgx (see DM) > Flashcards

diabetes Mgx (see DM) Flashcards

1
Q

what is diabetes mellitus

A

a metabolic disorder characterised by chronic hyperglycaemia due to defects in insulin secretion/action

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2
Q

4 actions of insulin in the body

A
  1. increases glycogenesis
  2. increased peripheral glucose uptake
  3. inhibition of hepatic glucose production
  4. inhibition of lipogenesis/lipolysis
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3
Q

4 drug classes that can induce diabetes

A
  1. steroids
  2. thiazides (e.g. diuretics for HF)
  3. anti-psychotics
  4. BBs
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4
Q

impaired fasting glucose test values

A

> 6.1mmol/L but <7.0mmol/L

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5
Q

impaired glucose tolerance test values

A

fasting <7.0mmol/L;
OGTT >7.8 but <11.0mmol/L

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6
Q

what type of hormone is insulin

A

a peptide hormone

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7
Q

what is the precursor molecule to insulin

A

preproinsulin

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8
Q

proinsulin -> insulin pathway (check this)

A

proinsulin -> cleaved by proprotein convertase (removes the middle C-peptide) -> carboxypeptidase -> insulin

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9
Q

what is the half life of insulin?

A

6 minutes

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10
Q

what are the 4 types of manufactured insulin doses and how long dose each last

A

short acting: 4-6 hrs
intermediate: 12-10hrs
long: 24hrs
mixed: comprises of short + intermedite acting

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11
Q

what are the blood glucose targets for T1 diabetes (3)

A

On waking: fasting blood glucose 5–7 mmol/L;
Before meals: blood glucose 4–7 mmol/L;
Post meals: test after 90 minutes, blood glucose 5–9 mmol/L;

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12
Q

what is HbA1c

A

glycated haemoglobin - average blood glucose (sugar) levels for the last two to three months; Glycated haemoglobin occurs due to non-enzymatic irreversible modification of the beta globin chain in haemoglobin

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13
Q

what is the “honeymoon period” (T1 diabetes)

A

The honeymoon period can occur in newly diagnosed patients in whom there is residual beta cell function -> This may negate the need for exogenous insulin for a period

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14
Q

what are diabetes sick day rules (5)

A

a number of recommendations in T1DM with an intercurrent illness. Advice includes:
1. Continue insulin therapy, alterations may be required, advice from a specialist may be sought;
2. Increase frequency of blood glucose monitoring;
3. Consider ketone monitoring;
4. Maintain good hydration and when possible a normal meal pattern, meals may be replaced by carbohydrate based drinks;
5. Seek urgent medical attention if unable to tolerate oral intake, drowsy or sustained vomiting

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15
Q

why do diabetics often get foot complications

A

Due to loss of sensation and poor blood supply, patients are at risk of a number of complications including diabetic ulcers, secondary infection (e.g. cellulitis, osteomyelitis), skin necrosis and eventually amputation

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16
Q

what is charcot’s joint

A

complex neuropathic arthropathy that results from loss of sensation and subsequent repeated micro-trauma to the foot

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17
Q

what is the main macrovascular complication of diabetes

A

atherosclerosis

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18
Q

4 prophylactic measures to reduce CVD risk

A
  1. Smoking cessation
  2. Nutritional support & exercise
  3. Consideration of anti-lipid therapy (e.g. atorvastatin)
  4. Blood pressure control
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19
Q

what is the MOA of Sulphonylureas

A

block K+ Ch opening => cell membrane depol occurs leading to Ca2+ influx and thus insulin release

20
Q

what amino acid increases the chance of beta-cell depol and why

A

Arganine, it is positively charged

21
Q

metformin MOA (3)

A
  1. Metformin decreases blood glucose levels by decreasing hepatic glucose production (gluconeogenesis);
  2. decreases the intestinal absorption of glucose
  3. increases insulin sensitivity by increasing peripheral glucose uptake and utilization
22
Q

2 side effects of sulphonylureas

A
  1. hypoglycaemia
  2. weigh gain (1-4kg in 6 months)
23
Q

meglitinides MOA

A

insulin secretagogues -> stimulates the release of insulin from beta cells e.g. repalinide potentiates the effect of extracellular glucose on ATP-sensitive potassium channel (relies on there being some beta-cell function)

24
Q

2 examples of meglitinides

A
  1. natiglinide
  2. repaglinide
25
Q

2 side effects of meglitinides

A

weight gain; hypoglycemia

26
Q

what is prandial glucose

A

prandial = while eating food => prandial glucose is glucose acquried from eating

27
Q

α-glucosidase inhibitors MOA

A

prevents the cleaving of carbohydrates into monosaccharides thus lowering prandial glucose

28
Q

thiazonlidinediones MOA (pioglitazone)

A

agonist of peroxisome proliferator activated receptor gamma - a receptor in adipose tissue, muscle, liver, vascular endothelium and beta cells -> reduced hepatic gluconeogenesis, promotes adipogenesis, insulin sensitivity, tissue glucose uptake and reduces inflammation

29
Q

by how much does pioglitazone reduce HbA1c reduction?

A

0.5-1.4%

30
Q

how fast does pioglitazone produce results

A

gradual onset - reaches maximal effect in 2-3 months

31
Q

side effects of thiazolidinediones (3)

A
  1. increased risk of fracture
  2. oedema
  3. weight gain (2-3kg per 1% HbA1c reduction)
32
Q

what conditions are thiazolidinediones contraindicated in (3)

A
  1. heart failure;
  2. uninvestigates macroscopic haematuria;
  3. bladder cancer
33
Q

what do DPP4 inhibitors increase the risk of?

A

pancreatitis

34
Q

SGLT-2 inhibitor MOA

A

inhibits the action of SGLT2 (proximal convoluted tubule) ->allows for glucose to be excreted in the urine rather than be reabsorbed into the blood

35
Q

side effects of SGLT-2 inibitors (6)

A
  1. mild diuresis (risk of hypovolemia and dizziness)
  2. calorie loss
  3. reduced blood pressure
  4. weight loss
  5. risk of genital/urinary tract infections
  6. euglycemic/hyperglycemia DKA
36
Q

what does euglycemic mean

A

when blood glucose is within the normal range

37
Q

GLP1 receptor agonist MOA

A

activates GLP1 receptors which increase the level of incretin hormone -> increases insulin secretion and reduces glucagon secretion

38
Q

what drug is a true analogue of GLP1

A

liraglutide

39
Q

side effects of GLP1 receptor agonists (4)

A
  1. enhanced satiety;
  2. delayed gastric emptying;
  3. weight loss (avg 3.2Kg);
  4. reduced BP
40
Q

what is the HbA1c reduciton with using GLP1 receptor agonists

A

0.5-1.5%

41
Q

what can be given for hyperglycaemic rescue therapy

A

insulin or sulfonylurea

42
Q

target HbA1c levels in T2 diabetes

A

48mmol/L-53mm/L

43
Q

who should intensive glycaemic control treatment be given to

A

uncomplicated, young pts, who will benefit the most out of glycaemic control and avoiding future complications

44
Q

what is a red flag for nephropathy

A

microalbuminuria

45
Q

OGTT prediabetic values

A

7.8-11.0 mmol/L

46
Q

What drugs should be stopped according to sick day rules

A

DAMN drugs - diuretics, ACEi/ARBs, metformin, NSAIDs

47
Q

When do sick day rules apply

A

When dehydrated (check this)

3D week 1 - diabetes (5 decks)

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