HD46-7 Diabetes Flashcards by 13D Philippa Minimum | Brainscape

Q

Why is blood glucose raised in type 1 diabetes?

A

• Due to autoimmune destruction of beta cells= insulin

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Q

Why is blood glucose raised in type 2 diabetes?

A

• Due to combination of insulin resistance and relative insulin lack

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Q

what are the types of diabetes?

A

1, 2 , gestational, or secondary to other condition

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Q

Uses of measurements of glycated Haemoglobin:

A

Diagnosis can also be made by HbA1c level of over 48mmol/mol

This test is also used over a few weeks to measure success of tx.

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Q

Does this raise or lower blood glucose?

food

A

raise

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Q

Does this raise or lower blood glucose?

starvation

A

lower

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Q

Does this raise or lower blood glucose?

glucagon

A

raise

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Q

Does this raise or lower blood glucose?

adrenaline

A

raise

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Q

Does this raise or lower blood glucose?

cortisol

A

raise

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Q

Does this raise or lower blood glucose?

growth hormone

A

raise

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Q

Does this raise or lower blood glucose?

Insulin

A

lowers

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Q

Does this raise or lower blood glucose?

anti-diabetic drugs

A

lowers

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Q

Does this raise or lower blood glucose?

illness

A

raises

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Q

Does this raise or lower blood glucose?

stress

A

raises

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Q

Does this raise or lower blood glucose?

excersize

A

lowers

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Q

Which 4 hormones increase glucose levels?

A

Glucagon – made by a alpha cell of islets of Langerhann in pancreas = make
Adrenaline
GH
Cortisol – hydrocortisone steroid hormone

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
sulphoylureas

A

secretagogue

can cause hypoglycaemia and weight gain

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
gliclazide

A

secretagogue
(a type of sulphonyureas )
(can cause hypoglycaemia and weight gain)

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
DPP4 inhibitors

A

secretagogue (also described as having combined actions)

-liptin= DPP4 inhibitor

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
sitagliptin

A

secretagogue (also described as having combined actions)

-liptin= DPP4 inhibitor

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
vildagliptin

A

secretagogue (also described as having combined actions)

-liptin= DPP4 inhibitor

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
GLP-1 binder

A

tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )

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Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
exanetide

A

-tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )

Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
liraglutide

A

tide= GLP-1 binder
secretagogue
(also described as having combined actions:stimulates insulin secretion, reduced glucagon secretion and delayed gastric emptying. = prevent weight gain )

Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
biguanides

A

biguanides (metformin)

sensitiser

Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
metformin

A

biguanides (metformin)

sensitiser

Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
thiazolidines

A

thiozolidinediones (“glitazones”e.g. pioglitazone

sensitiser

Q

is it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
pioglitazone

A

thiozolidinediones (“glitazones”e.g. pioglitazone

sensitiser

Q

it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
acarbose

A

Delayed carbohydrate absorption:

Acarbose: alpha-glucosidase inhibitor (rarely used= wind)

Q

it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
guar gum

A

delayed carb absorption

Q

it a secretagogue or sensitzer, or does it delay carbohydrate absortion:
alpha glucosidase inhibitors

A

Delayed carbohydrate absorption:

Acarbose: alpha-glucosidase inhibitor (rarely used= wind)

Q

Short acting types of insulin:

A

soluble e.g. actrapid, humulin S,

2) insulin aspart e.g. novorapid
3) insulin lispro e.g. humalog

Q

intermediate / long acting types of insulin

A

1) isophane insulin e.f. humulin I, insulatard
2) insulin glargine e.g. lantus
3) insulin detemir e.g. levemir

Q

Biphasic types :

A

1) biphasic isophane insulin
2) biphasic insulin aspart
3) biphasic lispro

Q

concs of soluble in insulin to isophane in biphasic isophane insulin:

A

30% soluble, 70% isophane

mixtard 30 or Humulin M3

Q

concs of insulin aspart to isophane in biphasic aspart insulin:

A

30% insulin aspart
70% aspart protamine
(novomix)

Q

concs of insulin lispro to isophane in biphasic lispro insulin:

A

25% lispro

75% lispro protamine

Q

2 ways of taking insulin injections other than the insulin pump:

A

1) basal-bolus (Can check insulin level before they eat and adjust the amount of insulin they need to inject in accordance with the amount of carbohydrate they are going to eat, take a intermediate action one in morning or night)
2) Twice daily (take soluble and isophane insulin twice so don’t have to inject at lunch)

Q

group the following newer modified insulin into very long acting and very quick acting:
glulisine glargine,lispro, aspart, detimir

A

Newer modified insulins
• Very long acting – glargine, detimir
• Very quick acting – lispro, aspart, glulisine

Q

what are the 3 acute complications of diabetes:

A

ketoacidosis (type 1)
• Hyperosmolar hyperglycaemic state (type 2)
• Hypoglycaemia – complication of treatment

Q

what are the chronic complication of diabetes:

A

•	Microvascular 
o	Retinopathy
o	Neuropathy
o	Nephropathy
•	Macrovascular
o	Peripheral
o	Coronary
o	Cerebral
•	Neuropathy
•	Foot problems

Q

true or false

Microvascular problems and foot problems are unique to diabetes

A

true

Q

What is Diabetic cheiroarthropathy

A

limited joint mobility can’t flatten hands, occurs in those with diabetic neuropathy

Q

Prevention of long-term complications

A

•	Meticulous glucose control - difficult
•	Control of blood pressure
•	Avoidance/treatment of other risk factors
o	Smoking
o	Hyperlipidaemia
o	Obesity
o	Inactivity
•	Early detection and management - SCREENING

Q

How is the following complication of diabetes treated:• Retinopathy

A

laser photocoagulation (burns out bits of ischemic retina)

Q

How is the following complication of diabetes treated: Nephropathy

A

ACE inhibition, dialysis & transplantation

Q

How is the following complication of diabetes treated: Neuropathy

A

advice about foot care = amputation if necessary

Q

How is the following complication of diabetes treated: PVD

A

peripheral vascular disease (ache in leg)– bypass surgery, angioplasty with stents or amputation

Q

How is the following complication of diabetes :

foot ulcers

A

chiropody, protection from pressure, good footwear & surgery

Q

What hospital procedures require diabetics to fast?

A

.e. endoscopy

• For short procedures ‘fast and check’

Q

for short procedures in hospital operations for diabetics, how are they carried out different to normal?

A

Omit morning insulin/tablets and breakfast
Do procedure first on list
Give treatment and breakfast immediately afterwards

Q

for major/longer procedures in hospital operations for diabetics, how are they carried out different to normal?

A

• Intravenous treatment with drip and insulin
• GKI – glucose, potassium, insulin infusion
o Monitor glucose hourly – adjust insulin content of bag to keep between 6 and 12

Q

GKI is given IV during major operations, All recipes contain:
2) glucose is monitored hourly, what is the range of gluc conc that is considered fine?

A

glucose , insulin and potassium

2) 4-10

Q

what is the folloowing a recipe for:
•	10% dextrose 500ml
•	10mmol KCl
•	16u soluble (short-acting)  insulin
•	Rate 100ml/hour

A

GKI

Q

in a major hospital op a pt is recieving GKI via IV, there blood glucose falls to bellow 6 and is falling after 2 hours into the operation. What is the response?
2) what is the infusion rate at the start of the operation and after replacing the GKI

A

replace GKI with one containing 4 less units of insulin. , diet diabetic may not need insulin but stress and illness may alter glucose levels so monitor glucose
2)2) NB – infusion rate is constant, it is the insulin content which is adjusted.= 100ml/hour

Q

in a major hospital op a pt is recieving GKI via IV, there blood glucose is above to and rising after 2 hours into the operation. What is the response?
2) what is the infusion rate at the start of the operation and after replacing the GKI?

A

replace bag with one containing 4 more units of insulin

2) NB – infusion rate is constant, it is the insulin content which is adjusted.= 100ml/hour