pancreas disorders - Diabetes Flashcards
what are the features of metabolic syndrome
hypertension >130 mmHg
hyper-triglyceridemia >1.7 mmol/L
hyperglycemia {fasting} >5.6mmol/L
central obesity >100cm circumference
low HDL and cholesterol 1 mmol/L
Insulin resistancedisease associated with metabolic syndrome
cardiovascular diabetes type 2 nonalcoholic fatty liver hyperuricemia obstructive sleep apnea
what are the drugs used for metabolic syndrome
metformin GLP-1 inhibitors thiazolidinediones DPP-4 inhibitors sulfonylurea
what drugs induce diabetes
Beta adrenergic agonist
glucocorticoids
thiazides (class of sulfur-containing diuretics)
epinephrine
Diagnostic criteria for diabetes mellitus
impaired Fasting plasma glucose of >7mmol/L [126mg/dl]
hemoglobin A1C >6.5%
oral glucose tolerence test of >11.1 mmol/L [200mg/dl]
symptoms of diabetes plus plasma glucose of 11.1/mmol/L [200 mg/dl]
what are the labs for prediabetes
impaired fasting plasma glucose of 5.6-6.9mmol/L [100-125 mg/dl]
glucose tolerance test of 7.8-11mmol/L [for mg/dl x20]
Diabetes risk factors
impaired fasting glucose test obesity family history [diabetes type 2 has a stronger genetic component than type 1] hypertension polycystic ovary syndrome low cholesterol/ HDL hemoglobin A1C >5.7/6.4 mmol/L
what are insulin independent tissues
Brain
intestine
placenta
through GLUT 3 transporter
type of glucose transporter is in the muscles and adipose tisssue
GLUT 4 insulin dependent
what are the antibodies present in type 1 diabetes
islet cell antibody [ICA]
insulin autoantibody [IAA]
antibody to glutamic acid decarboxylase [GAD]
antibody to tyrosine phosphatase IA2
major genetic risk factor for diabetes type 1
HLA-DR3 and DR4 haplotypes
compare obesity and age of onset between type 1 and type 2 diabetes
type 1; usually children, not obese with a recent history of weight loss, 10% have relatives with diabetes type 1
type 2; usually adults, obese, 70-90 % have relatives with type 2 diabetes
whats the definition of insulin resistance
when a larger amount of insulin is needed to push glucose into the cells. (more insulin needed to push the same amount of glucose into cells)
P.S eventually beta cells become “tired” and insulin secretion becomes low => type 2 diabetes patients need insulin at LATE STAGES not early [metformin is useful because it lowers hepatic gluconeogenesis]
pathophysiology in insulin resistance in muscle tissue
chronic inflammation of adipose tissue causes insulin resistance in muscle cells.
P.S inhibition of NF kappa B causes a reduction in insulin resistance.
increase in adipose tissue causes increase in triglycerides levels in the plasma
how does diabetes type 2 come about
insulin resistance (through various mechanisms)=> increased insulin secretion =>normal glucose levels=> insulin decompensation=> b cells failure=> diabetes type 2
the liver exacerbates hyperglycemia by continuing gluconeogenesis and glycogenolysis and VLDL synthesis (caused by increased lipolysis in the adipose tissue due to resistance to insulin which may cause nonalcoholic liver disease)
whats maturity onset diabetes of the young (MODY)
onset <25, FEMALE, genetic (dominant)
insulin secretion impairment
whats familial partial lipodystrophy
genetic disease(mutation in LMNA) where they cant store fats in legs, arms hips, so they have hypertriglyceridemia and cushingoid appearance since fat that cannot be stored in said locations is stored in abdomen and face. in addition they have insulin resistance
what are the signs and symptoms of diabetes mellitus
polyuria polyphagia polydipsia rapid weight loss (type 1) hyperventilation mental confusion
labs for the diagnosis of diabetes mellitus
plasma glucose levels glycosylated hemoglobin Hb A1C ketone bodies electrolytes C peptide microalbuminuria
what are the long term medical care guidelines for DM patients
self monitoring blood glucose glycemic control aspirin unless contra indicated serum creatinine pneumonia/hepatitis b/ influenza immunization
yearly:
eye exam
screening for nephropathy
lipid profile
multiple times a year:
HbA1c 2-4 times
foot examination 2 times a year, and the patients does it daily
blood pressure measurement and control 4 times a year
whats the mechanism of action (MOA) of metformin and its side effects (SE)
MOA: lowers gluconeogenesis, increase glycolysis, increase peripheral uptake of glucose.
SE: METabolic acidosis(lactic acidosis), B12 deficiency, GI upset.
contraindicated in patients with eGFR<30 because metformin wont be secreted properly which will lead to fatal lactic acidosis
mechanism of sulfonylurea
increase release of insulin by opening K channels and causing depolarization
mechanism of action of thiazolidinediones and side effect
reduce insulin resistance by acting on PPAR gamma (nuclear factor)
side effect: Heart failure(name so long it gave me a HF), increased fractures, anemia
drug names ends with glita (bring the glitter to the party, surprise parties causes shock (heart)), diones= bones
mechanism of action of DPP4 inhibitors and their side effect
they potentiate GLP1 by inhibiting DPP4
food=>glucagon like peptide 1(GLP1)=>increase in insulin
DPP4 inhibits GLP1. Inhibiting DPP4 causes increase GLP1
Side effects (liptins) respiratory and urinary infections
insulin types and mnemonic
rapid acting: Lispro, aspart, glulisin (rapid dont lag) short acting: regular regular and short intermediate: NPH Not Particularly Hasty slow acting: glargine, determir (gnar and tryndamere) God Damn 24h is a long time
what are the acute complications of diabetes
Diabetic ketoacidosis
hyperglycemic hyperosmolar nonketotic coma
hypoglycemia (due to insulin shot without food)
what are the clinical features of ketoacidosis, and what are the key features of it
Clinical features: abdominal pain hyperglycemia nausea, vomiting hypotension (can occur due to diabetic diuresis)
key features:
Hyperglycemia
positive serum/urine ketones
metabolic acidosis
how do you manage diabetic ketoacidosis
confirm diagnosis: ⬆glucose, ⬆ketones, acidosis
assess electrolytes, acid-base status
fluid replacement (saline) then 5%glucose once blood glucose reaches 200mg/dl
administer short acting insulin[0.1/kg] (unless he has hypokalemia, then correct it first)
assess patient with questions then initiate workup
glucose and BP monitoring
administer long acting insulin as soon as the patient starts eating
complications of hyperosmolar hyperglycemic nonketotic syndrome
cerebral edema fluid overload heart failure pulmonary edema hypokalemia hyperglcemia
