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diabeties Flashcards

1
Q

Where is insulin and glucagon released from

A

islet of langerhans

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2
Q

where does all glucose come from

A

LIVER

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3
Q

what does insulin do

A

Supresses hepatic glucose output
 Glycogenolysis
 Gluconeogenesis
Increases glucose uptake into insulin sensitive tissues (muscle, fat)
Suppresses Lipolysis

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4
Q

what does glucagon do

A

Increases hepatic glucose output
 Glycogenolysis
 Gluconeogenesis
Reduce peripheral glucose uptake
Stimulate peripheral release of gluconeogenic precursors (glycerol, AAs)
Lipolysis
Muscle glycogenolysis and breakdown

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5
Q

what is diabeties mellitus

A

A disorder of carbohydrate metabolism characterised by hyperglycaemia
high sugar levels

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6
Q

how does diabeties mellitus cause morbidity

A

acute metabolic emergencies diabetic ketoacidosis (DKA) and hyperosmolar coma (Hyperosmolar Hyperglycaemic State )
Chronic hyperglycaemia leading to tissue complications

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7
Q

Complications of diabeties mellitus

A

stroke
blindness
diabaetic neuropathy
heart disease

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8
Q

types of diabetes

A

type 1
type 2 to include gestational and medication induced
MODY
pancreatic
endocrine diabeties
malnutrition related

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9
Q

symptoms of diabetes

A

polyuria
fatigue
fasting plasma glucose more than 7
Hba1c > 48mmol/ mol

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10
Q

treatment of type 1 diabetes

A

insulin treatment - basal bolus
once or twice daily of slow acting
ability to judge carbohydrate intake
awareness of blood glucose lowering effect of exercise

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11
Q

pathogenesis of type 1 diabates

A

Destruction of beta cells in the islet of langherhans caused by an autoimmune response

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12
Q

what would happen if you take too much insulin

A

cerebral dysfunction
hypoglycaemia
- release of glucagon
-sweating
-hunger
-loss of consciousness

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13
Q

failure of insulin secretion leads to

A

-Continued breakdown of liver glycogen
-Unrestrained lipolysis and skeletal muscle breakdown providing gluconeogenic precursors
-Inappropriate increase in hepatic glucose output and suppression of peripheral glucose uptake

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14
Q

failure to treat insulin resistance leads to :

A
  • increase in circulating glucagon, increases glucose
    -perceived ‘stress’ leads to increased cortisol and adrenaline
  • progressive catabolic state and increasing levels of ketones
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15
Q

aetiology of type 2 diabetes

A

genes and environment
impaired insulin secretion/ insulin resistance
impaired glucose tolerance
type 2 diabetes
progressive hyperglycaemia

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16
Q

impaired insulin action leads to

A

Reduced muscle and fat uptake after eating
Failure to suppress lipolysis and high circulating FFAs
Abnormally high glucose output after a meal

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17
Q

summary of type 1 diabetes

A

Severe insulin deficiency due to autoimmune destruction of the beta cell

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18
Q

signs and symptoms of type 1 dibaetes

A

polydipsia, polyuria, weight loss
- short history of severe symptoms

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19
Q

typical patient presenting with new T1DM

A

polydipsia, polyruia, rapid weight-loss, young, BMI >25
genetic history of disease

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20
Q

summary of type 2 diabetes

A

Insulin resistance and impaired insulin secretion due to a combination of genetic predisposition and environmental factors (obesity and lack of physical activity)

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21
Q

principles of treatment for diabetes

A
  • control of symptoms
    -prevention of acute emergencies, ketoacidosis
  • correct diagnosis
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22
Q

risk factors for T2DM

A

Lifestyle- obesity, lack of exercise, calorie and alcohol excess
- asian men
- HT
- ABOVE 40

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23
Q

SIGNS and symptoms of type2 diabetes

A

polydipsia
polyuria
glycosuria
central obesity
slower onset
blurred vision

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24
Q

3 step management process for diabetes

A

1- metformin - to inc insulin sensitivity
2- if HBA1C still high then dual therapy with dpp4, sulphonyl
3- if still high - triple therapy
then insulin

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25
define DKA
Diabetic ketoacidosis - complete lack of insulin results in high ketone production and hyperglycaemia medical emergency glucose and ketones escape in urine but lead to osmotic diresis
26
Absence of insulin would cause
absence of insulin- uncontrolled catabolism,- unrestrained gluconeogenesis and decreased peripheral glucose uptake
27
signs of DKA
Pear drop breath due to ketones hypotension tachycardia
28
symptoms of DKA
Nausea+ vomitting weight loss very thirsty confusion lethargy abdo pain
29
dka complications
cerebral oedema adult resp distress syndrome thromboembolism aspiration pneumonia death
30
treatment for DKA
replace fluid - 0.9 saline 3l for 3hrs IV insulin- to stop ketones being made restore electrolytes
31
how do sulphonylureas work
- stimulate insulin release by binding to b-cell receptors - improve glycaemic control -can cause hypoglycaemia
32
what medication can cause osteoporosis, heart failure and weight gain
thiazolidinediones
33
ideal drug for type 2 diabetes would;
Reduce appetite and induce weight loss Preserve -cells and insulin secretion Increase insulin secretion at meal time Inhibit counterregulatory hormones which increase blood glucose such as glucagon Not increase the risk of hypoglycaemia during treatment
34
what do SGLT2 inhibitors do
-block the reabsorption of glucose in kidney in the Pct, increase glucose excretion and lowers blood glucose
35
define HHS
hyperosmolar hyperglycaemic state marked hyperglycaemia mild/ no ketosis
36
signs and symptoms of hhs
confusion and reduced mental state lethargy severe dehydration
37
investigations for HHS
- random plasma glucose >11 mmol -urine dipstick- glucosuria - plasma osmolality -high U + E
38
pathophysiology of hhs
low insulin> increased gluconeogenesis
39
first line treatment for diabetes type 2
metformin
40
How do ddp4 inhibitors work
Inhibit the release of glucagon Can cause weight gain
41
side effects of sglt2 inhibitors
-genital thrush - inc risk of euglycaemic ketoacidosis
42
what is shown with euglycaemic ketoacidosis
breakdown of fats with fasting ketone levels rise acidotic and nauesous glucose levels are normal
43
hypoglycaemia?
low blood sugar
44
pathophysiological effects of hypoglycaemia
brain- cognitive dysfunction, seizures heart- heart attack msk- falls, fractures circulation- inflammation, blood coagulation, endothelial dysfunction
45
neuroglycopenia?
shortage of glucose in the brain resulting in alteration of neuronal function.
46
neuroglycopenia symsptoms
-difficulty concentrating - confusion -weakness -dizziness -vision changes -fatigue
47
symptoms of hypoglycaemia
- trembling -palpations -sweating -anxiety -hunger
48
causes of hypoglycaemia
-long duration of diabetes -tight glycaemic control -old age -drugs, alcohol -sleeping -increased physical activity
49
to prevent hypoglycaemia in community
- educate patients and caregivers on how to treat and recognise -instruct patients to report
50
how to treat hypoglycaemia
- recognise symptoms -confirm the need for treatment -treat with fast acting 15g carb to relieve symptoms -retest in 15 mins to ensure blood glucose -eat a long acting carb to prevent recurrence of symptoms
51
Adv and dis of pre mixed insulin in diabetes
- both basal and prandial components in a single prep - can cover insulin requirements for whole day Dis - requires consistent diet and exercise - increase risk for nocturnal hypoglycaemia
52
How would hypoglycaemia be avoided in the body
When glucose levels are low Glucagon and adrenaline are released which allows for glycogenolysis
53
Consequences of low blood sugar with diabetics
Altered thresholds, patient is unable to realise that levels are low Glucose levels can go very low and they may pass out
54
objectives if t2dm treatment other than glucose control
to reduce risk of cvd chronic kidney disease microvascualr complications
55
microvascular complications linked to diabetes
diabetic retinopathy nephropathy severe non / proliferation neuropathy microalbuminuria
56
hba1c target
7%
57
presenting feautures of diabetes
thirst polyuria- excess urine weight loss and fatigue hunger blurred vision vaginal candidiasis
58
type 1 sugggestive features
onset in childhood/ normally sudden lean body habitus prone to DKA high levels of islet autoantibodies
59
what would happen if you stopped producing insulin
increased and uncontrolled fat metabolism, impair glucose uptake, FFA are transported into the liver
60
three things you need for definitive diagnosis of DKA
- HYPERGLYCAEMIA -RAISED PLASMA KETONES -METABOLIC ACIDOSIS
61
what is the significance of ANTI- gad
the more anti gad you have the more likely you are to have type 1 diabetes
62
type 2 suggestive feautures
usually presents in over 30's onset is gradual FH is often positive diet exercise and oral meds can control it
63
3 main issue with neuropathy
pain autonomic issues insensitivity
64
signs of vascular disease
diminished or absent pedal pulses cold feet and toes poor skin and nails abscence of hair and nails
65
most common cause of blindness in the working population
diabetic retinopathy
66
risk factors of DR
long duration diabetes poor glycaemic control hypertensive on insulin treatment pregnancy
67
hallmark of diabetic nephropathy
development of proteinuria followed by progressive decline in renal function
68
risk factors for diabetic nephropathy
poor bp control poor bg control
69
pathophysiology of diabetic nephropathy
glomerulus changes increase ofr glomerular injury filtration of proteins diabetic nephropathy
70
treatment of diabetic nephropathy
blood pressure control glycemic control ARB/ACEI proteinuria control cholestrol control
71
leading cause of amputations
diabetic nephropathy
72
what can cause excess protein in urea
exercise infection fever congestive heart failure marked hypertension pregnancy
73
specific values needed to diagnose diabetes
symptoms and random glucose of more than 11.1 mmol/l fasting plasma glucose more than 7.0 mmol/l hba1c of more than 48
74
what is a normal glucose level
between 4-7 mmol/l
75
biochemical values of DKA
glucose around 50mmol/l high K+ hco3- less than 15mmol urea and creatinine raised
76
what is MODY
maturity onset diabetes of the young diagnosed at <25y
77
which genes have been found to have mutations that cause MODY
HNF1A HNF4A
78
how would you treat MODY3
with sulphonylurea often do not need insulin
79
what would make you think MODY instead of type 1 diabetes
if a parent is affected absecence of islet autoantibodies
80
what would c peptide tell you about mody and type 1
MODY the patient would have normal levels of c peptide meaning they can produce their own insulin T1- low levels of c peptide
81
what physical signs would indicate permanent neonatal diabetes
small babies epilepsy muscle weakness ( floppy baby )
82
most common cause of chronic pancreatitis
alcohol
83
cushings syndrome ?
Body produces excess cortisol increased insulin resistance , reduced glucose uptake into peripheral tissues
84
what occurs in pheochromocytoma
excess production of adrenaline increased gluconeogenesis decreased glucose uptake
85
which group of drugs increase insulin resistance the most
steroids
86
macrovascular complications of DM
-coronary artery disease -peripheral ischemia -stroke -ht
87
microvascular complications of DM
-peripheral neuropathy - retinopathy - kidney disease
88
infection related complications of DM
- UTI - pneumonia -skin and soft tissue infection -fungal infection
89
Sglt2 inhibitors cause a side effect of ….
Glycosuria
90
Common examples of sglt2 Inhibitors
Dapaglifozin Cinaglifozin Empaglifozin
91
What are dpp4 inhibitors
They work to inhibit the dpp4 enzyme
92
Pathiphysiology of dpp4 inhibitors
Glp1 aids in Decrease in gastric emptying Increase insulin release, decrease glucagon Decreases appetite Inhibits allow this to occur
93
Common example of dpp4 inhibitor
Sitagliptib
94
What medication commonly causes hypoglycaemia
Gliclazide
95
What medication can cause UTI in women
Sglt2
96
When managing dka what electrolyte should be managed closely
Potassium

endocrinology (6 decks)

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