Unit 5+6 Flashcards
At what waist circumference is a man thought be at medium risk
94-102cm
What waist cirumference is a woman thought to be at medium risk
80-88cm
What are adipokines
signalling agents found in WAT which influence processes like coagulation, appetite regulation
What is metaboliv syndrome
Cluster of conditions that cause an increased risk of DM and Cardiovascular related mortality
What do you need to to be diagnosed with MS
BMI over 30, central obesity raised triglycerides Reduced HDL cholesterol Raised BP Raised fasting blood glucose
What do triglycerides need to be over in MS
More than 150mg/dL
What does HDL need to be less than in Metabolic syndrome
Less than 40mg in males and 50mg in women
What does Raised BP need to be more than in Metabolic syndrome
more than 130/85
What does fasting glucose need to be more than in Metabolic syndrome
more than 5.6mmol/L
What is the main function of BAT
Thermoregulation- produces heat by oxidation of fatty acids
Whats the importance of UCP1 in BAT
Acts as a proton channel- diverts pool of protons in the mitochondiral intermembrane space away from ATP synthase- more heat produced less ATP
Where is BAT found on the body
Upper back and chest
Where is WAT found in the body
Subcutaneous in buttocks, hips, abdo regoins and
visceral fat- around organs
WHich type of WAT are women more likely to get
Subcutaneous- around hips, buttocks and abdomen
Why is Visceral fat good to be surrounded by organs
Contains macrophages + WAT derived signalling agents e.g. adipokines- sent to liver
What are the 6 types of Adipose derived signalling molecules
Adiponectin,,Free-fatty acids, IL6,leptin, Resistin,TNFa
Whats the role of Adiponectin in Diabetes
its a antiinflammaory and antiatherosclerosis,
Increases insulin sensitivity
Lower adiponectin fatter people ,
Role of free fatty acids in diabetes
Elevated FFA stimulate insulin secretion
Chronic elevation stops insulin production
Visceral FFA are deposited into liver, increasing hepatic gluconeogenesis and production of VLDL
What does the chronic inflammation of FFAs cause
Impairs the stimulation of insulin, damages beta cells and so no pancreatic insulin
How are beta cells involved in diabetes
Beta cells produce insulin
What happens to the levels of IL6 in diabetes
IL6 increases as weight does, its a pro-inflammatory cytokine
IL6 causes lipolysis which produces FFAs and increases leptin
How does leptin work in diabetes
Leptin is a satiety hormone, in obesity there is leptin resistance so you can’t tell when you’re full
How does resistin work in diabetes
Associated with insulin resistance, visceral produces 15x the amount of resistin than subcutaneous
How does TNFa work in diabetes
pro-inflammatory
Increases leptin, lipolysis, lipogenesis in adipocytes and imapirs insulin signalling
In low carb diets what is the max carb you’re allowed
20g, then increase to 100g when you’ve reached weight loss
What is ketosis
Fatty acids coverted to ketone bodies which are used for energy
How does high protein keep you satiated for longer
Decreases the expression for neuropeptide Y
How do low GI foods keep you satiated for longer
Digested more slowly
What are the health consequences associated with obesity
CVD
decreased life expectancy
T2DM
ARTHRITIS, INFERTILTIY
What are 3 symptoms associated with T1DM
Unexplained weight loss, polyuria, polydipsia
What does your HBA1c , random, fasting and 2 hr plasma conc need to be over to be diagnosed with DM
HBA1c: over 48mmol/mol
Random- less than 11.1mmol/mol
Fasting: less than 7
Name the rapid acting insulin
Aspart, glulisine, lispro
Onset is 15 mins
Peaks- 1-2hrs
Duration 4-6hrs
Short acting insulin
ActRapid
30-60mins
Peak- 2-4 hrs
Duration- 6-8
Name a long acting insulin analogue
Detemir
Glargine
Degludec- Tresiba
Name some intermediate acting analogue
Aspart (Novomix30) and Lispro
How often should blood glucose be monitored in T1DM in adults and children
Adults- QDS
Children- 5 capillary blood tests a day
When are you allowed to be on CSII
When HBA1c is 69mmol/mol despite on Multiple injections
Older than 12: Tried MDI but still get hypoglycemia
Where should you inject insulin
Fatty tissue, stomach, side of thigh or buttocks
Why should you leave a gap every time you inject insulin
Hard lumps called lipose are formed which stop insulin being absorbed
How should you inject insulin
prime pen so inlin leaking
Insert at 90 degree angle, count to 10
Which is the longest duration of action of insulin
Glargine- 20-24hrs
Detemir- 12-24 hrs
To manage T2DM how long do they have to try dietary and lifesyle advice
3 months before medication
What is the MOA of metformin
Increases peripheral uptake of glucose
Reduces hepatic gluconeogenesis
Side effects of metformin
GI disturbances, weight loss, lactic acidosis, reduces b12 absorption
What are the symptoms of hypoglycaemia
Sweating, dizziness, nausea and confusion
MOA of sulphonylureas
Increase insulin secretion
Side effects of sulphonylureas with examples of them
Gliclazide, Glimepride, Glipizide, Gilbenclamide
Hypoglycemia, weight gain, hypersensitivity
Examples of Meglinitides and which class of drug are they similar to
Regpaglinitide
Similar to Sulphonylurea as they increase isnulin but have shorter duration and rapid onset
Side effects of Meglinitides
Hypoglycemia, weight gain, hypersensivity, visual disturbances, abdo pain and diarrhea
MOA of Acarbose
Inhibitor alpha glucosidase, and decreases metabolism of carbs and sugars
Mechanism of Pioglitazone
PPARy agonist
Weight gain
Dont use in heart failure patients
Mechanism of DDP4 inhibitors
Gliptins
Increase incretins which stimualte insulin secretion
Examples of icnretin mimetics
Exanatide, Liraglutide
SGLT2I MOA
Inhibit reuptake of glucose and water so excreted in pee
Whats the intial treatment of DM
Add metformin
What if metformin is contraindicated in stage 1
Use Pioglitazone (PPYAR agonist)
Sulphonylurea or
DPP4I- liptins
What is first intensification
Dual therapy
Metformin +sulphonylurea
Metformin +pioglitazone
Metformin +DDPP4I
What is second intensification
Triple therapy
Metformin, DPP4I + sulphonylurea
Metformin, Pioglitazone +sulphonylurea
Start insulin therpay
When would you use a incretin mimetic (Glucagon-1-peptide)
in triple therpay with metformin, sulphonylurea when metformin and 2 other oral drugs don’t work
When can you use an incretin mimetic, under what conditions
BMI over 35+ a problem associated with obesity
BMI under 35+ can’t use insulin therapy, weight loss will benefit
When would you definitely give a Statin in TYPE 1 diabetes
Older than 40
Diabetes more than 10yrs
Have established nephropathy
Have other CVD risk factors
When would you give statin in T2DM
Give atorvastatin 20 to ppl who have a 10% or greater 10 yr risk of developing CVD
How do you find out CVD risk
use QRISK3 tool
When don’t you use aspirin/clopidogrel in diabetes
Don’t use it if they have T2 diabetes without CVD
What is the main cause of blindness in CVD
Diabetic nephropathy
How are the cells of the retina damaged
High blood glucose damages the blood vessels that supply the retina
What are the risk factors for retinopathy
Poor diabetic control, hypertension, renal disease and hyperlipidaemia
How should you manage diabetic nephropathy
Control BP and blood glucose , smoking cessation
What should be the BP for people with DM with nephropathy
Less than 130/80
What are the symptoms of peripheral neuropathy
Allodynia,leg cramps, numbness, pain, tingling
What drugs should be sued in peripheral neuorpathy
Amitriptyline,duloexetine, gabapentin or pregablin
What drug is used in acute rescue therapy
Tramadol
Which cream do you give for localized neuropathic pain
Capsaicin cream
What level of HBA1c should you avoid getting pregnant
above 86mmol/ml
Which long acting insulin should be used during pregnancy
Isophane insulin (NPH)
Which drugs should be discontinued in pregnancy with DM
Statins, ARBs, ACEIs
What range does hypoglycaemia start
Less than 4mmol/mol
What is thyrotoxicosis
syndrome where you’ve been exposed to elevated levels of thyroid hormones for a long time
Thyrotoxicosis is most likely to produce which disease
Graves disease
WHo is hyperthyroidism most common in
Women
What is graves disease
Abnormal IgE which occupies TSH receptor- so mimicks TSH causing cell division and stimulating thyroid hormone secretion
What are TRABs
Stimulatory Igs which inhibit TSH receptor
What levels are elevated in Nodular disease
Only T3
Which type of thyroidism has a gradual onset
Hypothyroidism
Which thyroidism do you get weight gain
Hypothyroidism
Which drugs alleviate symptoms of palpitations, tremor, anxiety in severe thyrotoxicosis
Non-selective beta blockers
MOA of carbimazole
Prodrugs, converted to methiazole, prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, reduceing T3 and t4
How long is the treatment for graves disease
6-12 months
Name the anti-thyroid drugs
Thiamazole, carbimazole, propylthiouracil, thionamide
Which type of thyroidism does Hashimotos cause
Hypothyroidism
What is the most common side effect of anti-throid drugs
Rash and Arthropathy(inflammation of the joint)
Which 3 symptoms require urgent FBCs as a side effect of the Anti-thyroid drugs
Mouth ulcers, sore throat and pyrexia
Carbimazole
dose
Half life
biological effect
40-60mg
4-6 hrs for half life
Biological effect lasts up to 40 hrs
How often do you check t4 conc with carbimazole
Every 6 weeks until they’re normalized
Which anti thyroid drug ispreferred in 1st trimester of pregnancy
Propylthiouracil over carbimazole
What drugs are reccomended for postutal hypotension
Fluodrocortisone 100-400mcg OD + can combine with flurbiprofen and ephedrine HCL
What drug can be used in gustatory sweating
Antimuscarinic Propantheline bromide
What are the symptoms of Thyroid crisis
Tachycardia, muscle weakness, hyperthermia, sweating and vomiting, anxious and psychotic
Drug management for thyroid crisis
Propylthiouracil oral +lugols iodine
IV glucocorticoids- inhibit deiodinase
IV BB-propanolol is preffered bc it inhibtis deiodinase
