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DM Flashcards

1
Q

what are the characteristics only associated with type II diabetes?

A

> 30 yrs old (60yrs = peak), obesity, family history, complications (long term) gradual onset, osmotic symptoms, no ketones in urine, high HbA1c

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2
Q

what are the characteristics only associated with type II diabetes?

A

> 30 yrs old (60yrs = peak), obesity, family history, complications (long term) gradual onset, osmotic symptoms, no ketones in urine, high HbA1c

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3
Q

what are the characteristics only associated with type I diabetes?

A
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4
Q

where is type II diabetes more common?

A

Asia, Africa, Carribean

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5
Q

where is type I diabetes more common?

A

Northern Europe

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6
Q

what are the symptoms of diabetes?

A 
polyuria and polydypsia (osmotic diuresis)
thrush (puritis vulvae and balaritis)
gunger?
blurred vision (glycated lens proteins)
fatigue (impaired use of glucose)
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7
Q

what is the cause of type I diabetes?

A

pancreatic b cell destruction so insufficient insulin produced, autoimmune

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8
Q

what is the cause of type II diabetes?

A

insulin resistance of tissues - impaired cellular response to insulin: receptor down-regulation, reduced signalling

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9
Q

what is latent autoimmune diabetes in adults?

A

onset 40-60 years of type 1 diabetes develops more slowly

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10
Q

what is mature onset diabetes of the young?

A

early onset of type 2 diabetes no insulin autosomal dominant

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11
Q

what is gestational diabetes and what does it increase the risk of in later life?

A

diabetes during pregnancy increases the risk of getting type 2 later in life

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12
Q

why might diabetes occur secondary to another condition?

A

pancreatic obstruction, cushings, acromegaly

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13
Q

2 of which 3 symptoms are needed in order to diagnose type 1 diabetes?

A

weight loss
severe symptoms for short history
ketones in urine

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14
Q

2 of which 3 symptoms are needed in order to diagnose type 1 diabetes?

A

weight loss
severe symptoms for short history
ketones in urine

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15
Q

what are the characteristics only associated with type I diabetes?

A
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16
Q

where is type II diabetes more common?

A

Asia, Africa, Carribean

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17
Q

where is type I diabetes more common?

A

Northern Europe

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18
Q

what are the symptoms of diabetes?

A 
polyuria and polydypsia (osmotic diuresis)
thrush (puritis vulvae and balaritis)
gunger?
blurred vision (glycated lens proteins)
fatigue (impaired use of glucose)
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19
Q

what is the cause of type I diabetes?

A

pancreatic b cell destruction so insufficient insulin produced, autoimmune

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20
Q

what is the cause of type II diabetes?

A

insulin resistance of tissues - impaired cellular response to insulin: receptor down-regulation, reduced signalling

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21
Q

what is latent autoimmune diabetes in adults?

A

onset 40-60 years of type 1 diabetes develops more slowly

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22
Q

what is mature onset diabetes of the young?

A

early onset of type 2 diabetes no insulin autosomal dominant

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23
Q

what is gestational diabetes and what does it increase the risk of in later life?

A

diabetes during pregnancy increases the risk of getting type 2 later in life

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24
Q

why might diabetes occur secondary to another condition?

A

pancreatic obstruction, cushings, acromegaly

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25
Q

which type of diabetes has ketones in the urine?

A

type 1

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26
Q

2 of which 3 symptoms are needed in order to diagnose type 1 diabetes?

A

weight loss
severe symptoms for short history
ketones in urine

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27
Q

what must random plasma glucose levels be with symptoms to diagmnose DM?

A

> 11mmolo/l

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28
Q

what must random plasma glucose be on 2 occassions without symptoms in order to diagnose DM?

A

> 11mmol/l

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29
Q

what must fasting plasma glucose be greater than with symptoms to diagnose DM?

A

> 7mmol/l

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30
Q

what must GTT - glucose tolerance test - (75g) be at fasting and after 2 hours in order to diagnosis diabetes without symptoms?

A

after fasty >7mmol/l after 2 hours >11mmol/l

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31
Q

what must HBA1c be greater than in order to diagnose diabetes?

A

> 48mmol/l

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32
Q

when is HBA1c unsuitable to diagnose diabetes?

A

stress hyperglycaemia, children and young adults, DMT1 for less than 2 months, haemotological abnormalities affecting HBA1c, pregnancy, drug induced diabetes, symptoms less than 2 months

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33
Q

what effect does insulin have on metabolsim?

A

signals fed state with lots of energy
growth hormone
promotes the use of energy for synthesis or storage

34
Q

name 5 processes promoted by insulin

A

glycolysis, protein synthesis, fatty acid synthesis, glucose uptake, glycogen synthesis

35
Q

how does insulin cause glucose uptake by cells?

A

binds to tyrosine kinase receptor –> PKB, P13K phosphorylate proteins –> GLUT4 inserted into membranes of insulin sensitive cells

36
Q

which reactions are promoted if insulin is low?

A

-ase enzymes are increased so things are broken down

gluconeogenesis, glycogenolysis, ketogenesis, lipolysis, proteolysis

37
Q

what does glucagon signal?

A

starvation so tries to increase plasma glucose levels for the brain

38
Q

what do very high levels of glucagon stimulate?

A

lipolysis, preteolysis

39
Q

which enzyme is responsible for breaking down lipids in the fasting state?

A

hormone senstive lipase breaks down adipose tissue into fatty acids

40
Q

why do diabetics have high blood glucose?

A

low insulin or tissues not responsive to insulin so GLUT4 not expressed so high glucose levels in blood
gluconeogenesis and glycogenolysis stimulated producing more glucose, glycogen synthesis inhibited

41
Q

why do diabetics have glucose in their urine?

A

high plasma glucose exceeds the renal threshold

42
Q

why do diabetics have ketone body formation?

A

gluconeogenesis in the liver uses krebs cycle intermediates. accelerated fatty acid breakdown leads to more acetyl coA available
XS acetyl coA can’t be metabolised by krebs cycle so ketone bodies are formed instead

43
Q

what do diabetics have high HBA1c?

A

RBCs have a memory! glycated form of Hb
covalkent bond between N-terminal of Valine and Hb
index of average blood glucose concentration over the lifetime of Hb

44
Q

what sort of acidosis do diabetics have and what compensation occurs?

A

metabolic acidosis, respiratory compensation to decrease co2

45
Q

what are the 4 main long term microvascular complications of DM?

A

retinopathy, nephropathy, neuropathy, lens damage

46
Q

why does retinopathy occur?

A

basement membrane of capillaries damaged so increased permeability of capillaries leads to small haemorrhages in the eye

47
Q

how does hyerglycaemia and fluctuating insulin affect minor metabolic pathways?

A

increased use of minor metabolic pathways such as POLYOL pathway producing sorbitol and fructose that are osmotically active so lead to swelling

48
Q

what sort of proteins could be glycated in DM?

A

basement membrane, HBA1c

49
Q

why does lens damage occur in DM?

A

glycation of proteins in the lens –> cataracts

osmotic changes due to sorbitol from polyol pathway

50
Q

why does neuropathy occur?

A

demyelination of neurones due to blood vessel damage and sorbitol accumulation so decreased sensitivity and do not feel damage (loss of sensory perception)
vascular degeneration decreses healing so ulcers and infection can occur

51
Q

why does nephropathy occur?

A

thickening of the basement membrane, disrupted filtering ability so leakage of large molecules

52
Q

at what level of glucose in the blood does coma and seizures occur?

A

1mmol/l

53
Q

how much higher is the risk of CHD?

A

2-3x

54
Q

why is there an increase in circulating LDLs in DM?

A

glycated LDLs and receptors reduces uptake so more in blood

55
Q

what can increased levels of LDL lead to?

A

LDL –> arteriole endothelium –> atherosclerosis

56
Q

why is there a danger of stasis in DM?

A

glycation of proteins in capillary membrane

57
Q

why are there higher ciculating levels of fatty acids?

A

xs lipolysis

58
Q

what are the treatments for retinopathy?

A

regular eye tests, laser treatment

59
Q

what are the negatives of tight glucose control?

A

increased risk of hypoglycaemia

60
Q

how can nephropathy be prevented?

A

urine test for microalbumin = very early sign

U+Es

61
Q

what is the important triangle?

A

lower blood glucose (control it), limit glucose variability, avoid hypoglycaemia

62
Q

what is the treatment for DMT2?

A

insulin
2 x daily mixture short/ mild acting insulin
basal bolus 1 or 2x daily and pre meal

63
Q

what must DMT2 patients taking insulin be aware of?

A

judging CHO intake

awareness of blood glucose being lowered by exercise

64
Q

at what level of glucose in the blood does irreversible brain damage occur?

A
65
Q

at what level of glucose in the blood does coma and seizures occur?

A

1mmol/l

66
Q

what are the autonomic consequences of hypoglycaemia?

A

nausea, sweating, tremor, tachycardia, pallor, anxiety

67
Q

what are the neuroglycogenic symptoms of hypoglycaemia?

A

slurred speech, confusion, lethargy, coma, drowsiness, aggression, lack of concentration

68
Q

what is the blood glucose target for before meals?

A

4-7nM

69
Q

what is the blood glucose target for after meals?

A
70
Q

what is the target HBA1c?

A
71
Q

what are the positives of tight glucose control?

A

decreased risk of complications

72
Q

what are the negatives of tight glucose control?

A

increased risk of hypoglycaemia

73
Q

what 2 things should reverse DMT2 if substancial?

A

weight loss and exercise

74
Q

which medication can be used for DMT2?

A

hypoglycaemic agents to prevent complications

75
Q

where does metformin act and what does it do?

A

liver - inhibits gluconeogenesis

76
Q

whwre do a-gl;ucosidae inhibitors act?

A

inhibit glucose absorption in the stomach but not used because of flatulence

77
Q

how do glifoxins work?

A

increase glucose loss from the kidneys and decrease reabsorption leading to weight loss. -ve = UTIs

78
Q

how do sulphonylureas work?

A

increase insulin secretion from the pancreas

79
Q

WHERE DOES glp-1 ACT AND WHAT DOES IT DO?

A

GLUCAGON LIKE PEPTIDE 1 CAUSES PANCREASE TO PRODUCE INSULIN SO YOU FELL FULL

80
Q

HOW DO glp-1 ANALOGUES ACT?

A

like GLP-1 they increase insulin production from the liver so you decrease sugar and lose weight

81
Q

where does pioglitazone act?

A

liver, muscle, adipose increases insulin sensitivity but too many side effects so not used

GI (10 decks)

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