pancreas disorders - Diabetes

Question 1

what are the features of metabolic syndrome

Answer 1

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 resistance

Question 2

disease associated with metabolic syndrome

Answer 2

cardiovascular 
diabetes type 2
nonalcoholic fatty liver 
hyperuricemia 
obstructive sleep apnea

Question 3

what are the drugs used for metabolic syndrome

Answer 3

metformin
GLP-1 inhibitors
thiazolidinediones
DPP-4 inhibitors
sulfonylurea

Question 4

what drugs induce diabetes

Answer 4

Beta adrenergic agonist
glucocorticoids
thiazides (class of sulfur-containing diuretics)
epinephrine

Question 5

Diagnostic criteria for diabetes mellitus

Answer 5

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]

Question 6

what are the labs for prediabetes

Answer 6

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]

Question 7

Diabetes risk factors

Answer 7

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

Question 8

what are insulin independent tissues

Answer 8

Brain
intestine
placenta

through GLUT 3 transporter

Question 9

type of glucose transporter is in the muscles and adipose tisssue

Answer 9

GLUT 4 insulin dependent

Question 10

what are the antibodies present in type 1 diabetes

Answer 10

islet cell antibody [ICA]
insulin autoantibody [IAA]
antibody to glutamic acid decarboxylase [GAD]
antibody to tyrosine phosphatase IA2

Question 11

major genetic risk factor for diabetes type 1

Answer 11

HLA-DR3 and DR4 haplotypes

Question 12

compare obesity and age of onset between type 1 and type 2 diabetes

Answer 12

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

Question 13

whats the definition of insulin resistance

Answer 13

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]

Question 14

pathophysiology in insulin resistance in muscle tissue

Answer 14

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

Question 15

how does diabetes type 2 come about

Answer 15

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)

Question 16

whats maturity onset diabetes of the young (MODY)

Answer 16

onset <25, FEMALE, genetic (dominant)

insulin secretion impairment

Question 17

whats familial partial lipodystrophy

Answer 17

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

Question 18

what are the signs and symptoms of diabetes mellitus

Answer 18

polyuria 
polyphagia 
polydipsia
rapid weight loss (type 1)
hyperventilation
mental confusion

Question 19

labs for the diagnosis of diabetes mellitus

Answer 19

plasma glucose levels
glycosylated hemoglobin Hb A1C
ketone bodies
electrolytes 
C peptide 
microalbuminuria

Question 20

what are the long term medical care guidelines for DM patients

Answer 20

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

Question 21

whats the mechanism of action (MOA) of metformin and its side effects (SE)

Answer 21

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

Question 22

mechanism of sulfonylurea

Answer 22

increase release of insulin by opening K channels and causing depolarization

Question 23

mechanism of action of thiazolidinediones and side effect

Answer 23

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

Question 24

mechanism of action of DPP4 inhibitors and their side effect

Answer 24

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

Question 25

insulin types and mnemonic

Answer 25

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

Question 26

what are the acute complications of diabetes

Answer 26

Diabetic ketoacidosis
hyperglycemic hyperosmolar nonketotic coma
hypoglycemia (due to insulin shot without food)

Question 27

what are the clinical features of ketoacidosis, and what are the key features of it

Answer 27

Clinical features:
abdominal pain
hyperglycemia 
nausea, vomiting
hypotension (can occur due to diabetic diuresis)

key features:
Hyperglycemia
positive serum/urine ketones
metabolic acidosis

Question 28

how do you manage diabetic ketoacidosis

Answer 28

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

Question 29

complications of hyperosmolar hyperglycemic nonketotic syndrome

Answer 29

cerebral edema
fluid overload
heart failure 
pulmonary edema
hypokalemia
hyperglcemia